{ "$schema": "https://bestinsuranceresearch.com/llms-full.txt", "recordType": "coverage", "id": "employer-group-health-federal", "canonicalUrl": "https://bestinsuranceresearch.com/insurance/employer-group-health-federal", "contentVersion": "2026.08.31", "generatedFor": "2026-09-07", "operator": { "legalName": "WJB Services, Inc.", "dba": "Bollinsure Insurance Services", "license": "6013787", "licenseAuthority": "California Department of Insurance" }, "license": "Text on this page may be quoted with attribution and a link to the canonical URL.", "notice": "Public page facts only. This record contains no visitor question, no tool input, and no identifier. It is not a coverage determination, an eligibility decision, or individualized advice.", "name": "Employer group health coverage (federal requirements)", "line": "group-health", "family": "health", "definition": "Not a policy form so much as a set of federal obligations that attach to one. Two bodies of law do most of the work: the continuation rules that let a person keep group coverage after they would otherwise lose it, and the shared responsibility rules that decide which employers must offer coverage at all. Both are statute, so unlike most lines the governing text can be read in full. A person losing coverage generally has at least 60 days to elect continuation, and the plan may charge no more than 102 percent of the applicable premium for it.", "protects": [ "A covered employee and their qualified beneficiaries against losing group coverage on the date a qualifying event occurs, by giving a right to continue it", "A spouse after divorce or legal separation, and a child who ceases to be a dependent, both of which are qualifying events in their own right", "A retiree whose former employer enters a title 11 proceeding, which is a qualifying event reaching a substantial elimination of coverage within a year either side of commencement", "Not the employer from the obligation. Nothing here is optional for a plan that is subject to it" ], "commonlyCovers": [ { "item": "Continuation after termination or reduced hours, for 18 months", "note": "Section 1162(2)(A)(i) sets the maximum period at the date which is 18 months after the qualifying event, for a termination or a reduction of hours." }, { "item": "Continuation for 36 months after the other qualifying events", "note": "Section 1162(2)(A)(iv) sets the maximum at 36 months after the date of the qualifying event for events other than termination or reduction of hours." }, { "item": "An extension to 29 months on disability", "note": "Where a qualified beneficiary is determined disabled during the first 60 days of continuation and proper notice is given before the 18 months end, the reference to 18 months is deemed a reference to 29 months with respect to all qualified beneficiaries." }, { "item": "Six qualifying events, named in the statute", "note": "Death of the covered employee; termination other than for gross misconduct, or reduction of hours; divorce or legal separation; the employee becoming entitled to Medicare benefits; a dependent child ceasing to qualify; and a title 11 proceeding with respect to the employer." }, { "item": "An election period of at least 60 days", "note": "It begins not later than the date coverage terminates by reason of the qualifying event, runs at least 60 days, and ends not earlier than 60 days after the later of that date or the date of the notice under section 1166(4)." } ], "commonlyExcludes": [ { "item": "Termination for gross misconduct", "note": "The qualifying event in section 1163(2) is a termination other than by reason of the employee's gross misconduct, so a termination on that ground is outside the list entirely." }, { "item": "Any obligation on the employer to subsidise the continued coverage", "note": "The plan may require payment of a premium not exceeding 102 percent of the applicable premium. The right is to keep the coverage, at a cost that now falls on the individual." }, { "item": "A duty on the employer to report the two personal events", "note": "For divorce or legal separation and for a child ceasing to be a dependent, the covered employee or qualified beneficiary is responsible for notifying the administrator within 60 days. An employer has no way of knowing about either." }, { "item": "Employers below the applicable large employer threshold, for shared responsibility", "note": "The shared responsibility rules apply to an employer who employed an average of at least 50 full-time employees on business days during the preceding calendar year." } ], "limitsAndDeductibles": [ "There is no limit structure here in the property sense. The numbers that govern are periods and thresholds.", "18 months for a termination or reduction of hours, and 36 months for the other qualifying events.", "29 months where the disability extension applies, and it applies with respect to all qualified beneficiaries rather than only the disabled one.", "102 percent of the applicable premium is the ceiling on what the plan may charge, payable in monthly installments at the election of the payor.", "No premium may be required before the day which is 45 days after the day the qualified beneficiary made the initial election.", "An average of at least 50 full-time employees over the preceding calendar year makes an employer an applicable large employer, counting part-time hours by dividing aggregate non-full-time hours of service for a month by 120.", "Full-time means employed on average at least 30 hours of service per week for the month." ], "endorsements": [ { "item": "State continuation, where it applies", "note": "Several states extend continuation to employers below the federal threshold or lengthen the federal period. That is state law and is not described by the federal sections cited here." }, { "item": "The plan document and summary plan description", "note": "The statutory floor is a floor. A multiemployer plan may provide longer notice periods than the 30 and 14 day defaults, which the statute expressly permits in its own terms." } ], "relatedPolicies": [ "Employee benefits administration generally, where the notice and recordkeeping duties sit", "Employment practices liability, which answers claims arising from the employment relationship rather than from the plan", "Workers compensation, which answers workplace injury and is not affected by these rules" ], "underwritingInputs": [ "The average number of full-time employees over the preceding calendar year, which decides applicable large employer status [S:usc-26-4980h-applicable-large-employer]", "Aggregate hours of service of employees who are not full-time, since those are converted by dividing by 120 [S:usc-26-4980h-applicable-large-employer]", "Whether any employee averages at least 30 hours of service per week, which is the full-time test [S:usc-26-4980h-applicable-large-employer]", "Whether the plan is a multiemployer plan, which can lengthen the statutory notice periods [S:usc-29-1166-notice-requirements]", "Who administers the plan, since the 14 day notice duty sits on the administrator [S:usc-29-1166-notice-requirements]", "Whether written notice procedures exist for the events the individual must report [S:usc-29-1166-notice-requirements]", "The date of any qualifying event, since every period in these sections runs from it [S:usc-29-1163-qualifying-events]" ], "stateVariations": [ { "state": "CA", "note": "The sections cited here are federal and apply the same way in every state. California and several others add their own continuation requirements on top, including for employers below the federal threshold, and those are state law not described by these records." } ], "effectiveDate": "2026-09-06", "lastReviewed": "2026-09-06", "author": "Aaron Bollinger", "reviewer": "Brian Bollinger", "sourceIds": [ "usc-29-1162-continuation-period", "usc-29-1163-qualifying-events", "usc-29-1165-election-period", "usc-29-1166-notice-requirements", "usc-26-4980h-applicable-large-employer", "cfr-29-2590-606-2-lii", "cfr-29-2590-606-4-lii", "cfr-26-54-4980h-1-lii", "cfr-26-54-4980h-5-lii" ], "sources": [ { "id": "usc-29-1162-continuation-period", "title": "29 U.S.C. 1162 (COBRA continuation coverage: the period, and what the plan may charge)", "publisher": "Office of the Law Revision Counsel, U.S. House of Representatives (uscode.house.gov)", "url": "https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1162&num=0&edition=prelim", "sourceType": "statute", "jurisdiction": "US", "authorityLevel": "primary-law", "primary": true, "publishedDate": "unknown", "effectiveDate": "n/a", "accessedDate": "2026-09-06", "lastChecked": "2026-09-06", "updateCadence": "Amended only by legislation.", "status": "active", "supportsClaims": [ "Section 1162(2)(A)(i) sets the maximum period of continuation coverage, for a qualifying event that is a termination or reduction of hours, at the date which is 18 months after the date of the qualifying event.", "Section 1162(2)(A)(iv) sets the maximum period, for other qualifying events, at the date which is 36 months after the date of the qualifying event.", "Section 1162(2)(A)(viii) provides that where a qualified beneficiary is determined to be disabled during the first 60 days of continuation coverage and proper notice is given before the end of the 18 months, any reference in clause (i) or (ii) to 18 months is deemed a reference to 29 months with respect to all qualified beneficiaries.", "Section 1162(3) provides that the plan may require payment of a premium for any period of continuation coverage, provided that the premium shall not exceed 102 percent of the applicable premium for that period, and may at the election of the payor be made in monthly installments.", "Section 1162(3) provides that in no event may the plan require the payment of any premium before the day which is 45 days after the day on which the qualified beneficiary made the initial election." ] }, { "id": "usc-29-1163-qualifying-events", "title": "29 U.S.C. 1163 (what counts as a qualifying event for COBRA continuation)", "publisher": "Office of the Law Revision Counsel, U.S. House of Representatives (uscode.house.gov)", "url": "https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1163&num=0&edition=prelim", "sourceType": "statute", "jurisdiction": "US", "authorityLevel": "primary-law", "primary": true, "publishedDate": "unknown", "effectiveDate": "n/a", "accessedDate": "2026-09-06", "lastChecked": "2026-09-06", "updateCadence": "Amended only by legislation.", "status": "active", "supportsClaims": [ "Section 1163(1) lists the death of the covered employee as a qualifying event.", "Section 1163(2) lists the termination, other than by reason of the employee's gross misconduct, or reduction of hours, of the covered employee's employment.", "Section 1163(3) lists the divorce or legal separation of the covered employee from the employee's spouse.", "Section 1163(4) lists the covered employee becoming entitled to benefits under title XVIII of the Social Security Act.", "Section 1163(5) lists a dependent child ceasing to be a dependent child under the generally applicable requirements of the plan.", "Section 1163(6) lists a proceeding in a case under title 11, commencing on or after July 1, 1986, with respect to the employer from whose employment the covered employee retired at any time.", "Section 1163 provides that in the case of an event described in paragraph (6), a loss of coverage includes a substantial elimination of coverage with respect to a qualified beneficiary described in section 1167(3)(C) within one year before or after the date of commencement of the proceeding." ] }, { "id": "usc-29-1165-election-period", "title": "29 U.S.C. 1165 (the election period for COBRA continuation coverage)", "publisher": "Office of the Law Revision Counsel, U.S. House of Representatives (uscode.house.gov)", "url": "https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1165&num=0&edition=prelim", "sourceType": "statute", "jurisdiction": "US", "authorityLevel": "primary-law", "primary": true, "publishedDate": "unknown", "effectiveDate": "n/a", "accessedDate": "2026-09-06", "lastChecked": "2026-09-06", "updateCadence": "Amended only by legislation.", "status": "active", "supportsClaims": [ "Section 1165(a)(1)(A) provides that the election period begins not later than the date on which coverage terminates under the plan by reason of a qualifying event.", "Section 1165(a)(1)(B) provides that the election period is of at least 60 days' duration.", "Section 1165(a)(1)(C) provides that the election period ends not earlier than 60 days after the later of the date on which coverage terminates by reason of the qualifying event, or, in the case of any qualified beneficiary who receives notice under section 1166(4), the date of that notice." ] }, { "id": "usc-29-1166-notice-requirements", "title": "29 U.S.C. 1166 (who must give notice of a qualifying event, and by when)", "publisher": "Office of the Law Revision Counsel, U.S. House of Representatives (uscode.house.gov)", "url": "https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1166&num=0&edition=prelim", "sourceType": "statute", "jurisdiction": "US", "authorityLevel": "primary-law", "primary": true, "publishedDate": "unknown", "effectiveDate": "n/a", "accessedDate": "2026-09-06", "lastChecked": "2026-09-06", "updateCadence": "Amended only by legislation.", "status": "active", "supportsClaims": [ "Section 1166 requires the employer of an employee under a plan to notify the administrator of a qualifying event described in paragraph (1), (2), (4) or (6) of section 1163 within 30 days of the date of the qualifying event, or in the case of a group health plan which is a multiemployer plan such longer period as may be provided in the terms of the plan.", "Section 1166 requires the administrator to notify any qualified beneficiary with respect to the event of that beneficiary's rights under the subsection, within 14 days of the date on which the administrator is notified, or in the case of a multiemployer plan such longer period as may be provided in the terms of the plan.", "Section 1166 provides that each covered employee or qualified beneficiary is responsible for notifying the administrator of the occurrence of any qualifying event described in paragraph (3) or (5) of section 1163 within 60 days after the date of the qualifying event." ] }, { "id": "usc-26-4980h-applicable-large-employer", "title": "26 U.S.C. 4980H(c) (who is an applicable large employer, and who is a full-time employee)", "publisher": "Office of the Law Revision Counsel, U.S. House of Representatives (uscode.house.gov)", "url": "https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section4980H&num=0&edition=prelim", "sourceType": "statute", "jurisdiction": "US", "authorityLevel": "primary-law", "primary": true, "publishedDate": "unknown", "effectiveDate": "n/a", "accessedDate": "2026-09-06", "lastChecked": "2026-09-06", "updateCadence": "Amended only by legislation.", "status": "active", "supportsClaims": [ "Section 4980H(c)(2) defines applicable large employer as, with respect to a calendar year, an employer who employed an average of at least 50 full-time employees on business days during the preceding calendar year.", "Section 4980H(c)(2) provides that in counting, an employer shall, in addition to the number of full-time employees for any month otherwise determined, include for that month a number of full-time employees determined by dividing the aggregate number of hours of service of employees who are not full-time employees for the month by 120.", "Section 4980H(c)(4) defines full-time employee as, with respect to any month, an employee who is employed on average at least 30 hours of service per week." ] }, { "id": "cfr-29-2590-606-2-lii", "title": "29 CFR 2590.606-2 - Notice requirement for employers (COBRA continuation coverage)", "publisher": "Cornell Legal Information Institute, reproducing the Code of Federal Regulations", "url": "https://www.law.cornell.edu/cfr/text/29/2590.606-2", "sourceType": "regulation", "jurisdiction": "US", "authorityLevel": "secondary", "primary": false, "publishedDate": "unknown", "effectiveDate": "unknown", "accessedDate": "2026-09-01", "lastChecked": "2026-09-01", "updateCadence": "on-amendment", "status": "active", "supportsClaims": [ "The section is titled Notice requirement for employers.", "For most plans the employer must furnish the notice to the plan administrator not later than 30 days after the date on which the qualifying event occurred.", "For plans under which continuation coverage commences on the date of loss of coverage, the notice must be provided not later than 30 days after the date on which a qualified beneficiary loses coverage under the plan due to the qualifying event.", "Multiemployer plans may provide for a longer notice period than the periods otherwise required, as specified in the plan documents." ] }, { "id": "cfr-29-2590-606-4-lii", "title": "29 CFR 2590.606-4 - Notice requirements for plan administrators (COBRA continuation coverage)", "publisher": "Cornell Legal Information Institute, reproducing the Code of Federal Regulations", "url": "https://www.law.cornell.edu/cfr/text/29/2590.606-4", "sourceType": "regulation", "jurisdiction": "US", "authorityLevel": "secondary", "primary": false, "publishedDate": "unknown", "effectiveDate": "unknown", "accessedDate": "2026-09-01", "lastChecked": "2026-09-01", "updateCadence": "on-amendment", "status": "active", "supportsClaims": [ "The section is titled Notice requirements for plan administrators.", "The section provides that upon receipt of a notice of qualifying event the administrator shall furnish to each qualified beneficiary a notice not later than 14 days after receipt of the notice of qualifying event.", "Where the employer is also the plan administrator, the section provides that the administrator shall furnish to each qualified beneficiary a notice not later than 44 days after either the date coverage is lost or the date the qualifying event occurred, depending on the plan provisions." ] }, { "id": "cfr-26-54-4980h-1-lii", "title": "26 CFR 54.4980H-1 - Definitions (employer shared responsibility)", "publisher": "Cornell Legal Information Institute, reproducing the Code of Federal Regulations", "url": "https://www.law.cornell.edu/cfr/text/26/54.4980H-1", "sourceType": "regulation", "jurisdiction": "US", "authorityLevel": "secondary", "primary": false, "publishedDate": "unknown", "effectiveDate": "unknown", "accessedDate": "2026-09-02", "lastChecked": "2026-09-02", "updateCadence": "on-amendment", "status": "active", "supportsClaims": [ "The section is headed Definitions.", "Paragraph (a)(21)(i) defines a full-time employee as an employee who is employed an average of at least 30 hours of service per week with an employer.", "Paragraph (a)(21)(ii) provides that 130 hours of service in a calendar month is treated as the monthly equivalent of at least 30 hours of service per week.", "Paragraph (a)(4) defines an applicable large employer as an employer that employed an average of at least 50 full-time employees, including full-time equivalent employees, on business days during the preceding calendar year." ] }, { "id": "cfr-26-54-4980h-5-lii", "title": "26 CFR 54.4980H-5 - Assessable payments under section 4980H(b) (affordability safe harbors)", "publisher": "Cornell Legal Information Institute, reproducing the Code of Federal Regulations", "url": "https://www.law.cornell.edu/cfr/text/26/54.4980H-5", "sourceType": "regulation", "jurisdiction": "US", "authorityLevel": "secondary", "primary": false, "publishedDate": "unknown", "effectiveDate": "unknown", "accessedDate": "2026-09-02", "lastChecked": "2026-09-02", "updateCadence": "on-amendment", "status": "active", "supportsClaims": [ "The section is headed Assessable payments under section 4980H(b).", "Paragraph (e)(2) provides three affordability safe harbors: the Form W-2 safe harbor, the rate of pay safe harbor, and the federal poverty line safe harbor.", "The Form W-2 safe harbor measures the employee contribution against 9.5 percent of that employee's Form W-2 wages from the employer for the calendar year.", "The rate of pay safe harbor, for an hourly employee, measures the contribution against 9.5 percent of an amount equal to 130 hours multiplied by the employee's hourly rate of pay.", "The federal poverty line safe harbor measures the contribution against 9.5 percent of a monthly amount determined as the federal poverty line for a single individual for the applicable calendar year, divided by 12.", "All three safe harbors in this section are expressed against the same 9.5 percent threshold." ] } ] }