The following is excerpted from our COBRA Training & Certification Program:

COBRA Coverage For Disabled Individuals

Special rules extending the COBRA coverage periods apply if a QB is or becomes disabled and if the QE originally giving rise to COBRA coverage was a termination or a reduction in hours.

If a disabled QB qualifies for the extension, the otherwise applicable 18-month COBRA period is extended to 29 months for the QB and all related QBs.

The purpose of the extension is to bridge the potential 11-month gap in coverage between the end of an 18-month COBRA coverage period and the date when an individual becomes entitled to Medicare. (Under Medicare, disabled individuals must complete a five-month waiting period plus a 24-month period of receiving Social Security disability payments (i.e., 29 months before being entitled to Medicare.)

Three requirements must be satisfied for this extension to apply to a QB and his or her related QBs:

• The QB is determined by the Social Security Administration (SSA), under the Social Security Act, to have been disabled at any time within the first 60 days of COBRA continuation coverage
• The SSA must make this determination during the original 18-month COBRA period
• The QB must notify the Plan Administrator of the SSA determination within 60 days of the determination and before the end of the original 18-month coverage period

If the QB is a child born to or placed for adoption with the covered employee during a period of COBRA continuation coverage, then the period to determine the existence of the disability is measured from the date of birth or placement for adoption and continues for 60 days hence.

QBs who have qualified themselves and their related QBs for the extended coverage but are no longer disabled are required to notify the Plan Administrator, who should terminate the extended COBRA coverage, but do not terminate the initial COBRA coverage if this occurs during the first 18 months.

Who Is Covered By the 11-Month Extension Period

COBRA's special disability extension period rules apply to all QBs related to a QB who meets the requirements stated above, and not just to QBs who are disabled former employees. That is, the 11-month extension could apply to the whole family, and not just to the disabled person.

Increased Premium During the 11-Month Extension Period

During the additional 11 months of coverage, a plan may charge the affected QB(s) up to 150% of the applicable premium.

Example: Christopher is a QB who was determined by the SSA to be disabled starting 59 days after the date of his QE. Christopher meets all of the notice and deadline obligations noted above. During his 18 months of COBRA coverage, he maintained single coverage at a cost of $200 per month. Starting in month 19, Christopher’s employer’s plan can charge Christopher $300 (assuming no rate changes), which is 150% of the regular premium, for continued coverage.

Related Links

• ADA Training & Certification Program
• FMLA Training & Certification Program
• COBRA Training & Certification Program
• Integrating FMLA, ADA, COBRA & Workers' Comp Training & Certification Program
• FMLA & ADA Certificate Program