Notices, deadlines and the penalties for missing them.
Esshaki Legal Media TeamCurrent as of April 2022
Group health coverage must be offered to qualified beneficiaries after certain
qualifying events, for defined periods.
Qualifying events. Termination other than for gross misconduct, reduction in
hours, death, divorce or legal separation, a dependent ceasing to qualify, and
for some plans the employer’s bankruptcy.
Notice chain. A general notice on becoming covered; the employer’s notice to
the administrator of employment-related events within a short period; the
administrator’s election notice to beneficiaries; and the beneficiary’s election
within sixty days, with payment within forty-five days of election.
Duration. Eighteen months for employment-related events, extendable for
disability and for second qualifying events, and thirty-six months for others.
Cost. Up to the full premium plus an administrative percentage.
Penalties. Statutory per-day penalties for notice failures, plus liability
for medical claims that would have been covered. Notice failures are the most
common and most avoidable exposure.
State continuation laws extend similar rights to smaller employers not
covered federally.
In transactions. Which party retains the obligation for existing qualified
beneficiaries depends on the structure and on whether the seller maintains any
group health plan, and it should be allocated expressly in the agreement.