Continuation of Benefits Coverage (COBRA) - Utah

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 Utah law, if employees are not covered by federal COBRA, they are covered under Utah provisions. State law includes the following provisions:

• Coverage may be continued for up to six months. (§31A-22-722)
• Employees do not have the right to extend coverage if they failed to pay any required individual contribution; acquire other group coverage covering all preexisting conditions including maternity, if the coverage exists; perform an act or practice that constitutes fraud in connection with the coverage; made an intentional misrepresentation of material fact under the terms of the coverage; were terminated for gross misconduct; have not been continuously covered under a group policy for a period of six months immediately prior to the termination of the policy; or are eligible for any extension of coverage required by federal law. (§31A-22-722)
• Coverage may be terminated prior to six months if the terminated insured establishes residence outside of this state; moves out of the insurer's service area; fails to pay premiums or contributions in accordance with the terms of the policy, including any timeliness requirements; performs an act or practice that constitutes fraud in connection with the coverage; makes an intentional misrepresentation of material fact under the terms of the coverage; becomes eligible for similar coverage under another group policy; or if employer's coverage is terminated. (§31A-22-722)
• Continuation coverage applies to any spouse or dependent, including a surviving spouse or dependents whose coverage under the policy terminates by reason of the death of the employee or member. (§31A-22-722)
• The employer must provide written notification of the right to extend group coverage and the payment amounts required for extension of coverage, including the manner, place, and time in which the payments shall be made. The notification must be sent first class mail within 30 days after the termination date of the group coverage. (§31A-22-722)
• The premium amount for extended group coverage may not exceed 102 percent of the group rate. (§31A-22-722)
• Within 30 days of the insured's exhaustion of extension of coverage, the employer must provide the terminated insured and the ex-spouse, or, in the case of the death of the insured, the surviving spouse, or guardian of any dependents, written notification of the right to an individual conversion policy. (§31A-22-722)
• If the plan covers spouses, it must not termination of coverage of a spouse covered under the policy, except by entry of a valid decree of divorce or annulment between the parties. (§31A-22-612)

State

Contact

Utah Insurance Department

Regulations

This state has enacted provisions in response to the federal American Recovery and Reinvestment Act of 2009 (P.L. 111-5) in regard to COBRA continuation. See R590-253.

Utah Code, Title 31A – Insurance Code, §31A-22-722 Utah mini-COBRA benefits for employer group coverage

Utah Code, Title 31A – Insurance Code, §31A-22-612 Conversion privileges for insured former spouse

Federal

Contact

Employee Benefits Security Administration (EBSA)

Regulations

26 CFR 54.4980B-1 et seq.