What is COBRA continuation coverage?
COBRA is a federal law that requires large employers (including Multnomah County) to offer employees and their families the opportunity to continue their health care coverage when there is a qualifying event that would result in a loss of coverage in the County's health plan. Depending on the type of Qualifying Event, Qualified Beneficiaries can include the employee (or retired employee) covered under the group health plan, the covered employee's spouse, and dependent children of the covered employee. (Certain newborns, newly adopted children and alternate recipients under Qualified Medical Child Support Orders may also be qualified beneficiaries.)
COBRA continuation coverage is the same coverage that the County provides to other participants or beneficiaries under the health plan who are not receiving COBRA continuation coverage. Each Qualified Beneficiary who elects continuation coverage will have the same rights under the health plan as other participants or beneficiaries covered under the health plan including open enrollment and special enrollment rights.
The description of COBRA continuation coverage on this page applies only to the group health benefits under the plan and not to any other benefits offered by Multnomah County. Nothing herein is intended to expand your rights beyond COBRA's requirements.
Although Multnomah County will allow domestic partners and same-sex spouses to purchase COBRA-like continuation coverage, they do not meet the requirements of a Qualified Beneficiary and do not have all the rights explained herein available to them. For more information, please contact the Multnomah County Employee Benefits Office.
How can you elect COBRA continuation coverage?
To elect COBRA continuation coverage, you must complete a COBRA Election Form and furnish it according to the directions on the form. Each listed individual has a separate right to elect continuation coverage. For example, the employee's spouse may elect continuation coverage even if the employee does not. Continuation coverage may be elected for only one, several, or for all dependent children who are Qualified Beneficiaries. A parent may elect to continue coverage on behalf of any dependent children. The employee or the employee's spouse (if the spouse is a Qualified Beneficiary) can elect continuation coverage on behalf of all of the Qualified Beneficiaries.
You may elect COBRA coverage for any one or more of the plans under which you were covered on the day before the Qualifying Event. For example, if you had the option to choose medical and/or dental coverage, you will have the option to continue any of the plans that you were covered under on the day before the Qualifying Event. If the health plan you are enrolled in at the time of your Qualifying Event is regionally specific (such as a managed care plan) and you move outside the service area, you may elect coverage under another health plan offered by Multnomah County if it is available in the area you have moved to. This also applies if you move after electing COBRA coverage. It is your responsibility to inform Multnomah County of your move.
Additional information about the benefits available under the plan is available in the plan's summary plan description (benefit booklet.) If you do not have a copy of the summary plan description, you may obtain one by contacting Multnomah County or by visiting www.multco.us/benefits/health-care.
Qualified Beneficiaries who are entitled to elect COBRA may do so even if they have other group health plan coverage or are entitled to Medicare benefits on or before the date on which COBRA is elected. However, as discussed in more detail below, a Qualified Beneficiary's COBRA coverage will terminate if, after electing COBRA, he or she becomes entitled to Medicare benefits or becomes covered under other group health plan coverage.
Special considerations in deciding whether to elect COBRA continuation coverage
In considering whether to elect continuation coverage, you should take into account that a failure to continue your group health coverage will affect your future rights under Federal Law. First, you can lose the right to avoid having pre-existing condition exclusions applied to you (or a family dependent) by other group health plans if you have more than a 63-day gap in health coverage, and election of continuation coverage may help you eliminate that gap. Second, if you do not purchase continuation coverage for the maximum time available to you, you will lose the guaranteed right to purchase individual health insurance policies that do not impose such pre-existing condition exclusions. Finally, you should take into account that you have special enrollment rights under Federal Law. You have the right to request special enrollment in another group health plan for which you are otherwise eligible (such as a plan sponsored by your spouse's employer) within 30 days after you group health coverage ends because of the Qualifying Event listed above. You will also have the same special enrollment right at the end of continuation coverage if you purchase continuation coverage for the maximum time available to you.
How long will COBRA continuation coverage last?
When loss of coverage due to end of employment or a reduction in hours of employment, coverage generally may be continued for up to a total of 18 months. When loss of coverage due to an employee's death, divorce or legal separation, the employee's becoming entitled to Medicare benefits, or a dependent child ceasing to be a dependent under the terms of the plan, coverage may be continued for up to a total of 36 months. When the Qualifying Event is the end of employment or reduction of the employee's hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the Qualifying Event, COBRA continuation coverage for the Qualified Beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. Your notice will show the maximum period of continuation coverage available to the individuals listed on your Election Form.
Continuation coverage will be terminated before the end of the maximum period if:
- any required premium is not paid in full on time; or
- a Qualified Beneficiary becomes covered, after electing continuation coverage, under another
- group health plan that either does not impose any pre-existing condition exclusion for a pre-existing
- condition of the qualified beneficiary, or if it does, this period has been exhausted or satisfied; or
- a covered employee becomes entitled to Medicare benefits (under Part A, Part B,
- or both) after electing continuation coverage; or
- the employer ceases to provide any group health plan for its employees.
Continuation coverage may also be terminated for any reason the plan would terminate coverage of a participant or beneficiary not receiving continuation coverage (such as fraud).
You must notify Multnomah County in writing within 30 days if, after electing COBRA, a qualified beneficiary becomes entitled to Medicare (Part A, Part B, or both) or becomes covered under other group health plan coverage. You must follow the notice procedures specified.
How can you extend the length of COBRA continuation coverage?
If you elect continuation coverage, an extension of the maximum period of coverage may be available if a Qualified Beneficiary is disabled or a second Qualifying Event occurs. You must notify Multnomah County of a disability or a second Qualifying Event in order to extend the period of continuation coverage. Failure to provide notice of a disability or second Qualifying Event may affect the right to extend the period of continuation coverage.
If any of the Qualified Beneficiaries is determined by the Social Security Administration (SSA) to be disabled, the maximum COBRA coverage period that results from a covered employee's termination of employment or reduction of hours (generally 18 months, as described above) may be extended to a total of up to 29 months. The disability has to have started at some time before the 61st day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. Each Qualified Beneficiary who has elected continuation coverage will be entitled to the 11-month disability extension if one of them qualifies.
The disability extension is available only if you notify Multnomah County in writing of the SSA's determination of disability within 60 days after the latest of:
- the date of the SSA's disability determination;
- the date of the covered employee's termination of employment or reduction of hours; and
- the date on which the qualified beneficiary loses (or would lose) coverage under the terms of the plan as a result of the covered employee's termination or reduction of hours.
You must also provide this notice within 18 months after the covered employee's termination of employment or reduction of hours in order to be entitled to a disability extension. In providing this notice, you must follow the notice procedures specified. If procedures are not followed or if the notice is not provided to Multnomah County during the 60-day notice period and within 18 months after the covered employee's termination of employment or reduction of hours, THEN THERE WILL BE NO DISABILITY EXTENSION OF COBRA COVERAGE.
If the Qualified Beneficiary is determined to no longer be disabled by the SSA, you must notify Multnomah County of that fact within 30 days after the SSA determination. You must follow the notice procedures specified.
Second Qualifying Event
An 18-month extension of coverage will be available to spouses and dependent children who elect continuation coverage if a second Qualifying Event occurs during the first 18 months of continuation coverage due to original Qualifying Event of employment loss. The maximum combined coverage period for continuation coverage available when a second Qualifying Event occurs is 36 months. Such second Qualifying Events may include the death of a covered employee, divorce or legal separation from the covered employee, the covered employee's becoming entitled to Medicare benefits (under Part A, Part B, or both), or a dependent child's ceasing to be eligible for coverage as a dependent under the Plan. These events can be a second Qualifying Event only if they would have caused the Qualified Beneficiary to lose coverage under the Plan if the first Qualifying Event had not occurred. (For example, Mark Smith terminated employment on January 14, 2008 and COBRA coverage for his spouse, Julie, and himself began on February 1, 2008. Coverage could last for up to 18 months - until July 31, 2009. However, on March 6, 2008, Mark and Julie divorced. Julie is now eligible for up to 36 months of COBRA coverage, measured from the date of the original COBRA event. Julie's COBRA coverage could last until January 31, 2011, Mark's COBRA coverage could last until July 31, 2009.) You must notify the Plan within 60 days after a second qualifying event occurs if you want to extend your COBRA continuation coverage by following the notice procedures specified.
How much does COBRA continuation coverage cost?
Generally, each Qualified Beneficiary may be required to pay the entire cost of continuation coverage unless the COBRA Election Form states otherwise. The amount a Qualified Beneficiary may be required to pay may not exceed 102% (or, in the case of an extension of continuation coverage due to a disability, 150%) of the cost to the group health plan (including both employer and employee contributions) for coverage of a similarly situated plan participant or beneficiary who is not receiving continuation coverage. The required payment for each continuation coverage period for each option will be described in your notice.
The Trade Act of 2002 created a tax credit for certain individuals who become eligible for trade adjustment assistance and for certain retired employees who are receiving pension payments from the Pension Benefit Guaranty Corporation (PBGC). Under the tax provisions, eligible individuals can either take a tax credit or get advance payment of premiums paid for qualified health insurance, including continuation coverage. If you have questions about these provisions, you may call the Health Coverage Tax Credit Customer Contact Center toll-free at 1-866-628-4282. TTD/TTY callers may call toll-free at 1-866-626-4282. More information about the Trade Act is also available at www.doleta.gov/tradeact/
When and how must payment for COBRA continuation coverage be made?
First payment for continuation coverage
If you elect continuation coverage, you do not have to send any payment for the continuation coverage with your completed COBRA Election Form. However, you must make your first payment for continuation coverage not later than 45 days after the date of your election. (This is the date the COBRA Election Notice is post-marked, if mailed, or the date your COBRA Election Form is received by Multnomah County, if faxed.) If you do not make your first payment for continuation coverage in full not later than 45 days after the date of your election, you will lose all continuation coverage rights. Coverage is not in effect until premiums have been paid.
Your first payment must cover the cost of COBRA continuation coverage from the time your coverage under employer sponsored coverage would have otherwise terminated up through the end of the month before the month in which you make your first payment. For example, Joan's employment ends on September 14, and her employer sponsored health plan coverage will end on September 30. Joan elects COBRA on November 15. Her initial premium payment equals the premiums for October and November and is due on or before December 30, the 45th day after the date of her COBRA election period.
Participant is responsible for making sure that the amount of the first premium payment is correct. You may contact the Multnomah County Employee Benefits Office to confirm the correct amount of your first payment. Claims for reimbursement under the health coverage elected will not be processed and paid until you have elected COBRA and made your appropriate payment.
Monthly payments for continuation coverage
After you make your first payment for continuation coverage, you will be required to make monthly payments for each subsequent coverage period. The amount due for each month for each individual is shown in your notice. The monthly payments for continuation coverage are due on the first day of the month for which coverage is provided. If you make a monthly payment on or before the first day of the coverage period to which it applies, your coverage will continue for that coverage period without any break. As a courtesy, Multnomah County will send one payment schedule to you after your completed COBRA Election Form is received. You will not receive any additional notice of payments due (that is, we will not send a bill to you for your COBRA continuation coverage - it is your responsibility to pay your premiums on time.)
Pre-payment of monthly premium
For your convenience, you may pre-pay for any month by submitting payments before they are due (for instance, you could submit a payment for October and November coverage by paying with one check in the amount equal to two months' premium on or before October 1st.) If you choose to pre-pay your payments are non-refundable. Your coverage periods will not be changed after payments are processed and eligibility has been submitted to the insurance carrier.
Grace periods for premium payments
Although monthly payments are due on the first day of each month of coverage, you will be given a grace period of 30 days after the first day of the month to make each monthly payment. Your COBRA continuation coverage will be provided for each month as long as payment for that month is made before the end of the grace period for that monthly payment.
However, if you pay a monthly payment later than the first day of the month to which it applies, but before the end of the grace period for the month, your COBRA continuation coverage will be suspended as of the first day of the coverage period and then retroactively reinstated during the next regularly scheduled eligibility transmission to the insurance carrier (going back to the first day of the coverage period) when the monthly payment is received. This means that any claim you submit for benefits while your coverage is suspended may be denied and may have to be resubmitted once your coverage is reinstated.
If you fail to make a monthly payment before the end of the grace period for that month, you will lose all rights to COBRA continuation coverage.
Your first payment and all monthly payments for COBRA continuation coverage should be sent to:
Multnomah County Employee Benefits Office
501 SE Hawthorne Blvd, Suite 400
Portland, OR 97214
Hand-delivered payments may be brought to:
Multnomah County Employee Benefits Office
501 SE Hawthorne Blvd, Suite 320
Portland, OR 97214
If mailed, your payment is considered to have been made on the date that it is postmarked. If hand-delivered, your payment is considered to have been made when it is received by a Benefits Staff Member at the address specified above. You will not be recognized to have made any payment by mailing or hand-delivering a check if your check is returned due to insufficient funds or otherwise.
Continuation of Coverage for Spouses Age 55 or Older:
Under Oregon law (ORS 743.600-743.602), if you are the legal spouse or state registered same sex domestic partner (age 55 or older) of an employee and your eligibility for group health plan coverage has ended due to legal separation, termination of marriage, termination of domestic partnership or the employee's death, you may be entitled to continue your plan coverage (including coverage for dependent children) until one of the following events occur:
- the date you become covered under any other group health plan, regardless if the other plan has an exclusion or limitation period;
- the date you become eligible for federal Medicare coverage, regardless if you enroll in Medicare;
- the last day of the month that premiums were paid to Multnomah County in the event of non-payment of premiums;
- the date the plan terminates or the date Multnomah County terminates participation under this plan;
- a dependent child may remain on the plan with you until he/she no longer meets the plan's definition of a dependent child.
Oregon continued coverage is available only if you (spouse or state registered same sex domestic partner age 55 or older) notify the Multnomah County Employee Benefits Office in writing of the legal separation, termination of marriage, termination of domestic partnership, or the death of your spouse/domestic partner within:
- thirty days of the date of the member's death;
- sixty days of the date of legal separation; or
- sixty days of the date your divorce or dissolution of domestic partnership becomes final.
You have 60 days from the date Multnomah County sent this COBRA Election Notice to you to exercise your Oregon continuation coverage rights.
For more information
This information does not fully describe COBRA continuation coverage or other rights which may be available to you. If you have any questions concerning your rights to coverage, you should contact:
Multnomah County Employee Benefits Office
501 SE Hawthorne Blvd, Suite 400
Portland, OR 97214
State and local government employees seeking more information about rights under Public Health Service Act (PHSA), including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, should contact HHS-CMS at www.cms.gov.
Keep your Plan Informed of Address Changes
In order to protect your and your family's rights, you should keep the Multnomah County Employee Benefits Office informed of any changes in your address and the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Multnomah County Employee Benefits Office.
Warning: if your notice is late or if you do not follow these notice procedures, you and all related covered individuals will lose the right to any extension of COBRA continuation coverage.
Notices Must Be Written: Any notice that you provide must be in writing and may be mailed, faxed or emailed. Oral notice, including notice by telephone, is not acceptable.
When to Send Notices: If mailed, your notice must be postmarked no later than the last day of the applicable notice period. If faxed, your notice must be received no later than the last day of the applicable notice period. (The applicable notice period are described in the paragraphs above entitled 'How long will COBRA coverage last," "Disability," and "Second Qualifying Event", if applicable to your notice.)
Where to Send Notices:
Multnomah County Employee Benefits Office, ATTN: COBRA
501 SE Hawthorne Blvd, Suite 400
Portland, OR 97214
Information Required for All Notices: Any notice you provide must include: (1) the name and address of any employee who is or was covered under the plan; (2) the name(s) and address(es) of all Qualified Beneficiary(ies) or other individual(s) who lost coverage as a result of the Qualifying Event; (3) the Qualifying Event and the date it happened; and (4) the certification, signature, name, address and telephone number of the person providing the notice.
Additional Information Required for Notice of Disability: Any notice of disability that you provide must include: (1) the name and address of the disabled Qualified Beneficiary; (2) the date that the Qualified Beneficiary became disabled; (3) the names and addresses of all Qualified Beneficiaries or other individuals who are still receiving COBRA coverage; (4) the date that the Social Security Administration made it's determination; (5) a copy of the Social Security Administration's determination; and (6) a statement whether the Social Security Administration has subsequently determined that the disabled Qualified Beneficiary is no longer disabled.
Additional Information Required for Notice of Second Qualifying Event: Any notice of a second Qualifying Event that you provide must include: (1) the names and addresses of all Qualified Beneficiaries who are still receiving COBRA coverage; (2) the second Qualifying Event and the date that it happened; and (3) documentation that verifies the second Qualifying Event.
Who May Provide Notices: The covered employee or former employee who is or was covered under the Plan, a Qualified Beneficiary or other individual who lost coverage due to the Qualifying Event described in the notice, or a representative acting on behalf of either may provide notices. A notice provided by any of these individuals will satisfy any responsibility to provide notice on behalf of all individuals who lost coverage due to the Qualifying Event described in the notice.