Continuation Coverage

• Your employee loses his or her job.
• Your employee experiences a reduction in hours that results in a loss of group health coverage.
• Your employee becomes eligible for Medicare and loses group health coverage but other members of his or her family still need insurance.
• Your employee divorces, legally separates or dies and his or her spouse and/or children need insurance.
• When a dependent child of your employee turns 26 and loses his or her dependent status.

As your insurer, Samaritan Health Plans will administer state continuation coverage under ORS 743.610. We will be responsible for sending all required notices to employees, providing any required forms or documents, and answering member questions about eligibility, enrollment, benefits and claims.

As the employer, you will answer questions about premium payments. At the beginning of each calendar year, Samaritan Health Plans will request you provide the date by which payment must be made and the manner in which payment must be provided. We will include this information on a premium rate sheet that will be sent to employees in their election packet. They will receive an election packet within 10 days after we receive notification from you or the employee that they have experienced an event that resulted in a loss of group health coverage.

Federal law requires you, as the plan sponsor/employer, (or the plan administer you have designated), to administer COBRA continuation coverage. There are extensive rules that require the plan sponsor to accurately follow eligibility criteria, send required notices and procedures, and meet specific timeframes and deadlines. Carefully tracking all COBRA implementation activities (for auditing purposes) and following all other additional requirements described in federal law makes COBRA administration complex. Federal oversight of COBRA is performed by powerful regulatory agencies, including the US Department of Labor (DOL), the Internal Revenue Service (IRS) and the US Department of Health and Humans Services (DHHS). Administration that is not compliant with federal rules puts you at risk for fines or litigation.

Samaritan Health Plans will enroll the spouse and/or dependents in COBRA continuation coverage after receiving notification from you of their election. Questions about enrollment, benefits and claims will continue to be answered by Samaritan Health Plans.

Qualifying events are specific situations that happen to a covered employee, spouse and/or dependent that result in a loss of group health coverage. Qualifying events include:

• Termination or reduction in hours of a covered employee for reasons other than gross misconduct.
• Death of a covered employee. 
• A covered employee becoming entitled to Medicare. 
• Divorce or legal separation of a covered employee and spouse. 
• A child’s loss of dependent status under the plan.  

Qualifying events occur while the employee/covered dependents are still receiving group health coverage. Second qualifying events occur after the employee/qualified beneficiaries are receiving COBRA continuation coverage.

It is the responsibility of the employee, spouse and/or dependent to report a divorce, legal separation or a child’s loss of dependent status to you or your plan administrator within the required time frame. Termination/reduction in hours, death, or entitlement to Medicare must be reported to the plan administrator (if one was designated) by the employer within 30 days of the event.