Who is a Qualified Beneficiary?

In general, a Qualified Beneficiary is an employee, a spouse, or a dependent child who, while enrolled on a group health plan, experiences a Qualifying Event and loses coverage from the plan as a result of the Qualifying Event.

Most importantly, you are a Qualified Beneficiary, since you have had a Qualifying Event and have received this notification.

A Qualified Beneficiary also includes a child who is born to, adopted by, or placed for adoption with a covered employee during a period of COBRA coverage, provided that the covered employee is a Qualified Beneficiary and the covered employee has elected COBRA.

A child of a covered employee who is receiving benefits under the Plan pursuant to a Qualified Medical Child Support Order (QMCSO) during the covered employee’s employment is entitled to the same rights to elect COBRA as an eligible dependent child of the covered employee.

What is a Qualifying Event?

A Qualifying Event is an event that causes you (and/or your spouse and/or any dependent child) to lose group health plan benefits. Qualifying Events are defined as:

  • Termination of the employee’s employment (whether voluntary or involuntary, except when employment terminates for gross misconduct)

  • Reduction in the employee’s work hours (to less than the minimum needed to remain covered by the plan)

  • A dependent child ceases to be an eligible dependent under the plan

  • Death of employee

  • Divorce or legal separation

  • Medicare entitlement of the employee (if this results in a loss of coverage from the plan)

  • Employer commences a bankruptcy proceeding (for covered retirees and their dependents only)