Level of Benefits Under COBRA

If an employee elects continuation coverage, the coverage will be identical to the coverage that is currently available under the plan to similarly situated active employees and their families (generally, this is the same coverage that was in place immediately before the qualifying event). The qualified beneficiary will also be entitled, while receiving continuation coverage, to the same benefits, choices, and services that a similarly situated participant or beneficiary is currently receiving under the plan, such as the right during an open enrollment season to choose among available coverage options.

You will also be subject to the same rules and limits that would apply to a similarly situated participant or beneficiary, such as co-payment requirements, deductibles, and coverage limits. The plan’s rules for filing benefit claims and appealing
any claims denials also apply.

Any changes made to the plan’s terms that apply to similarly situated active employees and their families will also apply to qualified beneficiaries receiving COBRA continuation coverage. If a child is born to or adopted by a covered employee during a period of continuation coverage, the child is automatically considered to be a qualified beneficiary receiving continuation coverage. You should consult your plan for the rules that apply for adding your child to continuation coverage under those circumstances.

From the 1999 Final COBRA Regulations

If a qualifying event occurs, each qualified beneficiary (other than a qualified beneficiary for whom the qualifying event will not result in any immediate or deferred loss of coverage) must be offered an opportunity to elect to receive the group health plan coverage that is provided to similarly situated nonCOBRA beneficiaries (ordinarily, the same coverage that the
qualified beneficiary had on the day before the qualifying event). See Q&A– 3 of § 54.4980B–3 for the definition of
similarly situated nonCOBRA beneficiaries.

This coverage is COBRA continuation coverage. If coverage under the plan is modified for similarly
situated nonCOBRA beneficiaries, then the coverage made available to qualified beneficiaries is modified in the same
way. If the continuation coverage offered differs in any way from the coverage made available to similarly
situated nonCOBRA beneficiaries, the coverage offered does not constitute COBRA continuation coverage and the
group health plan is not in compliance with COBRA unless other coverage that does constitute COBRA continuation
coverage is also offered. Any elimination or reduction of coverage in anticipation of an event described in
paragraph (b) of Q&A–1 of § 54.4980B–4 is disregarded for purposes of this Q&A–1 and for purposes of any other
reference in §§ 54.4980B–1 through 54.4980B–8 to coverage in effect immediately before (or on the day
before) a qualifying event. COBRA continuation coverage must not be conditioned upon, or discriminate on
the basis of lack of, evidence of insurability.

b) In the case of a qualified beneficiary who is a child born to or placed for adoption with a covered employee during a period of COBRA continuation coverage, the child is generally entitled to elect immediately to have the same coverage that dependent children of active employees receive under the benefit packages under which the covered employee has
coverage at the time of the birth or placement for adoption. Such a child would be entitled to elect coverage different from that elected by the covered employee during the next available open enrollment period under the plan.