Health Insurance

Guaranteed-Issue Plans Including COBRA & Mini-COBRA

This section addresses guaranteed-issue plans available in Florida. It should be noted that certain states (Massachusetts, Maine, New Jersey, New York, Vermont and Washington) have further requirements for insurance companies to provide guaranteed-issue coverage.

COBRA

The Federal Consolidated Omnibus Budget Reconciliation Act (COBRA) allows retiring employees, or those who lose coverage due to quitting a job or reduced work hours, to continue group coverage for a limited period of time. This also applies to their dependents who lose coverage because of divorce or legal separation; death of the covered employee; the covered employee qualifying for Medicare; or a loss of dependent status under the health plan's provisions. COBRA applies only to employers with 20 or more employees. If you qualify for COBRA benefits, your health plan administrator must give you a notice stating your right to choose to continue benefits provided by the plan. You then have 60 days to accept coverage or lose all rights to the benefits. Once you select COBRA coverage, you may have to pay 100 percent of the total insurance cost, plus a 2 percent processing fee.

Mini-COBRA

Florida's mini-COBRA law provides similar continuation of coverage protection for employees who work for employers with fewer than 20 employees. Under Florida's mini-COBRA law, the employee must notify the insurer within 63 days of losing group eligibility that he or she is eligible to continue coverage.

Check with your state insurance department to see if similar mini-COBRA laws apply in your state.

Qualifying For COBRA and Mini-COBRA

Continuation of coverage runs from a minimum of 18 months to a maximum of 36 months, depending upon the individual situation. The coverage may continue for an additional 11 months for an insured's disability that occurs during a qualifying event such as termination (except for gross misconduct) or a reduction in work hours for the employee; however, it cannot exceed the limit of 36 months. Other qualifying events may include:

• A beneficiary loses coverage due to the employee's death;
• A divorce or legal separation of the employee and a spouse;
• The employee's qualification for Medicare; and
• A dependent child's loss of status under the health plan's provisions.

In addition, Florida law gives you the option of converting your policy to an individual plan if you leave the group. If you terminate employment, get divorced or reach age 25 and no longer qualify under a parent's group plan, you may convert your group policy to an individual policy. A conversion policy usually costs more than a group policy. It may provide fewer benefits, but you don't need to medically qualify for coverage.

Back to Top | Back to Health Insurance Home

• What is Traditional vs. Managed Care?
• Types of Major Medical Health Insurance
• What is a Health Savings Account (HSA)?
• Guaranteed-Issue Health Plans Including "COBRA" and "Mini-COBRA"
• How Will I Be Impacted By 2010 Health Care Reform Legislation?