Know Your Rights Under COBRA in Ohio

13 September 2017

COBRA Health Insurance Rights and Laws

Thanks to an Ohio state law, every person who works for a company or agency of any size and receives employer-sponsored health insurance has access to COBRA. The program, created by federal Consolidated Omnibus Budget Resolution Act of 1985, gives people the option of staying enrolled in their job-related health plan when they might lose it after taking a new position or getting let go. The federal law extends COBRA eligibility to people at organizations that employ more than 20 workers. Ohio’s “mini-COBRA” law eliminates the exemption for employers with fewer than 20 workers.

The federal and state health insurance enrollment programs operate by almost all the same rules. If you do not see your question answered below, or if you believe you have a claim to make against your former employer or health insurer, contact a Columbus, Ohio, COBRA attorney with the Calig Law Firm to schedule a free, confidential consultation. Appointments are available by calling (614) 252-2300 or filling out this online contact form.


Exactly what is COBRA?

According to a guidebook issued by the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA), COBRA “requires continuation coverage to be offered to covered employees, their spouses, their former spouses, and their dependent children when group health coverage would otherwise be lost.”

The three key words in that description are “requires,” “offered,” and “group health coverage”. Employers are not required to offer health insurance as an employment benefit, but the ones that do must comply with COBRA.

Employees who leave a job or become otherwise ineligible for the health coverage they had while in the group plan may choose not to reenroll through COBRA. The offer to enroll must be made, but it can be declined. Deadlines do apply, but an employee has the right to reverse the decision to decline participation if he or she does so before the applicable deadline.

COBRA continuation of employer-sponsored health insurance does not extend to life insurance or stand-alone disability coverage provided as an employee benefit.


Who can request health care coverage under COBRA?

As mentioned above, all employers in Ohio that offer health insurance must offer COBRA continuous coverage. This includes state and local government organizations. Few types of employers receive an exemption from COBRA compliance and include churches and certain religious charities and nonprofits.

Each person covered by an employer-sponsored health plan can elect COBRA continuous coverage. Again, quoting the EBSA guide, this can include the employee, the employee’s souse, and the employee’s children. These individuals become eligible to ask for extended coverage when any of the following events occur:

  • The death of a covered employee
  • Termination for a reason other than gross misconduct
  • Reduction in the hours of a covered employee’s employment for a reason other than gross misconduct
  • Divorce
  • Legal separation from a covered employee
  • Becoming entitled to Medicare
  • Losing dependent child status (and therefore coverage) under the plan.

“Gross misconduct” means more than “fired for cause”. Stealing or assaulting a co-worker would constitute gross misconduct; regularly clocking in late or taking unapproved leave probably would not.


How long does COBRA eligibility last?

Ohio mini-COBRA plans last for 12 months. Plans subject to federal rules will last 18, 29, or 36 moths depending on the identity of the person requesting the extension and the terms of the policy extension agreement signed by the covered person. Consulting with a knowledgeable Columbus COBRA rights attorney will clarify how long an extended health insurance policy may last, and whether either the covered person or the insurer can lengthen or shorten the period for which the plan remains in effect.


What does COBRA require an employer to do?

Employers must give an employee written notice of COBRA eligibility. The information must include details on what plan extensions are available, what premiums will cost, how plan extensions relate to HIPAA and Affordable Care Act Healthcare Marketplace plans, and what will happen when the employee (or other person covered through the employee’s existing insurance policy) elects or declines extended coverage.

Failing to provide written notice of COBRA rights and procedures subjects an employer to criminal penalties and civil liabilities (i.e., monetary compensation and damage payments).

How much will extending health coverage through COBRA cost?

Employers usually pay half or more of the premiums for the health insurance they provide employees. COBRA continuous coverage almost always transfers the full cost of premiums to the covered person. Rules written to implement the law also allow plans to add a 2 percent service charge, so people who opt for COBRA continuous coverage generally pay 102 percent of their insurance premiums instead of the employer-subsidized premiums they previously paid.

The exact dollar amount will vary from person to person, employer to employer, and plan to plan. However — and this is an important legal point — the cost must be the same as for an employee who is still with the employer and who has the same plan as the person using COBRA. This means that a plan with annual premiums of $10,000 for an employee can only cost a person who opts for COBRA continuous coverage $10,200/year.

Charging too much for COBRA plans opens an insurance company up to criminal penalties and civil liabilities.

Who handles complaints about COBRA rights violations?

Suspected COBRA rights violations should be brought to the attention of an experienced Columbus employment discrimination lawyer. Filing complaints with the Ohio Department of Insurance or a federal agency like the Department of Labor or Department of Health and Human Services is complicated and time-consuming. Submitting all the proper paperwork and supporting evidence the first time is essential to holding a noncompliant employer or insurance company accountable.

Individuals who succeed with COBRA violation cases can receive reimbursement for overpaid premiums and deductibles, have meaningful coverage reinstated, and get settlements for outstanding medical debts.


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