A brief overview of eligibility as a COBRA subscriber is below. You can find a full description of COBRA eligibility rules in the Plan of Benefits.
COBRA, the Consolidated Omnibus Budget Reconciliation Act, requires that continuation of group health, dental, vision or Medical Spending Account coverage1 be offered to you and your covered spouse and children if you are no longer eligible for coverage due to a qualifying event. Qualifying events include:
- The covered employee’s working hours are reduced from full-time to part-time (outside of a stability period);
- The covered employee voluntarily quits work, retires, is laid off or is fired (unless the firing is due to gross misconduct);
- A covered spouse loses eligibility due to a change in marital status; or
- A child no longer qualifies for coverage.
PEBA serves as the benefits administrator for COBRA subscribers of state agencies, higher education institutions and public school districts. COBRA subscribers from participating optional employers keep the same benefits administrator.
For more information about COBRA, review the Insurance Benefits Guide.
Special eligibility situations
A special eligibility situation is an event that allows you, as a COBRA subscriber, to enroll in or drop coverage for yourself or eligible family members outside of an open enrollment period.2
You can make changes using MyBenefits if you have a special eligibility situation, such as adding a newborn, marriage, divorce or adoption. MyBenefits will display the documentation required for each change. The required documents can be uploaded through MyBenefits.
To make a change through your benefits administrator, you will need to:
- Contact your benefits administrator;
- Complete a Notice of Election form within 31 days3 of the event; and
- Upload documentation to MyBenefits or give documentation to your benefits administrator.
More details about special eligibility situations are available in the Insurance Benefits Guide.
1Individuals eligible for continued coverage under COBRA may continue to participate in a Health Savings Account as long as they remain covered by the Savings Plan and meet other eligibility requirements.
2A salary increase or decrease, or transfer does not create a special eligibility situation.
3Changes related to Medicaid or the Children’s Health Insurance Program (CHIP) must be made within 60 days.