OAR 101-030-0005: Continuation of Group Medical and Dental Insurance Coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA)

COBRA allows an eligible individual who is losing an employer’s group health plan coverage due to a qualifying event to continue coverage for a limited time. PEBB COBRA is a self-pay premium by the eligible individual. (1) PEBB participating organizations will issue an initial COBRA notice to all newly eligible employees and individuals that explains the right to continue employer medical and dental insurance plans if lost. (a) The notice must be mailed to the eligible employee's address of record immediately following enrollment in PEBB medical or dental insurance plans or personally delivered to the employee. The notice must include all PEBB covered individuals residing at the address, including family members, a domestic partner, and a domestic partner's dependent children. Agencies must send a separate notice to the address of record for eligible individuals residing separately from the eligible employee. (b) An initial COBRA notice must be mailed to individuals who become newly eligible for PEBB coverage due to marriage or the formation of a domestic partnership. (2) To initiate COBRA eligibility a COBRA triggering event must occur causing the loss of benefit coverage. COBRA triggering events include: (a) An involuntary reduction in hours or layoff. (b) A strike or lockout. (c) The beginning of an unpaid leave of absence. (d) The termination of employment. (e) Retirement. (f) A dependent child no longer satisfying eligibility requirements. (g) The loss of employer-sponsored group coverage for dependents due to Medicare eligibility. (h) A divorce or termination of a domestic partnership. (i) The death of the employee. (3) All individuals losing eligibility due to a triggering event must receive a COBRA continuation notice. PEBB participating organizations must notify PEBB’s Third Party Administrator (TPA) within 30 days of the date of benefit eligibility. The date eligibility is lost is the COBRA triggering event date. (a) The PEBB TPA mails a COBRA notice of continuation, to each eligible individual at their last address of record when eligibility for PEBB-sponsored insurance coverage is lost. The TPA must mail the notice to each eligible individual within 14 days of receiving the notification. (b) An eligible employee has 60 days from the date of the COBRA notice to activate their COBRA rights of continuation. PEBB-sponsored insurance coverage must be continuous through COBRA implementation. (4) An eligible individual continuing PEBB medical or dental insurance coverage or both under COBRA provisions has the same rights as active eligible employees for making changes during the open enrollment period and is eligible for qualified midyear changes. (5) An eligible employee ending employment may continue to participate in the Healthcare Flexible Spending Account through COBRA up to the end of the current plan year if when the triggering event occurs: (a) They have a positive balance in their account; and (b) They self-pay contributions to the account. Contributions after employment ends are paid on an after-tax basis.