Is Dental Insurance Covered Under COBRA?

Losing employer-sponsored health coverage can create uncertainty, especially regarding dental care. Individuals often wonder how to maintain access to their dental providers and services after employment changes or other life events. Understanding benefit continuation options is important for uninterrupted access to necessary healthcare.

COBRA’s Scope for Dental Benefits

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law that allows individuals to temporarily continue their group health coverage, including dental benefits, if they were part of their employer’s plan. COBRA is not a separate insurance plan; instead, it provides the right to continue the exact same group health plan coverage previously held through an employer. If an employer offered a dental plan, it is included as part of the COBRA continuation option.

COBRA applies to most private sector businesses with 20 or more employees, as well as state and local governments. If dental coverage was part of the benefits package provided by the employer, it can be continued under COBRA. This includes access to the same network of dental providers and the same benefit structure, such as annual maximums and deductibles.

Determining Eligibility for COBRA Dental

Eligibility for COBRA dental coverage depends on specific conditions related to the loss of group health plan coverage. An individual must have been covered under the employer’s group dental plan at the time of a “qualifying event.” These events trigger the right to elect COBRA and include voluntary or involuntary job loss (except for gross misconduct), reduction in work hours, death of the covered employee, divorce or legal separation from the covered employee, or a dependent child losing eligibility.

Individuals who can elect COBRA coverage are known as “qualified beneficiaries.” This group includes the employee, their spouse, former spouses, and dependent children who were covered under the plan before the qualifying event. The loss of coverage must be due to a qualifying event, and the individual must have been enrolled in the employer’s health plan.

Cost and Duration of COBRA Dental Coverage

Individuals electing COBRA dental coverage are responsible for the full premium cost. This includes both the portion the employee previously paid and the portion the employer contributed, plus an administrative fee of up to 2% of the premium. The total cost can be significantly higher than what employees paid while actively employed because the employer no longer subsidizes a portion of the premium.

The duration of COBRA coverage varies depending on the type of qualifying event. For most events, such as job loss or reduction in hours, coverage lasts for 18 months. However, certain qualifying events, like the death of the covered employee, divorce, or a dependent child losing eligibility, can allow for up to 36 months of coverage for spouses and dependent children. In specific circumstances, such as a qualified beneficiary being determined disabled, the 18-month period may be extended to 29 months.

Electing and Maintaining COBRA Dental Coverage

Following a qualifying event, the plan administrator is required to provide an election notice to eligible individuals. This notice describes the right to continuation coverage and explains how to make an election. The employer has 30 days to notify the plan administrator of the qualifying event, and the administrator then has 14 days to send the election notice.

Qualified beneficiaries have an election period of at least 60 days to choose whether to enroll in COBRA coverage. This 60-day period begins from the later of the date coverage was lost or the date the election notice was provided. If COBRA is elected, coverage is retroactive to the date of the qualifying event, provided premiums are paid. Timely payment of these premiums is necessary to avoid termination of coverage.