Continuation of Benefits Coverage (COBRA) - Tennessee

Summary of differences between federal and state regulations

Federal COBRA applies to employers who offer group health plans, and have 20 or more employees, but state laws may also apply. Under the Tennessee law all employers are covered. Tennessee law also has the following provisions:

• A group policy that provides hospital, surgical, or major medical insurance, but not one which provides benefits only for specific diseases or accidental injuries, shall provide for continuation coverage for an employee or member whose insurance discontinues for any reason except the discontinuance of the group policy in its entirety.
• Eligible employees will have been insured continuously under the policy for at least three months prior to the termination and will be entitled to coverage for the fractional policy month remaining at termination plus 3 additional months with payment of the full premium in advance to the employer. At the end of the continuation period, the individual is entitled to receive a policy of health insurance issued by the insurer.
• If the group policy was terminated in its entirety, members are not eligible for continuation, but the employee may have a right of conversion.
• There will be no continuation or conversion right available for an individual who fails to make premium payments, if the employee is eligible for Medicare, or if group coverage is replaced by similar group coverage within 31 days.
• In the case of loss of coverage due to divorce or death of insured spouse, coverage may continue for the affected beneficiary(ies) for the fractional policy month remaining and an additional period of up to 15 months upon payment to the employer in advance of the full premium in three-month increments.
• Individuals whose group coverage is terminated during pregnancy shall be entitled to have their coverage continued under the group policy for the fractional month remaining at termination plus a period of not less than six (6) months after the pregnancy ends and not more than the end of the second three-month period following the three-month period within which the pregnancy ends.  §56-7-2312

Policy Conversion: Issuance of a converted policy shall be subject to the following conditions:  Written application for the converted policy shall be made and the first premium paid to the insurer not later than thirty-one (31) days after termination under the group policy; the converted policy shall be issued without evidence of insurability; the initial premium for the converted policy for the first twelve (12) months and subsequent renewal premiums shall be determined in accordance with the insurer's table of premium rates applicable to the age and class of risk of each person to be covered under the converted policy and to the type and amount of insurance provided; the effective date of the converted policy shall be the day following the termination of insurance under the group policy; and  the converted policy shall cover the employee or member and such person's dependents who were covered by the group policy on the date of termination of insurance. §56-7-2313

State

Contact

Tennessee Department of Commerce and Insurance

Regulations

Tennessee Code, Title 56, Chapter 7, Part 23, §56-7-2312 Continuation of terminated group coverage - Conversion

http://www.lexisnexis.com/hottopics/tncode/

Federal

Contact

Employee Benefits Security Administration (EBSA)

Regulations

26 CFR 54.4980B-1 et seq.