COBRA Continued Benefits Coverage

The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986 is a federal law that allows individuals to continue medical, dental, vision or Health Care FSA coverage on an individual basis when they are no longer eligible for coverage under the employer's group plan. 

Upon loss of coverage, eligible individuals will receive written notification of their right to COBRA continuation coverage along with instructions for enrolling in the plans. If an individual elects to continue coverage and fails to make premium payments within a specified time frame, coverage will be terminated.

This page is intended to provide employees and their spouses with a summary of their rights and obligations under the continuation of coverage provisions of the law.

COBRA coverage is administered by PayFlex Systems for OU. Contact PayFlex at the number below with questions about current COBRA coverage or changes to coverage. Contact Human Resources with general questions about COBRA.

COBRA Rules & Requirements

Who is eligible for COBRA?

 

Employees of the University of Oklahoma, who are covered by the university’s medical, dental, vision, or healthcare Flexible Spending reimbursement account, have the right to choose COBRA Continuation Coverage if the employee loses coverage because of a reduction in hours of employment or the termination of employment for reasons other than gross misconduct.

Spouses of an employee covered by the university’s medical, dental, or vision plan have the right to choose COBRA Continuation Coverage if they lose group medical, dental, or vision coverage under the university’s plan for any of the following four reasons: 

  1. The death of the employee.
  2. A termination of the employee's employment for reasons other than their gross misconduct or reduction in their hours of employment with the university.
  3. Divorce or legal separation from the employee.
  4. The employee becomes entitled to Medicare.

A dependent of an employee covered by the university’s medical, dental, or vision plan has the right to COBRA Continuation Coverage if group medical, dental, or vision coverage under the university’s plan is lost for any of the following events:

  1. The death of the employee.
  2. A termination of the employee’s employment for reasons other than gross misconduct or reduction in the employee’s hours of employment with the university.
  3. The employee’s divorce or legal separation.
  4. The employee becomes entitled to Medicare.
  5. The dependent child ceases to be a “dependent child” under any of the COBRA qualified group plans.

Can an Adopted or Placed Child be Covered?

A child who is born to or placed for adoption with a covered individual during a period of COBRA coverage will be eligible for COBRA Continuation Coverage. These qualified individuals can be provided coverage if the employee notifies Human Resources within thirty-one (31) days of the qualifying event.

Responsibility for Notification

  • The employee or a family member has the responsibility to inform OU Human Resources in writing of a divorce, legal separation, or a child losing dependent status under the university’s medical, dental, vision, or healthcare Flexible Spending reimbursement account within thirty (30) days of the date of the event. This can be done use the Benefits Change process.
  • The University of Oklahoma has the responsibility to notify the appropriate plan administrator of the employee’s death, termination, reduction in hours of employment, or Medicare entitlement. Similar rights may apply to certain retirees, spouses, and dependent children if your employer commences a bankruptcy proceeding and these individuals lose coverage. 

When Human Resources has been notified of a COBRA qualifying event, all appropriate individuals will be formally notified in writing of their right to choose COBRA Continuation Coverage. COBRA qualified individuals will have sixty (60) days from the date the notice is sent to elect COBRA Continuation Coverage. If COBRA Continuation Coverage is not elected within the sixty (60) day election period, all COBRA qualified coverage will end.

How long is coverage available if elected?

If COBRA Continuation Coverage is elected, the University of Oklahoma is required to provide coverage, which is identical to the coverage provided under the plan to similarly situated employees or family members at the time the coverage is being provided. The law requires that qualified individuals be given the opportunity to maintain medical, dental, or vision coverage for thirty-six (36) months unless health coverage was lost because of a termination of employment or reduction in hours. In that case, the required continuation of coverage period for medical, dental, or vision is eighteen (18) months. The initial eighteen (18) month coverage period may be extended for affected individuals to a total of thirty-six (36) months if other qualifying events occur during the initial eighteen (18) month coverage period.

Qualifying events that could extend coverage include the following. 
  • Death
  • Divorce
  • Legal separation
  • Medicare entitlement

In all cases, healthcare Flexible Spending reimbursement account participation will only be extended to the end of the current plan year. In no event will COBRA Continuation Coverage extend beyond thirty-six (36) months from the date of the original COBRA qualifying event. The eighteen (18) months of extended coverage may be increased to twenty-nine (29) months if an individual eligible for COBRA coverage becomes disabled (as defined by the Social Security Administration) during the first sixty (60) days of COBRA Continuation Coverage. This eleven (11) month extension is available to all individuals who qualify for COBRA because of a termination of employment or reduction in hours of employment. To benefit from this extension, the qualified individual must notify Human Resources before the end of the original eighteen (18) month period and within sixty (60) days of the qualifying event. The affected individual must also notify Human Resources within thirty (30) days of any final determination declaring that the individual is no longer disabled.

Can COBRA coverage be terminated early?

COBRA Continuation Coverage may be terminated early for any of the following reasons.
  • The University of Oklahoma no longer provides the plan benefit to any of its employees.
  • The premium for COBRA Continuation Coverage is not paid on time.
  • The covered individual becomes covered under another group health plan that does not contain any exclusion or limitation of any pre-existing condition the participant may have.
  • The covered individual becomes entitled to Medicare after electing COBRA coverage.
  • The individual is covered under COBRA's disability criteria but is no longer classified as disabled.
  • The covered individual files a fraudulent claim under COBRA coverage.

Are there pre-existing conditions limitations?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) restricts the extent to which group medical plans may impose pre-existing condition limitations. These rules are generally effective for plan years beginning after June 30, 1997. HIPAA coordinates COBRA’s other coverage cut-off rule with these new limits as follows. If a qualified individual becomes covered by another group health plan and that plan contains a pre-existing condition limitation that affects the individual, their COBRA coverage cannot be terminated. However, if the other plan’s pre-existing condition rule does not apply to you by reason of HIPAA’s restrictions on pre-existing condition clauses, the University of Oklahoma may terminate COBRA coverage.

Is proof of insurability required?

Proof of insurability is not required to choose COBRA continuation of coverage. However, continuation of coverage under COBRA is provided subject to eligibility for coverage. The University of Oklahoma reserves the right to terminate COBRA coverage retroactively if the individual is determined to be ineligible.

Is payment required?

Under the law, a covered individual may have to pay all or part of the premium of their continuation of coverage. There is a grace period of at least 30 days for payment of the regularly scheduled premium.

Questions about COBRA can be answered by contacting Human Resources. Other updates like changes in marital status and address changes should also be reported to Human Resources.

Documents

COBRA
These documents provide include premium rates for COBRA participants.
COBRA RATES 2017
Campus: Norman, OUHSC, Tulsa
COBRA RATES 2018 - NORMAN
Campus: Norman, Tulsa
NOTICE OF RIGHT TO ELECT COBRA
Campus: Norman, OUHSC, Tulsa

Contact Plan Administrator

PayFlex Systems USA, Inc.
(800) 359-3921
P.O. Box 2239
Omaha, NE 68103-2239 

Contact HR

  • Norman, HR Benefits
    (405) 325-1826, NEL 205
  • HSC, HR Employee Service Center
    (405) 271-2180, SCB 118
  • Tulsa, HR
    (918) 660-3192, Rm 2C11

More HR Contact Information