This is a federal law that allows a disabled employee to continue health coverage after COBRA ends. OBRA coverage usually applies to individuals eligible for a Social Security disability program.

HISTORY

Congress passed the Omnibus Budget Reconciliation Act (OBRA) health coverage legislation in 1989. This law allows individuals who are considered disabled by Social Security the right to extend health coverage beyond COBRA provisions.

ELIGIBILITY

To be OBRA-eligible, the individual must be determined by Social Security to be disabled within certain timelines:

• The individual's Social Security award (SSI/SSDI) letter must indicate that the disability began (disability onset date) within 60 days of the qualifying event, and
• The individual must provide a copy of the Social Security award (approval) letter to his or her employer (COBRA administrator) within 60 days of its receipt.

BENEFIT

OBRA can last a maximum of 11 months. Most health insurance policies terminate at the eligibility date for Medicare, which may come sooner than the 11 months.

The employee is responsible for paying up to 150% of the total health insurance premium, including the portion of the premium the employer may have been previously paying.

Medicare eligibility begins in the 30th month of a Social Security approved disability. If an individual accesses COBRA and OBRA, there will be no gaps in coverage until Medicare begins.

COBRA (18 months) + OBRA (11 months) = 29 months

OBRA requires that eligible employees receive the same health coverage benefits that the employer provides to the current workforce.

For qualifying events occurring on or after January 1, 2003, Assembly Bill No. 1401 extends COBRA coverage by an additional 18 months, giving individuals a total of 36 months of coverage or until Medicare eligible.

OBRA may provide continuation of coverage to individuals who have self-insured trusts/self-funded plans or live outside of California.

ADDITIONAL INFORMATION

While covered under OBRA, benefits, premiums, or insurance carriers are subject to change if changes are made to the employer's group health insurance plan for the current work force.

If certain financial eligibility and or disability criteria are met, the Comprehensive AIDS Resources Emergency Health Insurance Premium Payment program (CARE/HIPP) or Medi-Cal/Health Insurance Premium Payment (Medi-Cal/HIPP) may cover the individual’s COBRA premium payments.