COBRA: Do I have the right to continued health insurance?

heart and stethoscope

COBRA is a federal law that gives some employees the right to temporarily continue their group health insurance despite an event that would usually end coverage. COBRA sets rules for when and how long certain employers must offer employees and their families continuation coverage.

What is COBRA?

In general, COBRA applies to private employers with at least 20 employees and to state and local government employers. It does not apply to the federal government or church employers. Many states also have their own COBRA laws that give similar rights to employees who work for private employers with fewer than 20 employees.

Under COBRA, a qualified beneficiary may elect continuation coverage after a qualifying event. A “qualified beneficiary” is an individual covered by the group health plan. Qualified beneficiaries may include employees, their current or former spouses, and their dependent children. A “qualifying event” is a change that causes loss of coverage. These events may include termination of employment, reduction in hours, death, divorce, separation, Medicare eligibility, and ceasing to be a dependent child under the plan’s terms.

Electing continuation coverage means that you will continue to receive the same health care benefits for a certain period of time. However, you employer will no longer be responsible for paying for your health care coverage. This means your monthly premium costs will increase significantly.

What are my rights?

You employer should provide you with a Summary Plan Description (SDP) that provides important information about the health plan, your rights, and how the plan works after you enroll. Your employer should also provide a Summary of Material Modifications (SMM) if there are any changes to the plan. If you don’t have a copy of your plan documents, submit a written request to your employer. Your employer must provide the documents within 30 days.

The duration of COBRA continuation coverage depends on the type of qualifying event. For termination of employment or reduction in hours, qualified beneficiaries are entitled to 18 months of continuation coverage. Qualified beneficiaries may elect up to 36 months of continuation coverage after other qualifying events.

What does COBRA require my employer to do?

Employers must notify the group health plan within 30 days of a qualifying event. Within 14 days of notifying the health plan, your employer must provide you with an election notice about your rights under COBRA so that you can make an informed decision about whether to continue your coverage. Employers who fails to provide the election notice on time may face a penalty of up to $110/day. They may also be required to reimburse qualified beneficiaries for medical expenses incurred as a result of the failure to notify.

What does COBRA require me to do?

You must timely notify your group health plan if you go through a divorce or legal separation, or if your child loses dependent status under the plan. Most plans require employees to provide notification of these qualifying events within 60 days. However, check your plan to see if your deadline is different. Your plan’s SDP and general notice should explain how to notify the plan of a qualifying event.

If you are a qualified beneficiary, you must have at least 60 days to decide whether to elect continuation coverage. Any or all qualified beneficiaries may elect continuation coverage. For example, your spouse may elect continuation coverage even if you do not. Even if you initlly waive coverage, you may change your mind at any time during the 60-day election period.

You may be required to make your first premium payment within 45 days or your election. You may lose your COBRA rights if you fail to pay on time.

Do you have questions about your rights under COBRA?

Do you have questions about your rights under COBRA? Alan Lescht and Associates has experienced attorneys who can help you navigate the COBRA process. Call us today at (202) 463-6036, email us, or visit our website.

Federal employees to be informed of appeal rights when adverse action is proposed

By law, federal employees are afforded protections in their employment well beyond those ordinarily held by those in the private sector. One of the most important protections under Title V of the U.S. Code is the right to advance notice when the federal government intends to take an adverse action against one if its employees—essentially, when an employee might be suspended, demoted, furloughed, or terminated.

Why is advance notice important?

Advance notice is significant in that it sets the stage for how an employee will proceed with many of the remaining rights, including response to the allegations, representation, and, potentially, appeal. Until recently, federal employees facing a potential adverse action under Chapter 75 were entitled to, in most cases, advance notice in writing and that the notice state “the specific reasons for the proposed action.”

What changed?

On December 12, 2017, the president signed into law the National Defense Authorization Act for Fiscal Year 2018 (“the Act”), which includes a provision requiring more detailed information be included. Specifically, the Act requires that proposed adverse action notices under Chapter 75 provide information regarding an employee’s right to appeal the final decision, where the employee may file the appeal, and whether the forum in which the employee chooses to file an appeal will impact her/his rights. The Act did not change any rights under Chapter 73 relating to management of performance, though adverse action may also be taken under this chapter.

This information must first be “developed” by the Director of the Office of Personnel Management. In doing so, the Director is to work with the Special Counsel, the Merit Systems Protection Board, and the Equal Employment Opportunity Commission; however, the Act does not provide a deadline by which the information must be finalized and included in prospective notices.

Did you receive notice of a proposed adverse action?

Contact Alan Lescht and Associates, PC, today. Call us at (202) 463-6036, email us, or visit our website. We represent private employees in DC, Maryland, and northern Virginia, and federal employees around the world.

December 2017 Victories at Alan Lescht & Associates!

We’ve had a busy December! Our team recently won two appeals before the U.S. Merit Systems Protection Board (MSPB) and the Office of Federal Operations (OFO) on behalf of federal employees seeking to reverse removal actions.

OFO Victory

Our client worked for the Department of Justice and suffered from severe medical conditions that made it difficult for her to arrive to work on time. She requested a reasonable accommodation of a flexible work schedule, which the Agency denied. This denial subsequently led to her removal from service.

Our client filed an EEO complaint based on disability and failure to reasonably accommodate. The Agency issued a Final Agency Decision (FAD) finding no discrimination. We appealed the decision to the OFO, who found that the Agency had indeed denied our client reasonable accommodations, leading to her removal. The OFO ordered the Agency to reinstate our client to her former position and pay her back pay, compensatory damages, and attorney’s fees. The OFO also ordered the Agency to consider taking appropriate disciplinary action against the officials involved in the discrimination.

MSPB Victory

Our client was improperly charged with AWOL and Failure to Follow Leave Procedures after failing to personally contact the Agency when he was too sick to report to work. Instead, his wife contacted one of his supervisors that morning on his behalf. When the client returned to work the next day, he requested sick leave but it was denied. The Agency later removed him based upon his absence.

We appealed the client’s removal and represented him in a hearing before MSPB. We argued that the Agency failed to prove that it properly denied our client’s leave request, so the AWOL charge should have been dismissed. We also argued the Failure to Follow Leave Procedures charge should be dismissed because our client’s wife contacted the Agency to request sick leave for him.

Ultimately, the Administrative Judge reversed the Agency’s decision on both charges and ordered the employee’s reinstatement with back pay and benefits. The Agency was required to grant our client sick leave because he demonstrated that he was too sick to perform his duties. The Agency also failed to show that the wife’s request for sick leave violated leave procedures.

Questions? Call us today at (202) 463-6036, email us, or visit our website. We assist federal employees asserting discrimination claims before the EEOC, responding to proposed discipline, appealing discipline to the MSPB, pursuing grievances, challenging clearance revocations, and appealing denial of within grade increases. Our attorneys have experience in all aspects of federal litigation involving Title VII, the Rehabilitation Act, the Americans with Disabilities Act (ADA), and the Family and Medical Leave Act (FMLA).