The Consolidated Omnibus Budget Reconciliation Act, COBRA, provides workers and their families the right to continue with employer provided health insurance when they leave their jobs. Job loss can be voluntary or involuntary for workers to be allowed to continue the group healthcare plan. Workers must pay for the entire premium, which still often is less than individual insurance. Former employees can maintain the coverage for up to 18 months under the COBRA laws, which cover a variety of lines of insurance.
Hospitalization
Under COBRA, employees are provided with access to the same benefits they had before they left the job. Hospitalization is covered at the same rate as the employee plan covered. All deductibles that were in place for the employee while at work are still in force. Hospitalization plans that cover only approved providers continue to allow only those providers as the employee was allowed to see prior to electing COBRA coverage. Patients must receive prior approval for medical procedures if that was a provision of the previous plan.
Doctor Care
Surgery and other physician medical services are typically covered under a COBRA plan. Coverage includes physician costs at the same rate as previously covered. Inpatient and outpatient doctor charges are covered with the same co-payments that were in place from the employer-provided insurance. COBRA is available for health maintenance organizations (HMOs), preferred provider organizations (PPOs) and pay as you go plans that were provided by the employer. COBRA recipients must continue to visit network doctors if the previous plan included approved provider lists.
Dental
Employers with 20 or more employees that offered health insurance coverage as part of a benefits package must offer all of the same coverage to COBRA recipients as are offered to employees, including dental care. Limitations that applied to the previous plan remain in force. Most dental insurance plans do not cover cosmetic dental services that continue to be disallowed under COBRA. Annual maximum payments, common in dental plans, still apply.
Vision
Vision plans must be offered to COBRA recipients if the benefit was included in an employee plan. The same level of benefits that covered eye exams, contact lenses and prescription eyeglasses must be offered in the package of benefits. Vision and dental plans usually carry additional premiums that the former employee may choose to carry or not. COBRA is a voluntary program meant to protect workers from losing important benefits during times of transition. Former employees do not have to continue with vision coverage even though they elect to continue with medical coverage if it is a separate policy.
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