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Federal COBRA law allows most former employees and eligible family members to continue health insurance coverage after the end of employment. The American Recovery and Reinvestment Act of 2009, as amended, established an employer-provided subsidy for health insurance and other medical-related insurance premiums for employees who were involuntarily terminated from employment between September 1, 2008 and May 31, 2010. These provisions also apply to an employee who had a reduction in hours that caused the employee to lose eligibility for health insurance at some time from September 1, 2008 through May 31, 2010 and the employee involuntarily terminated employment on or after March 2, 2010 and by May 31, 2010. An employee is this situation is eligible to enroll in COBRA coverage upon termination (even if the employee did not elect COBRA when eligibility was lost or elected COBRA but let it lapse) and may be eligible for COBRA premium assistance.

If eligible for COBRA premium assistance, the former employer pays up to 65% of the premium for health insurance and other medical-related insurance premiums for up to 15 months of COBRA coverage.

This program only applies to someone who involuntarily terminated employment on or before May 31, 2010. Anyone who terminates employment on or after June 1, 2010 is NOT eligible for any COBRA premium assistance under this program.

Eligibility Requirements and Insurance Premium Information

• Eligibility Requirements for COBRA Premium Assistance for Employees of UW System Institutions (Revised 4/19/10)
  
  
• 2011 Insurance Premium Rate Sheets for Employees Covered under the Wisconsin Retirement System (WRS) - includes health, dental and vision premiums
  
  
• 2011 Insurance Premium Rate Sheets for Employees Covered under the Graduate Assistant Health Insurance Plan (student assistants, employees-in-training, short-term academic staff)
  
  
• 2010 Insurance Premium Information for WRS-covered employees and employees covered under the Graduate Assistant Plan.
  
  
• 2009 Insurance Premium Information for WRS-covered employees and employees covered under the Graduate Assistant Plan.
  

Employee Forms

• Request for Treatment as an Assistance Eligible Individual - used by employees and/or their dependents to request treatment as an assistance eligible individual for COBRA premium assistance purposes. (Rev 4/20/10)
  
  
• State Group Health Insurance COBRA Continuation Form (ET-2311) - PDF or Word
  
  
• Anthem DentalBlue Dental Insurance Continuation Form with COBRA subsidy information (Rev 4/20/10)
  
  
• EPIC Dental & Excess Medical + EyeMed Vision Discount Continuation Form with COBRA subsidy information (Rev 4/20/10)
  
  
• VSP Vision Continuation Form with COBRA subsidy information (Rev 4/20/10)
  
  
• Participant Notification (UWS 92) - used by employees and/or their dependents to notify employer and health, dental and vision plans that they are no longer eligible for COBRA premium assistance due to eligibility for other group health insurance and/or Medicare. (Rev 12/23/09)

• Appeal Form - used to request review by Centers for Medicare and Medicaid Services (CMS) if you are denied COBRA premium assistance for which you believe you are eligible.
  
  
• Apuntes informativos en español - COBRA Fact Sheet in Spanish (Added 2/3/10)

For Employers

• COBRA Premium Assistance Process for UW System Institutions - this is a step-by-step guide outlining each institution's responsibilities in regards to implementing COBRA premium assistance provisions. (Rev 7/16/10)
  
  
• COBRA Cover Letter for Employees Who Terminate Employment on or before May 31, 2010 - this letter should be sent to employees and/or dependents who have a COBRA-qualifying event on or before May 31, 2010. All employees who terminate employment on or before May 31, 2010 should receive this letter and the full COBRA subsidy packet. Each institution should place this letter on its own letterhead and complete the employee-specific information in the letter. (Revised 4/19/10)
  
  
• COBRA Premium Assistance Informational Packet (PDF or Word) that institutions must send to all employees and/or dependents who are eligible for COBRA. This packet is not individualized and should be sent to employees in its current format. (Revised 4/20/10)
  
  
  • In the packet, include the rate sheet:
    
    
    • 2010 Insurance Premium Rate Sheets for Employees Covered under the Wisconsin Retirement System (WRS) - includes health, dental and vision premiums
      
      
    • 2010 Insurance Premium Rate Sheets for Employees Covered under the Graduate Assistant Health Insurance Plan (student assistants, employees-in-training, short-term academic staff)
      
      
    • Use the 2009/2010 Combined Rate Sheets if applicable (WRS and Grad)
      
      
  • In the packet, include the appropriate COBRA election forms:
    
    
    • State Group Health Insurance COBRA Continuation Form (ET-2311) - PDF or Word
      
      
    • Anthem DentalBlue Dental Insurance Continuation Form (Rev 4/20/10)
      
      
    • EPIC Dental & Excess Medical + EyeMed Vision Discount Continuation Form (Rev 4/20/10)
      
      
    • VSP Vision Continuation Form (Rev 4/20/10)
      
      
• Instructions for Submitting Payment for COBRA Premium Assistance (UWS 90) - employer must send this form along with the completed Request for Treatment as an Assistance Eligible Individual to all employees who apply for and are eligible for COBRA premium assistance. Employers must also submit a copy of this form to the UW Service Center. (Rev 12/23/09)
  
  
• Denial of Your Request as Treatment as an Assistance Eligible Individual (UWS 91) - employer must send this form along with the completed Request for Treatment as an Assistance Eligible Individual to all employees who apply for but are not eligible for COBRA premium assistance. This form should also be sent to an employee's dependent who applies for their own continuation coverage but is not eligible for COBRA premium assistance. (Rev 4/20/10)
  
  
• COBRA Tracking Document - this spreadsheet is a template to track COBRA notices sent and employees who apply for COBRA premium assistance.
  
  
• COBRA: Answers for Employers (IRS Website)

Layoff Resources

• How Layoff Impacts Your Benefits (UWS 41) with COBRA subsidy information - For Employees Under Minimum Retirement Age (age 55 for most employees, age 50 for protectives)
  
  
• How Layoff Impacts Your Benefits (UWS 42) with COBRA subsidy information - For Employees At or Above Minimum Retirement Age (age 55 for most employees, age 50 for protectives)
  
  
• Health Insurance Premium Payment at Layoff (UWS 40) with COBRA subsidy information - the employer should send this form to an employee when notified of an impending layoff. This form outlines the options an employee has regarding health insurance upon termination due to layoff.
  
  
• UWSA's Layoff Page

U.S. Department of Labor and IRS Resources

• Statement regarding the availability of the subsidy after May 31, 2010
  
  
• FAQs on the COBRA Premium Reduction Extension Provisions Related To The Temporary Extension Act Of 2010
  
  
• Fact Sheet: COBRA Premium Reduction
  
  
• FAQs About COBRA Continuation Health Coverage for Employees
  
  
• FAQs About COBRA Continuation Health Coverage for Employers
  
  
• U.S Department of Labor webpage for COBRA Continuation Coverage Assistance Under the American Recovery and Reinvestment Act of 2009
  
  
• IRS Website Dedicated to the COBRA Premium Subsidy
  
  
• IRS Notice 2009-27: Premium Assistance for COBRA Benefits

 

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This document was last revised on December 6, 2010