 | | | OBRA: Frequently Asked Questions
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1) What is OBRA? |
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OBRA is a federal law allowing an employee to continue health insurance coverage for 11 months after COBRA ends. OBRA coverage applies to individuals eligible for a Social Security disability program. Note : Previously, an individual would utilize OBRA after COBRA coverage ends. However, for qualifying events occurring on or after January 1, 2003, Assembly Bill No. 1401 extends COBRA coverage by an additional 18 months giving individuals 36 months of coverage or until Medicare eligible. With AB 1401 the individual continues to pay 102% of the premium payment, rather than 150% with OBRA. But, OBRA provides coverage to individuals who have self-insured trusts or live outside of California. |
2) Is OBRA health coverage? |
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No. OBRA is not health coverage. OBRA is health coverage protection that allows employer-sponsored group health coverage to continue uninterrupted until you become eligible for Medicare. |
3) Who is eligible for OBRA? |
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OBRA is for people who use COBRA and have left the workforce due to a disability. You are eligible for OBRA if: - The reason you elected COBRA was due to a disability that Social Security determines to have started within 60 days of filing for COBRA; and
- You provide proof to your former employer or COBRA administrator within 60 days of receiving your Social Security disability approval letter.
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4) What is a COBRA administrator? |
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This may be your previous employer or a company that your previous employer has chosen to process COBRA/OBRA premiums. |
5) What does the OBRA law provide and how long does it last? |
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OBRA requires that eligible employees receive the same health insurance benefits that the employer provides to the current work force. You can use OBRA to continue your employer-sponsored health coverage for a maximum of 11 months as an "employee." As a former employee you are responsible for paying 150% of the total health insurance premium. This includes the portion of premium the employer may have been paying for you. |
6) Who pays for OBRA? |
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You are responsible for paying 150% of the total health insurance premium. This includes the portion of the premium that your former employer may have been paying. |
7) To whom do I submit proof of Social Security approved disability? |
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The proof of your Social Security approved disability should be submitted to the COBRA administrator. |
8) Are there any medical eligibility requirements for OBRA? |
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Yes. To be eligible for OBRA you must: |
9) Does what I have in the bank or what I own, such as a home or car, affect my eligibility for OBRA? |
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No. There are no limitations on what you own or have in the bank for OBRA protection. OBRA is a law that provides continuation of employer-sponsored group health coverage based on the Social Security Administration's (SSA) determination that you are disabled. |
10) How do I prepare to use OBRA protections? |
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To be eligible for OBRA you need to provide Social Security's award letter, as proof of disability, to the COBRA administrator within 60 days and before COBRA ends. In some cases this will be several months before COBRA ends. |
11) How do I apply for OBRA? |
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To apply for OBRA, submit a copy of your Social Security award letter, as proof of disability, to the COBRA administrator within 60 days of receiving the letter. Social Security approval will need to occur before COBRA expires. |
12) How soon will I be eligible for OBRA? |
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To use your health coverage without interruption submit a copy of your Social Security award letter within 60 days to the COBRA administrator. OBRA coverage will begin after you have exhausted COBRA. You can continue to use your health coverage through the 11 months of OBRA as long as you pay premiums and until you are eligible for Medicare. |
13) What happens if I miss the 60 day deadline to provide the Social Security award letter as proof of disability? |
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Note : Previously, an individual would utilize OBRA after COBRA. However, for qualifying events occurring on or after January 1, 2003, Assembly Bill No. 1401 extends COBRA coverage by an additional 18 months giving individuals 36 months of coverage or until Medicare eligible. With AB 1401 the individual continues to pay 102% of the premium payment, rather than 150% with OBRA. But, OBRA provides coverage to individuals who have self-insured trusts or live outside of California. |
14) What happens if my disability is approved after COBRA ends? |
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- You have had at least 18 months of previous group coverage;
- You are no longer eligible for COBRA and ineligible for any other health coverage, including Medi-Cal or Medicare; and
- The date your last coverage ended was less than 63 days ago.
Note : Previously, an individual would utilize OBRA after COBRA. However, for qualifying events occurring on or after January 1, 2003, Assembly Bill No. 1401 extends COBRA coverage by an additional 18 months giving individuals 36 months of coverage or until Medicare eligible. With AB 1401 the individual continues to pay 102% of the premium payment, rather than 150% with OBRA. But, OBRA provides coverage to individuals who have self-insured trusts or live outside of California. |
15) What happens if Social Security determines that I am not disabled? |
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- You have had at least 18 months of previous group coverage;
- You are no longer eligible for COBRA and not eligible for any other health coverage, including Medi-Cal or Medicare; and
- The date your last coverage ended was less than 63 days ago.
Note : Previously, an individual would utilize OBRA after COBRA. However, for qualifying events occurring on or after January 1, 2003, Assembly Bill No. 1401 extends COBRA coverage by an additional 18 months giving individuals 36 months of coverage or until Medicare eligible. With AB 1401 the individual continues to pay 102% of the premium payment, rather than 150% with OBRA. But, OBRA provides coverage to individuals who have self-insured trusts or live outside of California. |
16) Can I qualify for OBRA while I am eligible for Medi-Cal? |
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17) Can I qualify for OBRA while I am eligible for Medicare? |
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No. Once you are eligible for Medicare you will be unable to access ability OBRA protection. |
18) Should I deny myself Medicare to continue with OBRA? |
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No. You can lose OBRA protection due to Medicare eligibility, irregardless of whether you choose to use Medicare. If you choose not to use Medicare you will lose OBRA automatically. |
19) How do I stay enrolled in and eligible for OBRA? |
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To remain enrolled in OBRA pay your premiums regularly for 11 months or until you become Medicare eligible. If you fail to pay premiums your coverage will be cancelled. OBRA provides a 30 day grace period after cancellation of a policy for non-payment of premiums that is allowed once every 12 months. If payments are made within 30 days of cancellation, OBRA can be reinstated. |
20) Are there rules for immigrants to qualify for OBRA? |
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No. Immigration rules related to your legal residency status and whether you are legally allowed to work in California will be considered. |
21) What is the difference between COBRA, OBRA and Cal-COBRA? |
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COBRA is federal health coverage protection that requires employers of 20 or more employees to provide employees, and their dependants, the right to continue health insurance benefits when a qualifying event occurs. COBRA lasts for 18 months. OBRA is the federal law that allows an employee to continue health insurance benefits after COBRA, if he/she has elected COBRA coverage due to a Social Security approved disability. OBRA is an 11 month extension of COBRA. Cal-COBRA is California's health coverage protection that requires employers of 2 to 19 employees to provide employees, and their dependents, the right to continue health insurance benefits when a qualifying event occurs. Cal-COBRA protection can last for 29 months. |
22) What happens if I work while receiving benefits from OBRA? |
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