Louisiana Administrative Code
Title 32 - EMPLOYEE BENEFITS
Part I - General Provisions
Chapter 3 - Uniform Provisions-Participation in the Office of Group Benefits
Section I-321 - COBRA
Universal Citation: LA Admin Code I-321
Current through Register Vol. 50, No. 9, September 20, 2024
A. Employees
1. Coverage under OGB for an enrollee will
terminate on the last day of the calendar month during which employment is
terminated (voluntarily or involuntarily) or significantly reduced, the
enrollee no longer meets the definition of an employee, or coverage under a
leave of absence has expired, unless the enrollee elects to continue coverage
at the enrollee's own expense. Employees terminated for gross misconduct are
not eligible for COBRA coverage.
2.
It is the responsibility of the participating employer to notify OGB within 30
days of the date coverage would have terminated because of any of the foregoing
events, and OGB will notify the enrollee within 14 days of his/her right to
continue coverage.
3. Application
for continued coverage shall be made in writing to OGB within 60 days of the
date of the election notification and premium payment shall be made within 45
days of the date the employee elects continued coverage, for coverage
retroactive to the date coverage would have otherwise terminated. After the
first payment, monthly payments for COBRA coverage are due on the first day of
the month for that month's coverage. A grace period of 30 days after the first
day of the month will be provided for each monthly payment.
4. Coverage under this section will continue
until the earliest of the following:
a.
failure to pay the applicable premium timely;
b. 18 months from the date coverage would
have otherwise terminated;
c.
entitlement to Medicare;
d. date
coverage begins under a group health plan; or
e. the employer ceases to provide any group
health plan coverage for its employees.
5. If employment for a covered employee is
terminated (voluntarily or involuntarily) or significantly reduced, the
enrollee no longer meets the definition of an employee, or a leave of absence
has expired, and the employee has not elected to continue coverage, the covered
dependents may elect to continue coverage at his/her/their own expense. The
elected coverage will be subject to the above-stated notification and
termination provisions.
B. Surviving Dependents
1. Coverage under an OGB plan for covered
surviving dependents will terminate on the last day of the month in which the
enrollee's death occurs, unless the surviving covered dependents elect to
continue coverage at their own expense.
2. It is the responsibility of the
participating employer or surviving covered dependents to notify OGB within 30
days of the death of the enrollee. OGB will notify the surviving dependents of
their right to continue coverage. Application for continued coverage shall be
made in writing to OGB within 60 days of the date of the election
notification.
3. Premium payment
shall be made within 45 days of the date the continued coverage was elected,
retroactive to the date coverage would have terminated. After the first payment
for COBRA coverage, monthly payments for each subsequent month of COBRA
coverage are due on the first day of the month for that month's COBRA coverage.
A grace period of 30 days after the first day of the month will be provided for
each monthly payment.
4. Coverage
for the surviving dependents under this section will continue until the
earliest of the following:
a. failure to pay
the applicable premium timely;
b.
36 months beyond the date coverage would have otherwise terminated;
c. entitlement to Medicare;
d. date coverage begins under a group health
plan; or
e. the employer ceases to
provide any group health plan coverage for its employees.
C. Divorced Spouse
1. Coverage under OGB for an enrollee's
spouse will terminate on the last day of the month during which dissolution of
the marriage occurs by virtue of a legal decree of divorce from the enrollee,
unless the covered divorced spouse elects to continue coverage at his/her own
expense.
2. It is the
responsibility of the divorced spouse to notify OGB within 60 days from the
date of divorce and OGB will notify the divorced spouse within 14 days of
his/her right to continue coverage. Application for continued coverage shall be
made in writing to OGB within 60 days of the election notification.
3. Premium payment shall be made within 45
days of the date continued coverage is elected, for coverage retroactive to the
date coverage would have otherwise terminated. After the first payment for
COBRA coverage, monthly payments for each subsequent month of COBRA coverage
are due on the first day of the month for that month's COBRA coverage. A grace
period of 30 days after the first day of the month will be provided for each
monthly payment.
4. Coverage for
the divorced spouse under this Section will continue until the earliest of the
following:
a. failure to pay the applicable
premium timely;
b. 36 months beyond
the date coverage would have otherwise terminated;
c. entitlement to Medicare;
d. date coverage begins under a group health
plan; or
e. the employer ceases to
provide any group health plan coverage for its employees.
D. Dependent Children
1. Coverage under an OGB plan for a covered
dependent child of an enrollee will terminate on the last day of the month
during which the dependent child no longer meets the definition of an eligible
covered dependent, unless the dependent elects to continue coverage at his/her
own expense.
2. It is the
responsibility of the dependent to notify OGB within 60 days of the date
coverage would have terminated and OGB will notify the dependent within 14 days
of his/her right to continue coverage. Application for continued coverage shall
be made in writing to OGB within 60 days of receipt of the election
notification.
3. Premium payment
shall be made within 45 days of the date the continued coverage is elected, for
coverage retroactive to the date coverage would have otherwise terminated.
After the first payment for COBRA coverage, monthly payments for each
subsequent month of COBRA coverage are due on the first day of the month for
that month's COBRA coverage. A grace period of 30 days after the first day of
the month will be provided for each monthly payment.
4. Coverage for children under this section
will continue until the earliest of the following:
a. failure to pay the applicable premium
timely;
b. 36 months beyond the
date coverage would have otherwise terminated;
c. entitlement to Medicare;
d. date coverage begins under a group health
plan; or
e. the employer ceases to
provide any group health plan coverage for its employees.
E. Dependents of COBRA Participants
1. If a covered terminated
employee has elected to continue coverage for him/herself and covered
dependents, and the enrollee dies, divorces his/her spouse, or the covered
dependent child no longer meets the definition of an eligible dependent during
the COBRA coverage period, then the dependents may elect to continue COBRA
coverage. Coverage will not be continued beyond 36 months from the employee
terminated.
2. It is the
responsibility of the spouse and/or the dependent child to notify OGB within 60
days of the date COBRA coverage would have terminated.
3. Monthly payments for each month of COBRA
coverage are due on the first day of the month for that month's COBRA coverage.
A grace period of 30 days after the first day of the month will be provided for
each monthly payment.
4. Coverage
for children under this section will continue until the earliest of the
following:
a. failure to pay the applicable
premium timely;
b. 36 months beyond
the date coverage would have otherwise terminated;
c. entitlement to Medicare;
d. date coverage begins under a group health
plan; or
e. the employer ceases to
provide any group health plan coverage for its employees.
F. Disability COBRA
1. If a plan participant is determined by the
Social Security Administration or by OGB (in the case of a person who is
ineligible for Social Security disability benefits due to insufficient
"quarters" of employment), to have been totally disabled on the date the plan
participant became eligible for continued coverage or within the initial 18
months of coverage, coverage under an OGB plan for the plan participant who is
totally disabled may be extended at his/her own expense up to a maximum of 29
months from the date the plan participant first became eligible for COBRA
coverage.
2. To qualify, the plan
participant shall:
a. submit a copy of
his/her Social Security Administration's disability determination to OGB before
the initial 18-month continued coverage period expires and within 60 days after
the latest of:
i. the date of issuance of the
Social Security Administration's disability determination; or
ii. the date on which the plan participant
loses (or would lose) coverage under the terms of the OGB plan as a result of
the enrollee's termination or reduction of hours;
b. in the case of a person who is ineligible
for Social Security disability benefits due to insufficient "quarters" of
employment, submit proof of total disability to OGB before the initial 18-month
continued coverage period expires. OGB will make the determination of total
disability based upon medical evidence, not conclusions, presented by the
applicant's physicians, work history, and other relevant evidence presented by
the applicant.
3. For
purposes of eligibility for continued coverage under this section, total
disability means the inability to do any substantial gainful activity by reason
of any medically determinable physical or mental impairment which can be
expected to last for a continuous period of 12 months. To meet this definition
one shall have a severe impairment which makes one unable to do his/her
previous work or any other substantial gainful activity which exists in the
national economy, based upon a person's residual functional capacity, age,
education, and work experience.
4.
Monthly payments for each month of extended COBRA coverage are due on the first
day of the month for that month's COBRA coverage. A grace period of 30 days
after the first day of the month will be provided for each monthly
payment.
5. Coverage under this
Section will continue until the earliest of the following:
a. failure to pay the applicable premium
timely;
b. 29 months from the date
coverage would have otherwise terminated;
c. entitlement to Medicare;
d. date coverage begins under a group health
plan;
e. the employer ceases to
provide any group health plan coverage for its employees; or
f. 30 days after the month in which the
Social Security Administration determines that the plan participant is no
longer disabled. (The plan participant shall report the determination to OGB
within 30 days after the date of issuance by the Social Security
Administration.) In the case of a person who is ineligible for Social Security
disability benefits due to insufficient "quarters" of employment, 30 days after
the month in which OGB determines that the plan participant is no longer
disabled.
G. Medicare COBRA
1. If an enrollee becomes
entitled to Medicare less than 18 months before the date the enrollee's
eligibility for benefits under OGB terminates, the period of continued coverage
available for the enrollee's covered dependents will continue until the
earliest of the following:
a. failure to pay
the applicable premium timely;
b.
36 months from the date of the enrollee's Medicare entitlement;
c. entitlement to Medicare;
d. date coverage begins under a group health
plan; or
e. the employer ceases to
provide any group health plan coverage for its employees.
2. Monthly payments for each month of COBRA
coverage are due on the first day of the month for that month's COBRA coverage.
A grace period of 30 days after the first day of the month will be provided for
each monthly payment.
H. Miscellaneous Provisions
1. During the COBRA
coverage period, benefits will be identical to those provided to others
enrolled in an OGB plan under its standard eligibility provisions for
enrollees.
2. In the event OGB
contracts for COBRA administration services, OGB may direct each plan
participant eligible for COBRA coverage to follow the directions provided by
OGB's COBRA administrator.
AUTHORITY NOTE: Promulgated in accordance with R.S. 42:801(C) and 802(B)(1).
Disclaimer: These regulations may not be the most recent version. Louisiana may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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