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State Members

COBRA

The Consolidated Omnibus Budget Reconciliation Act (COBRA), a federal law, requires MCHCP to offer temporary coverage to members when coverage under the plan would otherwise end. Special COBRA enrollment deadlines and premiums apply.

When MCHCP is notified a qualifying event has occurred, a letter is sent explaining the right to choose COBRA coverage. The member has 60 days from the date of coverage loss or notification from MCHCP, whichever is later, to elect COBRA coverage; otherwise coverage ends.

A member who has Medicare before becoming eligible for COBRA coverage is entitled to coverage under both. Medicare coverage is primary and COBRA is secondary.

Members may add dependents to COBRA coverage due to marriage, birth, or adoption within 31 days of the event. MCHCP requires proof of eligibility for the dependent before enrollment is complete. Members may also add eligible dependents to COBRA coverage during MCHCP's annual open enrollment in October.

Qualifying Events

  • Employment Change
    Subscribers and dependents have the right to COBRA coverage for up to 18 months in the event of:
    • Termination of employment for reasons other than gross misconduct
    • Reduction in work hours
  • Military Leave
    Employees on military leave are eligible for COBRA coverage for 24 months or until employee fails to return to employment after leave ends, whichever occurs first.
  • Additional Dependent Qualifying Events
    Dependents have the right to COBRA coverage for up to 36 months in the event of:
    • Death of subscriber
    • Subscriber becomes Medicare eligible
    • Divorce or legal separation from the subscriber
    • Child(ren) turns 26
  • Disability
    COBRA coverage for subscribers and dependents may be extended from 18 up to 29 months if the Social Security Administration determines individual is disabled within the first 60 days of COBRA coverage. The affected individual must notify MCHCP of the disability determination before the end of the original 18-month COBRA period. The affected individual must also notify MCHCP within 31 days of any final determination that the individual is no longer disabled.

Required Notifications

MCHCP must be notified within 60 days of the following events:

  • Death of COBRA subscriber
  • Subscriber becomes Medicare eligible
  • Divorce or legal separation from the subscriber
  • Child(ren) turns 26

Employer must notify MCHCP within 30 days of the following events:

  • Death of subscriber
  • Termination of employment for reasons other than gross misconduct
  • Reduction in work hours

Disability
The affected individual must notify MCHCP of the Social Security Administration's disability determination before the end of the original 18-month COBRA period. The affected individual must also notify MCHCP within 31 days of any final determination that they are no longer disabled.

COBRA Wrap-Around (Spouse)

Missouri State Law

Covered spouse may continue COBRA coverage until age 65 if the following two conditions are met:

  1. Loss of coverage is due to divorce, legal separation or death of subscriber; and
  2. The covered spouse continues COBRA coverage for 36 months; and is at least 55 years old when the 36 month COBRA coverage ends.

To elect COBRA Wrap-Around coverage, the covered spouse must notify MCHCP, in writing, of the request for the COBRA Wrap-Around coverage and their mailing address.

The covered spouse has a limited amount of time to request the COBRA Wrap-Around; if coverage is not elected by the deadlines listed below, coverage ends.

Deadlines to notify MCHCP of request for COBRA Wrap-Around:

  • Legally separated or divorced: Covered spouse has sixty (60) days from the date of the legal separation or the entry of a decree of dissolution of marriage, or before the expiration of the thirty-six (36) month COBRA period to notify MCHCP
  • Death of subscriber: Covered spouse or human resources/payroll representative has thirty (30) days from the death of the subscriber or before the expiration of the thirty-six (36) month COBRA period to notify MCHCP

Once elected, Spousal COBRA Wrap-Around coverage will terminate on the last day of the month prior to the month the covered spouse turns age 65 or upon the earliest of any of the termination reasons:

  • Premium for COBRA Wrap-Around coverage is not paid on time;
  • The date on which the legally separated, divorced or surviving spouse becomes insured under any other group health plan;
  • The date on which the legally separated, divorced or surviving spouse remarries and becomes insured under another group health plan;
  • The date on which the legally separated, divorced or surviving spouse reaches age 65; or
  • The employer no longer provides group health coverage to any of its employees.

Termination of COBRA Coverage

If COBRA coverage is terminated, the member may not enroll at a later date. COBRA coverage may end for any of these reasons:

  • Failure to pay premium on time;
  • Member becomes covered under another group health plan;
  • Member becomes Medicare eligible after the COBRA effective date;
  • Member covered under the disability extension receives a final determination that they are no longer disabled; or
  • The employer no longer provides group health coverage to any of its employees.
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