Why would someone be denied COBRA?
Asked by: Mr. Gonzalo Bradtke III | Last update: April 22, 2025Score: 4.7/5 (54 votes)
Under what circumstances can a COBRA be denied?
COBRA Exception: Gross Misconduct
Employees do not experience a COBRA qualifying event if their loss of coverage is caused by a termination of employment that is “by reason of the employee's gross misconduct.” The gross misconduct exception applies only to a termination of employment triggering event.
Why would someone not be eligible for COBRA?
Why would an employee not qualify to enroll in Cal-COBRA? The employee is enrolled in or eligible for Medicare. The employee does not enroll within 60 days of receiving the notice of eligibility from the employer. The employee is covered by another health plan.
What if my employer didn't offer me COBRA?
Penalties for COBRA Violations
If an employer fails to provide the required notice and a lawsuit results, the employer can also be required to pay the attorney's fees of the former employee's lawyer and other damages. If you have been unlawfully denied COBRA benefits, let us know. We can help.
What are the qualifying reasons for COBRA?
In general, the COBRA qualifying event must be a termination of employment or a reduction of the covered employee's employment hours. Second, the covered employee must be determined under title II or title XVI of the Social Security Act to be disabled.
My Employer Did Not Give Me My COBRA Continuation Health Coverage - What Do I Do?
What is the COBRA loophole?
If you decide to enroll in COBRA health insurance, your coverage will be retroactive, meaning it will apply to any medical bills incurred during the 60-day decision period. This loophole can save you money by avoiding premium payments unless you actually need care during this time.
Am I eligible for COBRA if I get fired?
COBRA coverage follows a "qualifying event". An example of a qualifying event would be if your hours were reduced or you lost your job (as long as there was no gross misconduct). Your employer must mail you the COBRA information and forms within 14 days after receiving notification of the qualifying event.
Can I sue my employer for not offering COBRA?
The employees along with the beneficiaries have the right to sue to cover the medical expenses that would have taken place when the COBRA should have been offered.
Is COBRA coverage worth it?
“If you're close to meeting your deductible on your current insurance plan and you have high health care costs, it may be worth it to temporarily stay on your COBRA plan,” explains Donovan. The same holds true if you're far into your employer plan's year and have already met your deductible.
Can I ask new employer to pay for COBRA?
Yes, an employer can pay all or part of a former or current employee's COBRA premiums. Employers may do so as a means to assist an employee during a merger, acquisition, layoff, termination, temporary or permanent disability, retirement, or as part of a recruitment strategy.
What types of employers are exempt from COBRA?
Indemnity policies, PPOs, HMOs, and self-insured plans are all eligible for COBRA extension; however, federal government employee plans and church plans are exempt from COBRA.
What are the rules for COBRA coverage?
- Your group health plan must be covered by COBRA.
- A qualifying event must occur.
- You must be a qualified beneficiary for that event.
Are people who quit eligible for COBRA?
You Can Get Health Coverage After You Quit
One avenue to explore is COBRA (Consolidated Omnibus Budget Reconciliation Act) insurance. This option allows you to retroactively continue with the same health plan you had under your most recent employer. Here's A Solution!
What triggers COBRA letter?
Strict legal requirements govern when many employers must send COBRA continuation notices to their employees. Employers are often required to send notifications (or have them sent by a plan administrator) when employees experience qualifying events — which can include a reduction in hours or termination.
What happens if I decline COBRA coverage?
After Open Enrollment ends, however, if you voluntarily drop your COBRA coverage or stop paying premiums, you generally will not be eligible for a special enrollment opportunity and will have to wait until the next Open Enrollment period.
What qualifies as gross misconduct for a COBRA?
Fighting, physical assault, abuse, or threatening behavior • Blatant disregard for the safety of others or serious breaches of health and safety rules • Deliberate acts of vandalism or sabotage • Any attempts to financially defraud the company or theft • Significant levels of insubordination • Dishonesty, falsification ...
What is the 60 day COBRA loophole?
You have 60 days to enroll in COBRA once your employer-sponsored benefits end. Even if your enrollment is delayed, you will be covered by COBRA starting the day your prior coverage ended.
What are the disadvantages of COBRA coverage?
- COBRA can be expensive, especially compared to the premiums you were paying before your qualifying event. ...
- COBRA does not apply to all employer-sponsored health plans—in particular, those organizations with fewer than 20 employees may have no requirements. ...
- Even if you get an extension, COBRA is only temporary.
Is there a better option than COBRA?
Marketplace insurance, available through the Affordable Care Act, often offers more affordable premiums than COBRA. The cost difference can vary based on the chosen plan, location, and income, as subsidies may reduce premiums for marketplace plans.
Can my employer deny me COBRA?
Under COBRA, a person who has been terminated for gross misconduct may be denied COBRA. Gross misconduct is not specifically defined by COBRA, but when based on an employer's practice or policy it could include misrepresentation during the hiring process or falsifying information on a Form I-9.
Can I get a COBRA if I'm fired?
The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires most employers with group health insurance plans to offer their employees the opportunity to continue their health coverage under their employer's plan even after they have been terminated or laid off or had another change in their employment ...
What is a COBRA violation?
Employers have numerous responsibilities under COBRA, including tracking employee notices and deadlines. All too often, employers fail to comply with these requirements. Some common COBRA violations include: Failure to supply initial notice to new employees. Failure to provide notice after a qualifying event.
Why is COBRA so expensive?
COBRA coverage is not cheap.
Why? Because you're now responsible for paying your portion of your health insurance: The cost your employer contributed to your premium, in addition to the 2% service fee on the cost of your insurance.
Can I go to the doctor while waiting for a COBRA?
You will be reimbursed for any medical bills that you pay out-of-pocket during this period. Contact the plan administrator for more information on filing a claim for benefits. Complete plan rules are available from the employer's benefits offices.
How long does it take for a COBRA to kick in?
COBRA coverage timeline
The coverage starts the day the previous coverage ends. The employer's COBRA administrator is responsible for sending out an election notice with information about deadlines for enrollment. For example, if employment ends on April 25, COBRA will pick up where the group health plan ends.