Mini-COBRA
Florida Stature 627.6692 known as the FLORIDA HEALTH INSURANCE COVERAGE CONTINUATION ACT, which became effective January 1, 1997, requires that employers with fewer than 20 eligible employees, offer eligible employees and their families the opportunity for a temporary extension of health coverage (called "continuation coverage") in certain instances where coverage under the plan would otherwise end. This notice is intended to inform you, in a summary fashion, of your rights and obligations under the continuation coverage provisions of the law. This summary of rights should be reviewed by both you, your spouse and covered dependents (if applicable), retained with other benefit documents, and referred to in the event that any action is required on your part.
If you are an employee of an employer with fewer than 20 employees and covered by its group health plan, you have a right to choose this continuation coverage if:
You lose your group health coverage because of a reduction in your hours
of employment; orthe termination of your employment (for reasons
other than gross misconduct on your part).
If you are the covered spouse of an employee, you have the right to choose continuation coverage for yourself if you lose group health coverage for any of the following four reasons:
- The death of the employee;the termination of the
employee's employment (for reasons other than gross misconduct) or a reduction in the
employee's hours of employment;divorce or legal separation from the employee; orthe employee become entitled to Medicare.
In the case of a covered dependent child of an employee, or covered spouse, he or she has the right to continuation coverage if group health is lost for any of the following six reasons:
- The death of the employee;the termination of the
employee's employment (for reasons other than gross misconduct) or reduction in the
employee's hours of employment;parents' divorce or legal separation;employee becomes entitled to Medicare; orthe dependent ceases to be a 'dependent child' under the terms of the
group health plan.you also have a right to elect continuation coverage if you are covered
under the plan as a retiree or spouse or child of a retiree, and lose coverage within one
year before and after the commencement of proceedings under Title XI (bankruptcy), United
State Code by the employer from whose employment the covered employee retired.
Under the law, a qualified beneficiary has the responsibility to inform the company of a qualified event. This notification must be made within 30 days of the date of the qualifying event which would cause a loss of coverage.
The notice must be in writing, and include:
- the name of the qualified beneficiarythe date of the
qualifying eventone of the types of qualifying events as listed abovethe name of the employerthe group health plan numberthe name and address of all qualified beneficiaries.
When the company is notified that one of these events has happened, it will in turn notify you that you have the right to choose continuation coverage. Under the law, you have 30 days from the date of receipt of the Election and Premium Notice form, to elect continuation coverage. If and when you make this election, return the Election and Premium Notice form with applicable premium to the company. Coverage will become effective on the day after coverage would otherwise be terminated.
If you do not elect coverage and pay the premium, your group health insurance coverage will terminate in accordance with the provisions outlined in your Certificate of Insurance or other applicable plan documents.
If you choose continuation coverage, your coverage will be identical to the coverage provided under the plan to similarly situated employees or family members. The law requires that you be afforded the opportunity to maintain continuation coverage for 18 months. However, the law also provides that your continuation coverage may be terminated for any of the following reasons:
- the employer/former employer no longer provides group health coverage to
any of its employees;the premium for your continuation coverage is not
paid by the expiration of the grace period, which is 30 days;you first become, after electing continuation coverage, covering under any
other group health plan (as an employee or otherwise) which does not contain any exclusion
or limitation with respect to any pre-existing condition;you are approved, after electing continuation coverage, for Medicare.
Note: A qualified beneficiary who is determined, under Title II or XVI of the Social Security Act, to have been disabled at the time of a qualifying event, may be eligible to continue coverage for an additional 11-months (29-months total) if the qualified beneficiary provides the written determination of disability from the Social Security Administration to the insurance carrier within 60 days of the date of determination of disability by the Social Security Administration and prior to the end of the 18-month continuation period. The insurance carrier can charge up to 150 percent of the group rate during the 11-month disability extension. The qualified beneficiary must notify the insurance carrier within 30 days upon the determination that the qualified beneficiary is no longer disabled under Title II or XVI of the Social Security Act.
You do not have to show that you are insurable to choose continuation coverage. However, you may have to pay up to 115% of the applicable premium for continuation coverage. The law also requires that, at the end of the 18-months or 29-months, continuation coverage period, you must be allowed to enroll in an individual conversion health plan provided under the current group health plan.
