1. Who is eligible for continuation?
Your COBRA continuation rights are described in the Federal/State Notifications section online. Both you and your dependents should take the time to read that section carefully. This section provides additional information about continuation coverage.
You do not have to provide evidence of insurability to enroll in continuation coverage. However, coverage is limited to the plan you had as an active employee or covered dependent. (For example, if you change plans January 1 and your dependent loses eligibility December 31, that dependent would be eligible for COBRA from the plan you were enrolled in on December 31. An exception is made when the participant resides in a county that does not include a primary care physician for the subscriber's plan at the time continuation is elected. In that case, the participant may elect a different plan that is offered in the county where the participant resides.) You may select another plan during the annual open enrollment period or if you move. If family coverage is in effect when continuation is first offered, each dependent may independently elect individual continuation coverage. A family of two may select two individual contracts at a lower cost than the premium for a family contract. The health plan will bill you directly.
There can be no lapse in coverage, so multiple premiums may be required.
If you terminate employment and are ineligible for an annuity, you will be offered an 18-month continuation coverage period. A second qualifying event while on continuation will not serve to extend your period of continuation. Coverage will be limited to the original time period. The only exception is if you are found to be disabled by the Social Security Administration (SSA). Then, you may be able to extend your coverage from 18 up to 29 months. You must notify ETF within 60 days of the date SSA issues their decision. At the end of the continuation period you will be allowed to enroll in a Marketplace or an individual conversion plan through the health plan.
2. When my dependent loses eligibility is he/she eligible for COBRA? What do I need to do to ensure COBRA coverage is offered?
You will need to report this change to your benefits/payroll/personnel office (or ETF for retirees and continuants) within 60 days of your dependent losing his/her eligibility to ensure COBRA coverage is offered. Your dependent will be entitled up to 36 months of continuation coverage.
3. Does my coverage change under continuation?
No, continuation coverage is identical to the active employee coverage. In most cases, you are eligible to maintain continuation coverage for 18 months from the month of the qualifying event. These events are termination of employment or reduction in work hours. Events such as death of employee, divorce or the loss of eligibility for a dependent child entitles the dependent to 36 months of coverage. Employees who are found to be disabled by the Social Security Administration (SSA) may have coverage for up to 29 months. You must notify ETF of SSA's decision.
You are allowed to change plans during the annual open enrollment period or if the subscriber moves. However, your continuation coverage may be cut short for any of the following reasons:
- The premium for your continuation coverage is not paid when due.
- You or a covered family member become covered under another group health plan that does not have a preexisting conditions clause that applies to you or your covered family member.
- You were divorced from an insured employee, and you subsequently remarry and are insured through your new spouse's group health plan.
- You or a covered family member become entitled to Medicare benefits.
If you or your covered dependent becomes eligible for Medicare, you may need to enroll in Medicare as soon as you are eligible. (See Question: When Must I Apply for Medicare?)
4. Will my premium change under continuation?
It may change, as you will pay the total premium amount, which includes both the employee and employer share. Contact your benefits/payroll/personnel office to obtain the total amount.
5. How do I cancel continuation coverage?
To cancel continuation coverage, send a signed, written notice to ETF. Include your name, Social Security number, birth date and address. ETF will forward your request to the health plan. Your coverage will be canceled at the end of the month in which ETF receives the request to cancel coverage.
6. How is my continuation coverage affected if I move?
If you move (either permanently or temporarily for three months or more), you are eligible to change plans. (See Question: What if I have a temporary or permanent move from the service area?)
Your application to change plans must be postmarked within 30 days after your move. Because you are on continuation coverage, call ETF at 1-877-533-5020 or download a Health Insurance Application/Change (ET-2301) form. Complete and submit the application to: Department of Employee Trust Funds, P. O. Box 7931, Madison, WI 53707-7931.
7. When is Marketplace or conversion coverage available?
As required by law, you are eligible to apply for Marketplace or conversion coverage when group continuation coverage terminates. Contact the plan directly to make application for coverage. Marketplace or conversion coverage is available without a waiting period for preexisting conditions. The coverage and premium amount may vary greatly from plan to plan.
If the health plan automatically bills you for coverage that you do not want, simply do not pay the premium for the coverage.
If you reside outside of the Local Health Plan service area at the time you apply for Marketplace or conversion coverage, you may only be eligible for an out-of-area policy through another insurance carrier. The benefits and rates of the plan are subject to the regulations in effect in the state in which you reside.
The Marketplace or conversion privilege is also available to dependents when they cease to be eligible under the subscriber's family contract. The request for Marketplace or conversion coverage must be received by the plan within 30 days after termination of group coverage. If you have questions, write or call the plan in which you are enrolled.
8. I'm covered under COBRA through my spouse. When COBRA ends, can I enroll in the State of Wisconsin Group Health Insurance Program?
No. The loss of COBRA is not a qualifying life event to permit you to enroll. For information about when you can enroll outside of the annual open enrollment period, see the Life Events Guide.