Continuing Health Care Coverage through COBRA
A federal law called the Consolidated Omnibus Budget Reconciliation Act (COBRA) enables a participant and the participant's covered dependents to continue health insurance if coverage ceases due to a reduction of work hours or termination of employment (other than for gross misconduct). Federal law also enables a participant's dependents to continue health insurance if their coverage stops due to the participant's death or entitlement to Medicare; divorce; legal separation; or when the child no longer qualifies as an eligible dependent. The participant must elect coverage according to the rules of the SAIC health care plans. Continuation is subject to federal law, regulations, and interpretations.
In accordance with COBRA, a participant and his or her family have some important rights concerning the continuation of group health care benefits if that coverage ceases.
Some state laws may offer additional COBRA benefits. For more information, review the insured plan's Evidence of Coverage booklet.
On This Page:
Who Is Eligible for COBRA*
- A covered participant who loses coverage due to termination (other than termination for gross misconduct) or reduction in work hours. Termination includes voluntarily quitting, layoff, and lack of work due to a work location closure.
- The spouse and/or dependent children of a covered participant who are covered under the plan and who lose coverage as a result of any of the following qualifying events:
- The death of a covered employee;
- The termination of a covered employee (excluding termination due to gross misconduct);
- The divorce or legal separation of the covered employee from his or her spouse;
- A dependent's ceasing to qualify as a "dependent child" under the terms of the plan; or
- The covered employee's becoming entitled to Medicare benefits.
*Domestic Partners are excluded from the legal definition of qualified beneficiary under federal COBRA law and are thereby ineligible for continuing SAIC health insurance coverage via COBRA.
How to Continue Coverage Through COBRA
To continue coverage, it is the participant's (or a family member's) responsibility to notify the Benefits POC within 31 days of a divorce, legal separation, or child's losing dependent status.
How Long COBRA Coverage May Last
The coverage period begins on the date of the qualifying event and ends upon the earliest of the following:
- 18 months in the case of termination of employment, layoff, or work force reduction;
- 24 months in the case of military leave of absence;
- 29 months in the event of a disability, according to Social Security;
- 36 months in the event of legal separation, divorce or death of the employee;
- 36 months in the event of all other qualifying events;
- Failure to pay any required premium when due;
- The date a covered participant, under the continuation program, becomes covered under another group plan or Medicare — one that does not impose any pre-existing condition limitations on the coverage; or
- The date that SAIC no longer provides a group medical plan to any of its employees.
The participant must apply for this coverage continuation within 60 days from the date the participant's SAIC medical coverage terminates or the date of notification, whichever is later. The participant then has 45 days from the date he or she elected continued coverage to pay all of the premiums back to the date he or she would have lost plan coverage. The participant will be charged the plan's full cost of providing a continued coverage, plus an additional 2% administrative fee (102% of the premium). If the participant wants to continue coverage through COBRA, please contact the number indicated on the notification letter, or, if eligible due to divorce, legal separation, or loss of dependent status, contact the Benefits POC for information and forms.
To be eligible for the additional 11 months coverage due to disability, the participant must provide the Plan Administrator with: a Social Security Disability Award (SSDI) during the first 18 months of COBRA indicating the onset of the disability was within 60 days of losing coverage; and the Plan Administrator is informed of that within 60 days of receipt of the Notice of Award letter from Social Security by receiving a copy of that letter. A participant who qualifies for the disability extension will be charged the plan's full cost of providing a continued coverage, plus an additional 50% administrative fee (150% of the premium).
Remember: Participants must apply for continuation of coverage under COBRA within 60 days after receiving COBRA notification and enrollment information.
The following table summarizes COBRA benefits under the SAIC health care plans:
| THE SITUATION: | OBTAINING INFORMATION: | WHO CAN BE COVERED: | HOW LONG COVERAGE CAN LAST: |
|---|---|---|---|
| The participant's employment with SAIC is terminated for reasons other than gross misconduct | It will be sent to the participant automatically by SAIC's COBRA administrator | The participant and the participant's dependents | 18 months |
| There is a reduction in the participant's work hours to the point where the participant no longer qualifies for benefits coverage | It will be sent to the participant automatically by SAIC's COBRA administrator | The participant and the participant's dependents | 18 months |
| The participant begins a military leave of absence | The participant must notify the group Human Resources/Benefits POC; forms sent upon notice of ineligibility | The participant and the participant's dependents | 24 months |
| The participant is disabled according to Social Security | The participant must notify by SAIC's COBRA administrator | The participant and the participant's dependents | 29 months |
| The participant dies | It will be sent to the covered dependents automatically by SAIC's COBRA administrator | The participant's currently covered dependents | 36 months |
| The participant becomes divorced or legally separated | The participant must notify the group Human Resources/Benefits POC; forms sent upon notice of ineligibility by SAIC's COBRA administrator | The participant's former spouse | 36 months |
| The participant's dependent reaches age 25 | The participant must notify the group Human Resources/Benefits POC; forms sent upon notice of ineligibility | The participant's dependent | 36 months |
| The participant's child loses eligibility status (e.g., dependent reaches age 19 or is no longer a student) | It will be sent automatically upon notice to SAIC of ineligibility by SAIC's COBRA administrator | The participant's dependent | 36 months |
Participants that lose health coverage as a result of an Open Enrollment action will not receive COBRA information.