Is Dental Insurance Covered Under COBRA?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law that enables individuals to temporarily continue group health benefits provided by their employer’s plan. This continuation right extends to various types of health coverage, and dental insurance is generally included if it was part of the employer’s group health plan. COBRA aims to bridge gaps in coverage that might arise from certain life events, allowing individuals to maintain their existing health, dental, and vision benefits.

Understanding COBRA Eligibility for Dental Coverage

COBRA coverage for dental insurance applies if the dental plan was part of the employer’s group health plan and available to active employees. The law generally applies to private-sector employers and state or local governments that employed 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 towards this threshold.

Eligibility for COBRA dental coverage arises when a “qualifying event” occurs. Qualifying events for employees include termination of employment (other than for gross misconduct) or a reduction in work hours. For spouses and dependent children, events can include the covered employee’s death, divorce or legal separation, or the employee becoming entitled to Medicare. A child’s loss of dependent status, such as aging out, also constitutes a qualifying event. Only individuals covered by the group health plan on the day before the event are “qualified beneficiaries” eligible to elect COBRA.

The COBRA Enrollment Process for Dental Coverage

Following a qualifying event, the employer is generally responsible for notifying the plan administrator within 30 days if the event is the covered employee’s termination, reduction in hours, death, or Medicare entitlement. The plan administrator then has 14 days to provide the qualified beneficiary with a COBRA election notice. If the employer also serves as the plan administrator, they have up to 44 days from the qualifying event to issue this notice.

For other qualifying events, such as divorce, legal separation, or a child’s loss of dependent status, the qualified beneficiary is responsible for notifying the plan administrator. This notification must occur within 60 days after the qualifying event. Once the election notice is received, qualified beneficiaries have an election period of at least 60 days to choose whether to continue coverage. This 60-day period begins on the later of the date the election notice is furnished or the date coverage would otherwise be lost. Each qualified beneficiary, including spouses and dependent children, has an independent right to elect COBRA coverage.

Costs and Duration of COBRA Dental Coverage

COBRA dental coverage comes with a higher cost compared to what active employees pay. Qualified beneficiaries may be required to pay up to 102% of the total cost, which includes both the employer’s and employee’s share, plus a 2% administrative fee. The plan must allow at least 45 days after electing COBRA for the initial premium payment. Subsequent premium payments are subject to a minimum 30-day grace period, and failure to make timely payments can result in the termination of COBRA rights.

The duration of COBRA dental coverage is temporary and depends on the specific qualifying event. For events like termination of employment or reduction in hours, coverage generally lasts for 18 months.

If a qualified beneficiary is determined by the Social Security Administration to be disabled within the first 60 days of COBRA coverage, all qualified beneficiaries may be eligible for an 11-month extension, totaling 29 months of coverage. A second qualifying event, such as the death of the covered employee, divorce, legal separation, or a child’s loss of dependent status, can extend coverage for affected beneficiaries to a total of 36 months from the date of the original qualifying event. COBRA coverage can also terminate early for reasons such as failure to pay premiums, the employer ceasing to maintain any group health plan, or the qualified beneficiary becoming covered under another group health plan.