The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) generally provides that certain qualified beneficiaries who lose coverage under an employer-sponsored health plan may elect to continue coverage under the plan in certain situations. COBRA applies only to employers with 20 or more employees. If an employer has fewer than 20 employees, those employees may have continuation coverage rights under state continuation coverage law (sometimes referred to as “mini-COBRA”) rather than COBRA. This article provides an overview of Ohio law on health plan continuation coverage under Ohio’s mini-COBRA provisions.

Q:       My employer has fewer than 20 employees and my employment has just been terminated. Am I eligible for health coverage under the Ohio continuation law?

A:                    To be eligible under the Ohio continuation law, you must have been:

1)    continuously insured under a group policy during the three-month period before your employment was terminated;

2)    involuntarily terminated for reasons other than gross misconduct; and

3)    not covered or eligible for coverage under Medicare, or under other group coverage.                    

You should check the terms of your former employer’s group insurance coverage to determine what continuation benefits you may be entitled to receive.

Q:       How long might my coverage last under the state continuation law?

A:        Your coverage may continue for up to 12 months.

Q:       What benefits may be continued under the state continuation law?  

A:        The continuation coverage requirement covers hospital, surgical and major medical benefits. In addition, continuation coverage must include prescription drugs if this coverage is included in the group coverage. Continuation need not cover dental or vision care.

Q:       How do I go about electing continuation coverage?

A:        You must apply within the earlier of:

1)    31 days of losing coverage;

2)    10 days from the day your coverage would otherwise end if you received notice of continuation rights before you lost your coverage; or

3)    10 days from the date you received notice about continuation coverage, if you received such notice after you lost your coverage.

Q:       Must employers in Ohio with fewer than 20 employees notify employees of the right to continue coverage at the time they are involuntarily terminated?

A:        Yes. Ohio law requires small employers to notify an employee of the right to state continuation coverage when the employee is notified of the employment termination. This notice must include details of the required monthly payment amount for continuation coverage (including the manner of payment). 

Q:       What if my former employer does not agree that I am eligible for group continuation coverage?

A:        You may contact the Ohio Department of Insurance (ODI) at (800) 686-1526 if you believe the insurance company is not complying with state group continuation coverage rules, or to get more information about state continuation law. Information is also available through www.insurance.ohio.gov (type “COBRA” in the search box).

     

This “Law You Can Use” column was provided by the Ohio State Bar Association. It was prepared by Jason Rothman and Charles Billington, attorneys in the Cleveland office of the international labor and employment law firm of Ogletree, Deakins, Nash, Smoak & Stewart, P.C. Articles appearing in this column are intended to provide broad, general information about the law. Before applying this information to a specific legal problem, readers are urged to seek advice from an attorney.