COBRA

COBRA OVERVIEW

COBRA is a continuation of coverage in which your ADOA benefits will start the day after your active benefits end.

Please note:

  • A COBRA packet and enrollment form will be mailed to you 14 business days after your agency/university ends your benefits. You cannot receive a form before this time.
  • You have 60 days to enroll after you receive the packet.
  • Coverage will not begin until payment is received.
     
Pay Bill | COBRA

COBRA FORMS

Please contact ADOA - Benefits Services Division at 602-542-5008, 1-800-304-3687 or [email protected].

ENROLLING - 60 DAY DEADLINE

  • You have 60 days from the date you received the notice to elect COBRA coverage.
  • You should complete enrollment form A and return it to the Benefit Services Division postmarked no later than 60 days from the date you received the notice.  
  • Your COBRA coverage will begin at the full premium amount.
  • Payment must be received within 45 days after the enrollment form has been received. 
  • COBRA will begin the day after active coverage ends.

COBRA COVERAGE WILL NOT BEGIN UNTIL PAYMENT IS RECEIVED. 

YOUR RIGHT TO COBRA COVERAGE

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), entitles you to elect continued coverage under the group health plan, if you will no longer have benefits with Benefit Options because of one of the following qualifying events:

  • End of employment
  • Reduction in the hours of employment
  • Death of the employee under whom coverage was received
  • Divorce or legal separation
  • Losing dependent child status

Your spouse and dependent children are elegible for COBRA if they were covered on your plan the day of the qualifying event.

COBRA ENROLLMENT OPTIONS

You can choose:

  1. To continue family or two-party coverage, if you had family or two-party coverage on the date of the qualifying event
  2. For one of more qualifying persons to individually elect single coverage
  3. For all qualifying persons to decline COBRA coverage entirely

COVERAGE DURATION

You are eligible for COBRA coverage for 18, 29, or 36 months, depending on the nature of the qualifying event.

Your COBRA coverage may terminate early if:

  • Any required premium is not paid in full and on time
  • If, after electing COBRA continuation coverage, a qualified beneficiary becomes entitled to Medicare benefits (under Part A, Part B, or both)
  • The employer ceases to provide group health coverage for any of its employees

DECLINING COBRA COVERAGE

  • To decline COBRA coverage, return COBRA enrollment Form A with the “I decline COBRA coverage” option marked.
  • COBRA coverage will not be available to you once it is declined.
  • If you fail to return an enrollment form, your right to COBRA coverage will expire after 60 days from the date on the COBRA notification.

COBRA RATES 2018