The federal Consolidates Omnibus Budget Reconciliation Act of 1985 (COBRA) requires that the city offer employees, retirees and their families the opportunity to continue group health and/or welfare coverage in certain instances where coverage would otherwise terminate. The monthly premium will be 102 percent of the group rate (or 150 percent of the group rate for the 19th through 29th months in cases for total disability). All group health benefits, including optional riders, are available. The maximum period of coverage is 18, 29 or 36 months, depending on the reason for continuation.
The state of New York recently enacted legislation intended to provide continued access to group health insurance for all persons eligible for COBRA or state continuation (“mini-COBRA”) coverage up to a total of 36 months of coverage. For more information concerning how this may impact your coverage under COBRA, visit the New York State Department of Financial Services website.
- Employees not eligible for Medicare — employees whose health and/or welfare fund coverage is terminated due to a reduction in hours of employment or termination of employment (for reasons other than gross misconduct). Termination of employment includes unpaid leaves of absence of any kind.
- Spouses/domestic partners not eligible for Medicare — spouses or domestic partners who lose coverage for any of the following reasons: (1) death of the city employee or retiree, (2) the termination of employee's city employment (for reasons other than gross misconduct), (3) loss of health coverage due to a reduction in the employee's hours of employment, (4) divorce from the city employee or retiree, (5) termination of domestic partnership with the city employee or retiree, or (6) retirement of the employee.
- Dependent children not eligible for Medicare — dependent children who lose coverage for any of the following reasons: (1) death of a covered parent, (2) termination of a covered parent's employment (for reasons other than gross misconduct), (3) loss of health coverage due to the covered parent's reduction in hours of employment, (4) the dependent ceases to be a "dependent child" under the terms of the Health Benefits Program, or (5) retirement of a covered parent.
Options Available When City Coverage Terminates
Employees and covered dependents may purchase individual health coverage through their health plan if their city group coverage ceases for any of the following reasons:
- An employee leaves city employment.
- An employee loses city coverage due to a reduction in the work schedule.
- An employee or retiree dies.
- A dependent spouse is divorced from the employee or retiree.
- A domestic partnership terminates.
- Dependent children exceed the age limits established under the group contract.
COBRA Periods of Continuation
If the benefits are lost due to termination of employment or reduction in work schedule, the maximum period for which COBRA can continue is 18 months. This period is calculated from the date of loss of coverage under the city program. If a COBRA beneficiary becomes disabled (as determined under Title 11 or XVI of the Social Security Act) during the first 60 days of the 18-month COBRA continuation period, coverage can be extended for an additional 11 months after the end of the original continuation period. If dependents lose benefits as a result of death, divorce, domestic partnership termination or loss of coverage due to the Medicare eligibility of the contract holder or due to the loss of dependent child status, the maximum period for which COBRA can continue coverage is 36 months. This period is calculated from the date of loss of coverage under the city program. Continuation of coverage can never exceed 36 months in total, regardless of the number of events that relate to the loss in coverage. Coverage during the continuation period will terminate if the enrollee fails to make timely premium payments or become enrolled in another group health plan (unless the new plan contains a pre-existing condition exclusion).
COBRA Notification Responsibilities
Under the law, the employee or family member has the responsibility of notifying their human resources department/benefits office and the applicable welfare fund within 60 days of the death, divorce or domestic partnership termination, or change of address of an employee or of a child's losing dependent status. Retirees and/or family members must notify the New York City Health Benefits Program city agency and the applicable welfare fund within 60 days on the case of death of the retiree or the occurrence of any of the events mentioned above.
Election of COBRA Continuation
To continue continuation of coverage under COBRA, the eligible person must complete a COBRA-Continuation Coverage Application. Employees and family can contact the Benefits Office. Retirees and or family members must contact the New York City Health Benefits Program, 212.513.0470.
Eligible persons electing COBRA must do so within 60 days of the date on which they receive notification of their rights, and must pay the initial premium within 45 days of their election. Premium payments will be made on a monthly basis. Payments after the initial payment will have a 30-day grace period.