Most plan administrators know that the recipe for a group health plan’s COBRA obligation includes three ingredients – a qualifying event that occurs while the individual is covered by the plan that triggers a loss of such coverage.One of the more common qualifying events is a divorce or legal separation from the covered employee. In most cases, this is fairly straightforward in practice – for example, employee’s spouse is covered under the plan, employees gets a divorce and, as a result of the divorce, the spouse loses coverage, and so the plan is obligated to offer 36-months of COBRA coverage to the ex-spouse. This assumes, of course, that one of the parties notified the plan or COBRA administrator within 60 days of the date of the divorce or legal separation.
However, an employee’s separation or divorce is not always this straightforward in real life. ...
[Example]:
- Employee legally separates from his spouse in September 2013, but because the terms of the employee’s health plan do not provide for termination of coverage on legal separation, the spouse remains covered by the plan. No COBRA obligation here, because there’s been no loss of coverage
- Employee drops spouse from coverage during the annual open enrollment election period, effective January 1, 2014. Again, no COBRA obligation, because the loss of coverage arose due to the employee’s election during open enrollment, which is not a COBRA qualifying event
- The employee and spouse finalize their divorce on April 1, 2014, at which point the ex-spouse notifies the plan administrator of the divorce within 60 days and requests COBRA continuation coverage. Even though the ex-spouse was not covered by the plan at the time of the divorce, the plan will likely have an obligation to extend COBRA at this point under the “In Anticipation of Divorce” rule
The “In Anticipation of Divorce” rule is often a surprise to plan administrators. Under this rule, which is included in the COBRA regulations (but not the COBRA statute), a plan is required to make COBRA continuation coverage available to a spouse following a divorce – even if that spouse is not enrolled in the plan at the time of the divorce – if the spouse’s coverage was eliminated by the covered employee in anticipation of the divorce (or legal separation if the separation would trigger a loss of coverage under the terms of the plan).
... [T]he rule is difficult to administer because it requires the plan administrator to make a judgment call about why the employee dropped his or her spouse from coverage. Was it in anticipation of the divorce or legal separation? Or was it for another reason, such as the spouse getting a new job which offered her more affordable or more comprehensive health coverage?
[Recommendations]:
- ... Include information about the rule in your summary plan description and/or COBRA election materials
- If the employee’s rationale for dropping coverage is not entirely clear, then gather additional information from the employee or ex-spouse that will be helpful in making your determination
- If you conclude that coverage was cancelled for a reason other than the anticipated divorce, then document your decision, including the rationale behind your conclusion, in a memorandum that you file with your plan records
Also remember:
- The 36-month maximum COBRA coverage period starts to run from the date of the divorce, not the date of the termination of coverage. So, you are not required to cover claims incurred between the date the employee dropped the spouse’s coverage and the date of the divorce/legal separation....
