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Loss of Group Health Plan Coverage

  • A member enrolled in COBRA will be entitled to enroll the member’s spouse or dependent who was not enrolled in COBRA continuation coverage when the member initially enrolled in COBRA for the duration of the member’s COBRA coverage if the member’s dependent loses coverage under another group health plan and the member’s dependent qualifies for special enrollment. The conditions that must be met to qualify for special enrollment are summarized below:

 

  1. At the time member enrolled in the plan, the member’s dependent must have been eligible for coverage but was not enrolled in the plan;

 

  1. At the time the member’s dependent declined coverage under the plan they must have been covered under another group health plan or had other health insurance;

 

  1. The dependent must be enrolled within 31 days after the termination of their other coverage; and

 

  1. The dependent’s loss of coverage under the plan must be for reasons other than the failure to pay a premium or for termination as a result of fraud.

 

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