Does COBRA Include Dental and Vision?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law providing temporary continuation of health coverage for individuals and their families who might otherwise lose it. This law applies when certain events lead to a loss of employer-sponsored group health benefits. A common question is whether dental and vision benefits are included in this coverage.

Understanding COBRA

COBRA provides a pathway for individuals to maintain health coverage after specific “qualifying events.” These events include job loss (voluntary or involuntary, excluding gross misconduct), a reduction in work hours, death of the covered employee, divorce or legal separation, or a dependent child ceasing to be a dependent. To be eligible, an individual must have been enrolled in the employer’s group health plan before the qualifying event.

The law applies to private-sector employers and state or local governments that sponsored a group health plan and had at least 20 employees on more than 50 percent of their typical business days in the previous calendar year. Both full-time and part-time employees are counted toward this threshold. Employers meeting these criteria are required to offer COBRA continuation coverage to eligible individuals.

Scope of COBRA Coverage

COBRA mandates that individuals can continue the same group health benefits they received as an active employee. If dental and/or vision coverage were part of the employer’s “group health plan” as defined by the Employee Retirement Income Security Act (ERISA), and were available to the employee and their family immediately before the qualifying event, then those benefits are included in the COBRA offering. A group health plan broadly covers medical care, which includes dental and vision care.

If dental or vision benefits were offered as part of this comprehensive plan, they are covered under COBRA. However, if dental or vision were offered via separate, standalone plans not considered part of the overall group health plan, their inclusion in COBRA depends on their specific structure and whether they independently qualify as group health plans under COBRA regulations.

Enrolling in Dental and Vision COBRA

The decision to elect COBRA coverage for dental and vision benefits is made as part of the overall COBRA election process. If these benefits were included in your employer’s group health plan, you receive an election notice detailing your options. This notice provides a period of at least 60 days to choose whether to elect continuation coverage.

If the original employer-sponsored plan allowed for separate elections of benefits (e.g., medical-only or medical plus dental), then COBRA offers similar choices. If dental and vision were bundled with medical coverage as a single offering, they remain bundled under COBRA. You cannot choose new coverage or switch to a different plan than the one you held prior to your qualifying event.

Financial Considerations for COBRA Coverage

Individuals electing COBRA coverage are responsible for paying the full premium for the benefits. This includes the portion previously paid by the employer and the employee, plus an administrative fee. The administrative fee can be up to 2% of the total premium. COBRA costs can therefore be up to 102% of the total cost of the plan.

This financial structure applies to dental and vision components if they are part of the elected COBRA package. The cost is higher than active employee premiums because the former employer is no longer contributing. Employers set premiums for a 12-month period, and plans must allow monthly payments if requested.