Oklahoma Administrative Code › Title 260 - Office of Management and Enterprise Services › Chapter 40 - Employee Benefits Department › Subchapter 33 - Cobra Coverage › Section 260:40-33-3 - COBRA administration

Current through Vol. 41, No. 20, July 1, 2024
(a) COBRA
				continuation is only available to those employees and/or dependents who were
				covered under the plans offered by the Plan Administrator that are eligible for
				COBRA continuation on the date of the qualifying event or as otherwise defined
				in section (c) below. A leave under FMLA is not a COBRA qualifying
				event.
(b) New dependents may be
				added to coverage, including newborns, provided the employee had all eligible
				dependents covered at the time of the qualifying event. New dependents must be
				added within thirty (30) days of acquiring eligibility.
(c) A qualified beneficiary is defined as any
				individual who, on the day before a qualifying event, is covered under a group
				health plan by virtue of being on that day either a covered employee, the
				spouse of a covered employee, or a dependent child of a covered employee. A
				qualified beneficiary is also any child who is born to a covered employee or
				placed for adoption with a covered employee during a period of COBRA
				continuation coverage. A child born to or adopted by a qualified beneficiary
				other than the former employee is not considered a qualified beneficiary under
				COBRA law.
(d) If the qualifying
				event is termination of employment, whether voluntary or involuntary, the
				employing agency shall make the determination whether or not the termination
				was due to gross misconduct. The Plan Administrator will not make that
				decision, nor will it question a decision by the employing agency on this
				issue. If a decision is made by the agency that the employee was terminated due
				to gross misconduct, the COBRA form should clearly specify that fact.
(e) Once election to continue coverage has
				been made, coverage will terminate in eighteen (18) months if the qualifying
				event is termination or reduction in hours, or thirty-six (36) months if the
				qualifying event is death, divorce or legal separation, or ceasing to be a
				dependent child. Coverage may also terminate if the Plan Administrator ceases
				to offer any plans eligible for COBRA continuation, or if the beneficiary fails
				to make timely payments of any premiums required, or if the beneficiary becomes
				covered under any other group plan unless the new group plan contains an
				exclusion or limitation with respect to any pre-existing condition of the
				participant.
(1) The maximum eligibility
				period may be extended to twenty-nine (29) months if the Social Security
				Administration determines that the qualified beneficiary was totally disabled
				under Title 11 or XVI of the Social Security Act on or before the COBRA event
				date or within the first sixty (60) days following the start of continuation
				coverage. The qualified beneficiary must provide the employer or designated
				COBRA administrator with a copy of the Social Security determination notice
				within 60 days after the determination is issued and before the end of the
				initial eighteen (18) months of COBRA.
(2) If the Social Security Administration
				reevaluates the participant's case and determines that the participant is no
				longer disabled, the participant must provide the agency or the designated
				COBRA administrator with a copy of the determination notice. This copy must be
				sent within thirty (30) days. Coverage will end at the end of the month that
				begins more that thirty (30) days after the date of the final determination.
				For example, if a final determination notice date is May 15, coverage would end
				June 30.
(3) If an employee is
				receiving Medicare prior to retirement or another COBRA event, he/she can
				continue COBRA coverage for eighteen months (18) after the retirement or other
				qualifying COBRA event. However, the spouse and or other qualified
				beneficiaries shall be allowed to have COBRA for thirty-six (36) months after
				the Medicare entitlement date.