COBRA

Consolidated Omnibus Budget Reconciliation Act

COBRA continuation coverage was created by the federal Consolidated Omnibus Budget Reconciliation Act of 1985. COBRA allows you and those family members who are covered under the Fund to choose COBRA continuation coverage under the New York State Nurses Association Benefits Fund when they lose group health coverage due to a life event known as a "qualifying event."

Answers to Commonly Asked Questions

How much will COBRA cost each month?

Answer:
The Fund requires qualified beneficiaries who elect COBRA continuation coverage to pay 102 percent of the total cost of coverage during the 18- or 36-month continuation coverage period. Current rates for 2020 range from $994 (per person, Plan A) to $961 (per person, Plan B). If you are eligible for the 11-month disability extension, the Fund requires you to pay 150 percent of the total cost of coverage during that period.

Payment of the initial premium must be received within 45 days after you notify the Fund that you have elected such coverage. Payment is due on the first day of the month thereafter with a 30-day grace period.

What kind of coverage does COBRA provide?

Answer:
If you choose continuation coverage, you are entitled to coverage that is identical to the coverage provided under the Fund to similarly situated participants (or their family members). All Fund group medical benefits, including medical, dental, vision, and prescription drug coverage, are available under COBRA continuation coverage. Life insurance and disability coverages are not offered under COBRA. For detailed coverage information, click here.

What happens if COBRA is not chosen?

Answer:
If you do not choose COBRA coverage (or when your COBRA coverage ends), your Benefits Fund group coverage will terminate and you will need to seek alternate coverage elsewhere.

Other coverage options may be available for your and your family through the Health Insurance Marketplace, effective Jan, 1, 2014. In the Marketplace, you could be eligible for a new kind of tax credit that lowers your monthly premiums, and you can see what your premium, deductibles and out-of pocket costs will be prior to enrolling.

Can my COBRA coverage be lost for any reason?

Answer:
Yes. Your continuation coverage may be shortened prior to the expiration of the 18-, 29-, or 36-month period for any of the following reasons:

  • The Fund no longer provides group health coverage to its participants,
  • The premium for continuation coverage isn't paid in a timely fashion,
  • The continuation enrollee becomes covered under another group health plan, unless the plan contains pre-existing condition exclusions or limitations,
  • The continuation enrollee becomes enrolled in Medicare, or
  • Coverage has been extended for up to 29 months due to disability and there has been a final determination that the individual no longer is disabled.

Since COBRA doesn't provide life insurance coverage, what are my options?

Answer:
You can convert your life insurance coverage to an individual policy through MetLife in certain circumstances. Call the Benefits Fund at (877) RN BENEFITS to find out if you qualify.

Where do I send my payment?

Answer:
Send a check or money order payable to the New York State Nurses Association Benefits Fund, PO Box 12430, Albany, NY 12212-2430.

Where can I find more information about COBRA?

Answer:
If you would like more information, or have questions, check the Benefits Fund Summary Plan Description, or contact the NYSNA Benefits Fund or the nearest regional or district office of the U.S. Department of Labor's Employee Benefits Security Administration. Addresses and phone numbers of regional and district EBSA offices are available through the EBSA Web site at www.dol.gov/ebsa.

How long can COBRA coverage be maintained?

Answer:
For each qualified beneficiary who elects COBRA continuation coverage, COBRA continuation coverage will begin on the date of the qualifying event. When the qualifying event is the termination of employment or the reduction of the participant's hours of employment, COBRA continuation coverage can be maintained for up to 18 months. When the qualifying event is the death of a participant, enrollment of the participant in Medicare (Part A, Part B, or both), divorce or legal separation, or a dependent child losing eligibility as a dependent child, COBRA continuation coverage can be maintained for up to 36 months. There are several ways in which the 18-month period of COBRA continuation coverage can be extended. They are:

  • A disability extension. If you or anyone in your family covered under the Fund is determined by the Social Security Administration to be disabled as of the date of the participant's termination or reduction in hours, or at any time during the first 60 days of COBRA continuation coverage and you notify the plan administrator in a timely fashion,you and your entire family can receive up to an additional 11 months of COBRA continuation coverage,for up to a total maximum of 29 months.You must notify the plan administrator of the Social Security Administration's determination within 60 days of the date of the determination and before the end of the 18-month period of COBRA continuation coverage.The notice should be sent to the NYSNA Benefits Fund, PO Box 12430, Albany, NY 12212-2430.Qualified beneficiaries must notify the plan administrator within 30 days if they no longer are disabled.
  • A second qualifying event extension. If your family experiences a second qualifying event while receiving COBRA continuation coverage,your spouse and dependent children can get up to a maximum of 36 months of COBRA continuation coverage.This extension is available to the spouse and dependent children if the former participant dies, gets divorced,or is legally separated. The extension also is available to a dependent child when the child stops being eligible under the Fund as a dependent child. Finally, this extension may be available if the former participant enrolls in Medicare (Part A, Part B, or both). In all of these cases you must notify the plan administrator of the second qualifying event within 60 days of the second qualifying event. The notice must be given either by phone at (877) RN BENEFITS or mail at PO Box 12430, Albany, NY 12212-2430.
  • New York State extension. Extends the initial 18-month period an additional 18 months for medical coverage only. Available for the RN, her spouse, or her dependents if they lose eligibility.

Under what circumstances am I eligible for COBRA?

Answer:
You are eligible for COBRA if you are a Benefits Fund participant who becomes a qualified beneficiary (loses coverage under the Fund because of a qualifying event) due to:

  • A termination of employment (for any reason other than gross misconduct), or
  • A reduction in hours.

What notification is required?

Answer:
The Fund will offer COBRA continuation coverage to qualified beneficiaries only after the plan administrator has been notified that a qualifying event has occurred. When the qualifying event is the termination of employment or reduction of hours of employment, death of the participant, or enrollment of the participant in Medicare (Part A, Part B, or both), the employer must notify the plan administrator of the qualifying event within 30 days of any of these events.

If the qualifying event is a divorce or legal separation, or your child is losing dependent status under the terms of the participant benefits program, you (or your spouse or child) must notify the plan administrator within 60 days. You are required to either call the Benefits Fund at (877) RN BENEFITS, or send the Fund a notice to PO Box 12430, Albany, NY 12212-2430.

Once the plan administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries within 14 days. Under the law, qualified beneficiaries must elect continuation coverage within 60 days after the Fund mails them a COBRA notice. Each qualified beneficiary is entitled to make a separate COBRA election. Qualified beneficiaries who fail to elect continuation coverage in a timely fashion will lose their COBRA rights, but still may be eligible for a conversion option.

What about a dependent child?

Answer:
If you are a dependent child (including children born to or placed for adoption with a covered participant while the participant is on the continuation coverage) of a participant, you will become a qualified beneficiary if you lose coverage under the Fund due to any of the following qualifying events:

  • Your parent-participant dies,
  • Your parent-participant's hours of employment are reduced,
  • Your parent-participant's employment ends for any reason other than his/her gross misconduct,
  • Your parent-participant becomes enrolled in Medicare (Part A, Part B, or both),
  • Your parents become divorced or legally separated, or
  • You stop being eligible for coverage under the Fund as a "dependent child."

What are my responsibilities under COBRA?

Answer:
Your responsibilities are to:

  • Notify the Fund of your choice to elect COBRA continuation coverage within 60 days after the Fund mails you a COBRA notice.
  • Notify the Fund within 60 days of an address change, death, divorce, legal separation, disability determination, or if a child loses dependent status.
  • Make monthly premium payments in a timely fashion. Payment of the initial premium must be received within 45 days after you notify the Fund that you have chosen COBRA continuation coverage. Future premiums are due the first day of each month thereafter with a 30-day grace period.

Who administers COBRA?

Answer:
The Fund is administered by the Trustees of the New York State Nurses Association Benefits Fund, PO Box 12430, Albany, NY 12212-2430, (877) RN BENEFITS or (800) 342-4324. The plan administrator is responsible for administering COBRA continuation coverage.

Is a spouse eligible for COBRA?

Answer:
If you are the spouse of an eligible participant, you will become a qualified beneficiary if you lose coverage under the Fund due to any of the following qualifying events:

  • Your spouse dies, 
  • Your spouse's hours of employment are reduced, 
  • Your spouse's employment ends for any reason other than his/her gross misconduct, 
  • Your spouse becomes enrolled in Medicare (Part A, Part B, or both), or, 
  • You become divorced or legally separated from your spouse.

What should I consider when I'm deciding whether to choose COBRA coverage?

Answer:
You should compare the cost, level, and scope of the COBRA continuation coverage offered by the Benefits Fund with those of individual health insurance plans that might be available.

Why do I need continuation health coverage?

Answer:
You need health coverage to help pay for any medical services you or your dependents might have after your group coverage through the Benefits Fund ends.