how does cobra insurance work in florida

COBRA Insurance: How Does It Work In Florida?

Florida employees that receive group health benefits through their employer may have the option to continue coverage after employment ends with Florida COBRA insurance.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) was passed by Congress in 1985, going into effect the following year. The act enables workers and their families to continue their health benefits under their former employer’s group health plan. Coverage only lasts, however, for a specified amount of time after employment terminates.

You may have questions like who is eligible for COBRA insurance in Florida? What does it cover? How do I make payments or how much does it cost? Plus, you should know what to do if you’ve been wrongfully terminated or retaliated against resulting in the unfair denial of health benefits. It’s also important to understand the COBRA election notice you receive so you can elect COBRA if you want to.

What You Should Know About COBRA Insurance in Florida

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Florida COBRA insurance isn’t much different from other states. If you were a full-time or part-time employee, you should be eligible to receive Florida COBRA healthcare coverage. Keep in mind that your eligibility must also meet other criteria such as plan coverage, qualifying events, and eligible beneficiaries. Under the U.S. Department of Labor (DOL) guidelines, an employer must have 20 or more employees in its group health plan. Those individuals must also be on that plan for 50% or more of a normal workday during the prior calendar year for the employer to offer COBRA coverage.

For an employee to be considered a “qualifying beneficiary,” the employer’s group health plan must previously have covered the individual (or spouse/partner or dependent child) before employment ended. The employee must also have a “qualifying event” that would have been the reason he or she lost health insurance coverage.

Individuals Eligible for Florida COBRA Insurance

COBRA allows employees to continue coverage for themselves, their spouses, former spouses, and dependent children if they lose group health coverage due to events like terminating employment. Often those participants who chose COBRA pay higher amounts than they might under a traditional individual health plan, and the main reason is that the employee must pay the full price for the COBRA health insurance coverage.

To elect COBRA insurance in Florida, an individual must experience one of the following:

  • Quit their job.
  • Be fired unless it was due to “gross misconduct.”
  • Have their hours reduced, and they no longer qualify for their employer’s health plan because they are no longer considered “full time.”
  • Retire.

Under Florida COBRA insurance, employees can continue their healthcare coverage for a minimum of 18 months, while their spouses and children may receive coverage for up to three years. Dependents may continue COBRA coverage for any of the following reasons:

  • They get divorced or legally separated from their covered spouse.
  • Their covered spouse or parent died.
  • The child of a covered employee turns 25 and is no longer eligible to be on his or her parent’s plan.
  • The covered employee goes on Medicare.

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How to Elect COBRA Insurance in Florida

Once a plan administrator is notified, they have 14 days to send the information on how to elect COBRA insurance. Under federal law, it’s the duty of the plan administrator to send the COBRA election notice documents to the former employee and their dependents by the deadline. Not doing so could result in monetary damages of up to $110 per day for each violation from the date the notice was supposed to be sent, in addition to attorney’s fees and costs.

Health insurance application on tablet

The former employee and his or her family then have 60 days to decide whether to continue with the coverage, but it’s not necessary for the entire family to elect COBRA insurance. It’s possible to change your mind about selecting it if it’s within the 60-day election period, and coverage can be canceled at any time. The former employee and his or her dependents are not required to carry it for the full 18 months.

Once Florida COBRA insurance is elected, the former employee notifies the plan administrator. The plan administrator is required by law to provide copies of the plan documents within 14 days or face the possibility of fines or other damages. As the former employee, it’s your responsibility to pay the health insurance premiums, and once the election forms are completed, the first premium payment is due within 45 days of the election date.

What is the Cost of COBRA Insurance?

Employees who are eligible for COBRA insurance are required to pay monthly premiums, which the employer is required to set out in the notice. Employers sometimes try to discourage former employees from electing COBRA in an effort to save money.

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Employees must also pay a two percent service charge to the insurer. To determine the monthly premium cost, contact your former employer’s Plan Administrator.

Some COBRA plans give a 30-day grace period and different payment options such as conversion plans, extensions, and disability considerations. Depending on your annual income per your income tax return, you may be eligible for a COBRA provision that offers a 65% federal subsidy for up to 15 months.

Benefits Covered Under COBRA Health Insurance

Once you choose continuation coverage under COBRA, it’s required that you’re given the same coverage that a plan offers to active employees and their families. The same rules apply as when you were an employee, such as co-payment requirements and deductibles. In addition to the same benefits, you have the right to choose between available coverages during open enrollment season as current employees and their beneficiaries.

Advantages of Choosing COBRA Insurance in Florida

Pharmacist and client at pharmacy

While COBRA may cost money, it’s better than going without health insurance. It’s especially helpful for those with existing health issues that may prevent them from qualifying for an individual policy – or if you do find a policy, the rates may be extremely high. If you have a coverage lapse plus a preexisting condition, you could face higher premiums than most.

Reasons Your COBRA Insurance in Florida May Be Terminated

Now that you know the basics of COBRA insurance in Florida, it’s important to be aware of the ways in which you can lose coverage. Scenarios can include:

  • The employer fails to keep any group health plan.
  • Premiums are not paid when due.
  • The employee enrolls for Medicare benefits after choosing COBRA health insurance coverage.
  • An employee begins coverage under a new employer group health plan before choosing continuation coverage, providing the new plan doesn’t force an exclusion or limitation concerning a preexisting condition of the qualified beneficiary.
  • An employee participates in fraudulent activities that justify the plan terminating coverage of a current participant or beneficiary.

What Should You Do If Your Employer Denies Your Florida COBRA Insurance Benefits?

If your former employer denies you COBRA benefits due to wrongful termination or retaliation, it’s in your best interest to contact an employment law attorney. While COBRA statute and case laws haven’t established a standard definition of “gross misconduct,” employers who choose to deny their former employees coverage based on misconduct must consider the following:

  • There must be a connection between the employee’s offense and their job.
  • The employee needs to understand the seriousness of the misconduct.
  • The offense must be willful.
  • If the employee chooses to challenge the denial of Florida COBRA insurance, it’s in the employer’s best interest to determine whether the cost of a potential lawsuit is worth it compared to offering COBRA coverage to the employee.

Because there isn’t a clear definition of “gross misconduct,” as defined by COBRA law, courts have differed widely on their decisions. Therefore, denying an employee COBRA coverage because of misconduct can result in a higher than average risk of litigation for the employer.

Get the Insurance You Deserve

If you find COBRA to be confusing, or if you believe you’re unfairly denied coverage, or if you have any questions or concerns about the election notice you received, speak with an employment law attorney at Wenzel Fenton Cabassa, P.A. today.

Our Florida COBRA rights attorneys have handled thousands of workplace rights cases, just like yours, and can help you preserve your rights and get the insurance you deserve.

Please Note: At the time this article was written, the information contained within it was current based on the prevailing law at the time. Laws and precedents are subject to change, so this information may not be up to date. Always speak with a law firm regarding any legal situation to get the most current information available.



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