Continuation of Benefits Coverage (COBRA) - Massachusetts

Summary of differences between federal and state regulations

Massachusetts has laws governing continuation of benefits. Under Massachusetts law, when an plan participant is involuntarily laid off or dies, the coverage for the participant, his spouse, and dependents is to continue for 39 weeks from the date of termination or death, or until the participant, his spouse, and dependents become eligible for benefits under another group plan, whichever occurs first. (Chapter 175, §110G)

The plan participants may elect to continue participation in such plan by giving at least 30 days written notice thereof to the employer. (Chapter 175, §110G)

Plan participants are responsible for the payment of the whole premium, including any and all amounts normally paid by the employer as employee's benefits, to the employer or policyholder throughout the extension period. After timely receipt of the premium payment from the responsible individual, if the employer or policyholder fails to make payment to the insurer or hospital or medical service corporation with the result that coverage is terminated, the employer or policyholder shall be liable for benefits. (Chapter 175, §110G)

If an employee is terminated due to a plant closing or covered partial closing, coverage must continue for 90 days from the date of termination or until the employee and his dependents become eligible for benefits under another group plan, whichever comes first. In this situation, the plan participants and employer is responsible for the payment of their respective shares of the premium. Again, if the employer or policyholder fails to make payment to the insurer or hospital or medical service corporation with the result that the coverage is terminated, the employer or policyholder shall be liable for the benefits. (Chapter 175, §110G)

The employer or policyholder must notify the plan participants of their eligibility to participate in the above-mentioned plans. (Chapter 175, §110G)

If there is a contractual agreement arrived at by a collective bargaining process that contains provisions requiring an employer to pay for the continuation of such insurance for employees whose employment is terminated by a plant closing or covered partial closing, it supercedes the above requirements when the contractual agreement provides for at least three months or ninety days continuation of such insurance. (Chapter 175, §110G)

Former spouses must be and remain eligible for benefits, notwithstanding the effective date of the plan, without additional premium or examination. This eligibility continues until the former spouse is remarried. Upon remarriage, the former spouse has the right, if so provided in the judgment, to continue to receive benefits by means of an additional rider to the family plan or the issuance of an individual plan, either of which may be at additional premium rates. (Chapter 175, §110I)

If you are a small company (those that, during at least 50 percent of the working days, had 50 or fewer eligible employees), coverage must extend for at least the period beginning on the date of the qualifying event and ending not earlier than the earliest of the following:

• If the employee was terminated (for reasons other than the employee's gross misconduct) or had a reduction of hours, 18 months after the termination or reduction of hours;
• If a qualifying event, (other than bankruptcy) occurs during the 18 months after termination or reduction of hours, coverage continues for 36 months after the termination or reduction of hours;
• If the qualifying event is bankruptcy proceedings, the date of the death of the former employee or qualified beneficiary or in the case of the surviving spouse or dependent children of the former employee, 36 months after the date of the death of the covered employee;
• If the qualifying event is death of employee, divorce, Social Security eligibility, or a dependent no longer being a dependent, 36 months after the date of the qualifying event;
• If a qualified beneficiary is disabled at the time of a qualifying event, the 18 months of coverage continuation may be extended to 29 months, but only if the qualified beneficiary has provided notice of the disability before the end of the 18 months;
• If a plan participant becomes eligible for benefits under title XVIII of the Social Security Act, without regard to whether such event is a qualifying event, the period of coverage for qualified beneficiaries other than the former employee can not terminate before the close of the 36-month period beginning on the date the covered employee becomes entitled to benefits under title XVIII of the Social Security Act;
• The date on which the carrier ceases to provide a health benefit plan to other similarly situated eligible employees of the eligible small business which formerly employed the qualified beneficiary;
• The date on which coverage ceases by reason of a failure to make timely payment;
• The date on which the qualified beneficiary first becomes covered under any other health benefit plan, or entitled to benefits under Title XVIII of the Social Security Act; or
• If a qualified beneficiary who is disabled at the time of a termination or reduction of hours, the month that begins more than 30 days after the date of the final determination that the qualified beneficiary is no longer disabled.

Qualifying events include the following:

• The death of the eligible employee;
• The termination, other than by reason of such employee's gross misconduct, or reduction of hours, of the eligible employee's employment;
• The divorce or legal separation of the eligible employee from the employee's spouse;
• The eligible employee becoming entitled to benefits under title XVIII of the Social Security Act;
• A dependent child ceasing to be a dependent child under the generally applicable requirements of the health benefit plan;
• A proceeding in a case under Title 11, United States Code, with respect to the employer from whose employment the eligible employee retired at any time.

(Chapter 176J, §9)

State

  Contact

Massachusetts Division of Insurance

Regulations

General Laws of Massachusetts

Part I, Title XXII, Chapter 175:§110G, and §110I

Chapter 176J: §9

Federal

Contact

Employee Benefits Security Administration (EBSA)

Regulations

26 CFR 54.4980B-1 et seq.