COBRA

COBRA INTRODUCTION

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

Process Overview

1. Packet: Your COBRA packet and enrollment form are mailed to you 14 business days after your agency/university enters your termination information into the system. You cannot receive a form before this time.
2. Enrollment: You have 60 days to enroll after you receive the packet.
3. Payment: You have an additional 45 days to pay AFTER you send in the enrollment form. (Recommended: Send in payment with your enrollment form since coverage does not begin until payment is received.)
4. Coverage:  Does not begin until the first payment is received. 
5. Monthly Billing: After the first payment is received at ADOA, you will receive a monthly billing statement in the mail. You may begin making payments online if desired. See "COBRA Online Bill Pay" below.

Extended Deadlines for COVID-19 National Emergency

• During the COVID-19 National Emergency, the election period is extended to 60 days after the end of the Outbreak Period or other announced date. Please see the full details.

AMERICAN RESCUE PLAN ACT OF 2021 | COBRA PREMIUM SUBSIDY

COBRA ONLINE BILL PAY

• You cannot make your FIRST COBRA PAYMENT online since your account is not set up until you submit your enrollment form and first payment via check or money order.
  • Mail your enrollment form with payment to ADOA-HITF, 100 N. 15th Ave., Suite 302, Phoenix, AZ 85007. Make the check/money order payable to: ADOA-HITF.
     
• Use this link only AFTER you have made your first payment and received a monthly billing statement in the mail,  so you will have the information needed to set up an account.
  • This includes the biller account number, and the online enrollment code printed on your billing statement.

COBRA FORMS

If you do not receive a form within 14 days of your agency/university ending your benefits, contact ADOA - Benefits Services Division at 602-542-5008, 1-800-304-3687 or [email protected].  

COBRA RATES

• COBRA Rate Sheet - 2022

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 eligible 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 or 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 AND DEPENDENTS TURNING AGE 26

• Age 26 process