Or. Admin. R. 111-050-0001 - Continuation of Group Medical and Dental Insurance Coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA)
COBRA allows an eligible individual losing group health plan coverage due to a qualifying event to continue their coverage for a limited time on a self-pay basis.
(1) OEBB
will issue or cause the issuance of an initial COBRA notice explaining the
right to continue medical and dental insurance plans to all newly eligible
employees and individuals.
(a) The notice must
be mailed to the eligible employee's known address immediately following
enrollment in OEBB medical or dental insurance plans. The notice must include
all known eligible individuals residing at the address. Known eligible
individuals residing separately from the eligible employee must be mailed a
separate notice at their known address.
(b) The initial COBRA notice must be mailed
to individuals becoming newly eligible due to marriage or the formation of a
domestic partnership.
(2) A COBRA triggering event must cause the
loss of benefit coverage. COBRA triggering events include:
(a) An involuntary reduction in hours or
layoff;
(b) A strike or
lockout;
(c) The beginning of an
unpaid leave of absence;
(d) The
termination of employment;
(e)
Retirement;
(f) A child no longer
satisfying eligibility requirements;
(g) The loss of employer-sponsored group
coverage for dependents due to Medicare eligibility;
(h) A divorce or termination of a domestic
partnership; and
(i) The death of
the employee.
(3) All
individuals losing eligibility due to a triggering event must receive a COBRA
continuation notice.
(4) An
eligible employee or dependent has 60 days from the receipt of the COBRA notice
to activate their COBRA rights of continuation and 45 days from the election
date to pay the initial premium. Generally, OEBB-sponsored insurance coverage
must be continuous.
(5) Generally,
medical plans may be continued under COBRA provisions for the following basic
maximum coverage periods:
(a) 18 months after
the date of the triggering events specified in section (2)(a)-(e) above;
and
(b) An 11 month extension is
provided to COBRA participants when there is a disability determination by the
Social Security Administration and the plan is notified within the required
timeline, resulting in a 29 month coverage period; or
(c) 36 months after the date of the
triggering events specified in section (2)(f)-(i) above.
(6) An eligible employee's spouse or domestic
partner who is 55 years of age or older and who loses benefit coverage due to
events specified in section (2)(h) and (i) above, may continue OEBB medical
insurance coverage for themselves and their children beyond the general
36-month COBRA continuation period. An eligible individual may continue their
OEBB medical insurance coverage until they are entitled to Medicare, are
covered under another group medical insurance plan or otherwise lose
eligibility.
(7) An eligible
individual continuing OEBB medical insurance coverage only or medical and
dental insurance coverage under COBRA provisions has the same rights as active
eligible employees for making changes midyear and during the open enrollment
period.
(8) COBRA coverage will
terminate on the last day of the month for which premiums are paid in
full.
Notes
Stat. Auth.: ORS 243.860 - 243.886
Stats. Implemented: ORS 243.864(1)(a)
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