Collapse to view only § 300bb-4. Applicable premium
- § 300bb-1. State and local governmental group health plans must provide continuation coverage to certain individuals
- § 300bb-2. Continuation coverage
- § 300bb-3. Qualifying event
- § 300bb-4. Applicable premium
- § 300bb-5. Election
- § 300bb-6. Notice requirements
- § 300bb-7. Enforcement
- § 300bb-8. Definitions
§ 300bb–1. State and local governmental group health plans must provide continuation coverage to certain individuals
(a) In general
(b) Exception for certain plans
Subsection (a) shall not apply to—
(1) any group health plan for any calendar year if all employers maintaining such plan normally employed fewer than 20 employees on a typical business day during the preceding calendar year, or
(2) any group health plan maintained for employees by the government of the District of Columbia or any territory or possession of the United States or any agency or instrumentality.
(July 1, 1944, ch. 373, title XXII, § 2201, as added Pub. L. 99–272, title X, § 10003(a), Apr. 7, 1986, 100 Stat. 232; amended Pub. L. 101–239, title VI, § 6801(a)(1), Dec. 19, 1989, 103 Stat. 2296.)
§ 300bb–2. Continuation coverage
For purposes of section 300bb–1 of this title, the term “continuation coverage” means coverage under the plan which meets the following requirements:
(1) Type of benefit coverage
(2) Period of coverage
The coverage must extend for at least the period beginning on the date of the qualifying event and ending not earlier than the earliest of the following:
(A) Maximum required period
(i) General rule for terminations and reduced hours
(ii) Special rule for multiple qualifying events
(iii) General rule for other qualifying events
(iv) Special rule for TAA-eligible individuals
(v) Medicare entitlement followed by qualifying event
(vi) Special rule for disability
(B) End of plan
(C) Failure to pay premium
(D) Group health plan coverage or medicare entitlement
The date on which the qualified beneficiary first becomes, after the date of the election—
(i) covered under any other group health plan (as an employee or otherwise) which does not contain any exclusion or limitation with respect to any preexisting condition of such beneficiary (other than such an exclusion or limitation which does not apply to (or is satisfied by) such beneficiary by reason of chapter 100 of title 26, part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1181 et seq.], or subchapter XXV of this chapter), or
(ii) entitled to benefits under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.].
(E) Termination of extended coverage for disability
(3) Premium requirements
The plan may require payment of a premium for any period of continuation coverage, except that such premium—
(A) shall not exceed 102 percent of the applicable premium for such period, and
(B) may, at the election of the payor, be made in monthly installments.
In no event may the plan require the payment of any premium before the day which is 45 days after the day on which the qualified beneficiary made the initial election for continuation coverage.2
2 See 1989 Amendment note below.
In the case of an individual described in the last sentence of paragraph (2)(A), any reference in subparagraph (A) of this paragraph to “102 percent” is deemed a reference to “150 percent” for any month after the 18th month of continuation coverage described in clause (i) or (ii) of paragraph (2)(A).(4) No requirement of insurability
(5) Conversion option
(July 1, 1944, ch. 373, title XXII, § 2202, as added Pub. L. 99–272, title X, § 10003(a), Apr. 7, 1986, 100 Stat. 233; amended Pub. L. 99–514, title XVIII, § 1895(d)(1)(C), (2)(C), (3)(C), (4)(C), Oct. 22, 1986, 100 Stat. 2937–2939; Pub. L. 101–239, title VI, §§ 6702(a), (b), 6801(b)(1)(A), (2)(A), (3)(A), Dec. 19, 1989, 103 Stat. 2295, 2297; Pub. L. 104–188, title I, § 1704(g)(1)(C), Aug. 20, 1996, 110 Stat. 1880; Pub. L. 104–191, title IV, § 421(a)(1), Aug. 21, 1996, 110 Stat. 2087; Pub. L. 111–5, div. B, title I, § 1899F(c), Feb. 17, 2009, 123 Stat. 429; Pub. L. 111–344, title I, § 116(c), Dec. 29, 2010, 124 Stat. 3616; Pub. L. 112–40, title II, § 243(a)(5), Oct. 21, 2011, 125 Stat. 420.)
§ 300bb–3. Qualifying event
For purposes of this subchapter, the term “qualifying event” means, with respect to any covered employee, any of the following events which, but for the continuation coverage required under this subchapter, would result in the loss of coverage of a qualified beneficiary:
(1) The death of the covered employee.
(2) The termination (other than by reason of such employee’s gross misconduct), or reduction of hours, of the covered employee’s employment.
(3) The divorce or legal separation of the covered employee from the employee’s spouse.
(4) The covered employee becoming entitled to benefits under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.].
(5) A dependent child ceasing to be a dependent child under the generally applicable requirements of the plan.
(July 1, 1944, ch. 373, title XXII, § 2203, as added Pub. L. 99–272, title X, § 10003(a), Apr. 7, 1986, 100 Stat. 234.)
§ 300bb–4. Applicable premium
For purposes of this subchapter—
(1) In general
(2) Special rule for self-insured plans
To the extent that a plan is a self-insured plan—
(A) In general
Except as provided in subparagraph (B), the applicable premium for any period of continuation coverage of qualified beneficiaries shall be equal to a reasonable estimate of the cost of providing coverage for such period for similarly situated beneficiaries which—
(i) is determined on an actuarial basis, and
(ii) takes into account such factors as the Secretary may prescribe in regulations.
(B) Determination on basis of past cost
If a plan administrator elects to have this subparagraph apply, the applicable premium for any period of continuation coverage of qualified beneficiaries shall be equal to—
(i) the cost to the plan for similarly situated beneficiaries for the same period occurring during the preceding determination period under paragraph (3), adjusted by
(ii) the percentage increase or decrease in the implicit price deflator of the gross national product (calculated by the Department of Commerce and published in the Survey of Current Business) for the 12-month period ending on the last day of the sixth month of such preceding determination period.
(C) Subparagraph (B) not to apply where significant change
(3) Determination period
(July 1, 1944, ch. 373, title XXII, § 2204, as added Pub. L. 99–272, title X, § 10003(a), Apr. 7, 1986, 100 Stat. 234.)
§ 300bb–5. Election
(a) In generalFor purposes of this subchapter—
(1) Election periodThe term “election period” means the period which—
(A) begins not later than the date on which coverage terminates under the plan by reason of a qualifying event,
(B) is of at least 60 days’ duration, and
(C) ends not earlier than 60 days after the later of—
(i) the date described in subparagraph (A), or
(ii) in the case of any qualified beneficiary who receives notice under section 300bb–6(4) of this title, the date of such notice.
(2) Effect of election on other beneficiaries
(b) Temporary extension of COBRA election period for certain individuals
(1) In general
(2) Commencement of coverage; no reach-back
(3) Preexisting conditionsWith respect to an individual who elects continuation coverage pursuant to paragraph (1), the period—
(A) beginning on the date of the TAA-related loss of coverage, and
(B) ending on the first day of the 60-day election period described in paragraph (1),
shall be disregarded for purposes of determining the 63-day periods referred to in section 2701(c)(2),1
1 See References in Text note below.
section 1181(c)(2) of title 29, and section 9801(c)(2) of title 26.(4) DefinitionsFor purposes of this subsection:
(A) Nonelecting TAA-eligible individualThe term “nonelecting TAA-eligible individual” means a TAA-eligible individual who—
(i) has a TAA-related loss of coverage; and
(ii) did not elect continuation coverage under this part 2
2 So in original. This subchapter is not divided into parts.
during the TAA-related election period.(B) TAA-eligible individualThe term “TAA-eligible individual” means—
(i) an eligible TAA recipient (as defined in paragraph (2) of section 35(c) of title 26), and
(ii) an eligible alternative TAA recipient (as defined in paragraph (3) of such section).
(C) TAA-related election period
(D) TAA-related loss of coverage
(July 1, 1944, ch. 373, title XXII, § 2205, as added Pub. L. 99–272, title X, § 10003(a), Apr. 7, 1986, 100 Stat. 235; amended Pub. L. 99–514, title XVIII, § 1895(d)(5)(C), Oct. 22, 1986, 100 Stat. 2939; Pub. L. 107–210, div. A, title II, § 203(e)(2), Aug. 6, 2002, 116 Stat. 970.)
§ 300bb–6. Notice requirementsIn accordance with regulations prescribed by the Secretary—
(1) the group health plan shall provide, at the time of commencement of coverage under the plan, written notice to each covered employee and spouse of the employee (if any) of the rights provided under this subsection,1
1 So in original. Probably should be “subchapter”.
(2) the employer of an employee under a plan must notify the plan administrator of a qualifying event described in paragraph (1), (2), or (4) of section 300bb–3 of this title within 30 days of the date of the qualifying event,
(3) each covered employee or qualified beneficiary is responsible for notifying the plan administrator of the occurrence of any qualifying event described in paragraph (3) or (5) of section 300bb–3 of this title within 60 days after the date of the qualifying event and each qualified beneficiary who is determined, under title II or XVI of the Social Security Act [42 U.S.C. 401 et seq., 1381 et seq.], to have been disabled at any time during the first 60 days of continuation coverage under this subchapter is responsible for notifying the plan administrator of such determination within 60 days after the date of the determination and for notifying the plan administrator within 30 days after the date of any final determination under such title or titles that the qualified beneficiary is no longer disabled, and
(4) the plan administrator shall notify—
(A) in the case of a qualifying event described in paragraph (1), (2), or (4) of section 300bb–3 of this title, any qualified beneficiary with respect to such event, and
(B) in the case of a qualifying event described in paragraph (3) or (5) of section 300bb–3 of this title where the covered employee notifies the plan administrator under paragraph (3), any qualified beneficiary with respect to such event,
of such beneficiary’s rights under this subsection.1
For purposes of paragraph (4), any notification shall be made within 14 days of the date on which the plan administrator is notified under paragraph (2) or (3), whichever is applicable, and any such notification to an individual who is a qualified beneficiary as the spouse of the covered employee shall be treated as notification to all other qualified beneficiaries residing with such spouse at the time such notification is made.
(July 1, 1944, ch. 373, title XXII, § 2206, as added Pub. L. 99–272, title X, § 10003(a), Apr. 7, 1986, 100 Stat. 235; amended Pub. L. 99–514, title XVIII, § 1895(d)(6)(C), Oct. 22, 1986, 100 Stat. 2939; Pub. L. 100–203, title IV, § 4009(j)(8), Dec. 22, 1987, 101 Stat. 1330–59; Pub. L. 101–239, title VI, § 6702(c), Dec. 19, 1989, 103 Stat. 2295; Pub. L. 104–191, title IV, § 421(a)(2), Aug. 21, 1996, 110 Stat. 2088.)
§ 300bb–7. Enforcement
Any individual who is aggrieved by the failure of a State, political subdivision, or agency or instrumentality thereof, to comply with the requirements of this subchapter may bring an action for appropriate equitable relief.
(July 1, 1944, ch. 373, title XXII, § 2207, as added Pub. L. 99–272, title X, § 10003(a), Apr. 7, 1986, 100 Stat. 236.)
§ 300bb–8. Definitions
For purposes of this subchapter—
(1) Group health plan
(2) Covered employee
(3) Qualified beneficiary
(A) In general
The term “qualified beneficiary” means, with respect to a covered employee under a group health plan, any other individual who, on the day before the qualifying event for that employee, is a beneficiary under the plan—
(i) as the spouse of the covered employee, or
(ii) as the dependent child of the employee.
Such term shall also include a child who is born to or placed for adoption with the covered employee during the period of continuation coverage under this subchapter.
(B) Special rule for terminations and reduced employment
(4) Plan administrator
(July 1, 1944, ch. 373, title XXII, § 2208, as added Pub. L. 99–272, title X, § 10003(a), Apr. 7, 1986, 100 Stat. 236; amended Pub. L. 100–647, title III, § 3011(b)(7), Nov. 10, 1988, 102 Stat. 3625; Pub. L. 101–239, title VI, § 6801(c)(1), Dec. 19, 1989, 103 Stat. 2297; Pub. L. 104–191, title I, § 102(d), title III, § 321(d)(3), title IV, § 421(a)(3), Aug. 21, 1996, 110 Stat. 1978, 2059, 2088; Pub. L. 114–255, div. C, title XVIII, § 18001(c)(2), Dec. 13, 2016, 130 Stat. 1344.)