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Cobra Insurance
Congress passed the landmark
Consolidated Omnibus Budget Reconciliation Act (COBRA)
health benefit provisions in 1986. The law amends
the Employee Retirement Income Security Act (ERISA),
the Internal Revenue Code and the Public Health
Service Act to provide continuation of group health
coverage that otherwise would be terminated.
COBRA contains provisions
giving certain former employees, retirees, spouses
and dependent children the right to temporary
continuation of health coverage at group rates.
This coverage, however, is only available in specific
instances. Group health coverage for COBRA participants
is usually more expensive than health coverage
for active employees, since usually the employer
formerly paid a part of the premium. It is ordinarily
less expensive, though, than individual health
coverage.
The law generally covers group
health plans maintained by employers with 20 or
more employees in the prior year. It applies to
plans in the private sector and those sponsored
by state and local governments.{2} The law does
not, however, apply to plans sponsored by the
Federal government and certain church- related
organizations.
Group health plans sponsored
by private sector employers generally are welfare
benefit plans governed by ERISA and subject to
its requirements for reporting and disclosure,
fiduciary standards and enforcement. ERISA neither
establishes minimum standards or benefit eligibility
for welfare plans nor mandates the type or level
of benefits offered to plan participants. It does,
though, require that these plans have rules outlining
how workers become entitled to benefits.
Under COBRA, a group health
plan ordinarily is defined as a plan that provides
medical benefits for the employer's own employees
and their dependents through insurance or otherwise
(such as a trust, health maintenance organization,
self-funded pay-as-you-go basis, reimbursement
or combination of these). Medical benefits provided
under the terms of the plan and available to COBRA
beneficiaries may include:
- Inpatient and outpatient
hospital care
- Physician care
- Surgery and other major medical
benefits
- Prescription drugs
- Any other medical benefits,
such as dental and vision care
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