42 U.S.C. § 300bb–2 — Continuation coverage

For section 300bb–1, "continuation coverage" means coverage that meets all of these rules: (1) Type of benefit coverage: The coverage must be identical, at the time it's provided, to what the plan gives similarly situated beneficiaries who haven't had a qualifying event. If the plan changes coverage for one of those groups, it must make the same change for everyone getting continuation coverage because of that group. (2) Period of coverage: Continuation coverage must run from the date of the qualifying event until at least the earliest of these events: (A) Maximum required period: (i) For a qualifying event that is a job termination or reduced hours (described in section 300bb–3(2)), coverage generally runs 18 months — except as the next rules describe. (ii) If a second qualifying event happens within 18 months of that first termination-or-reduced-hours event, coverage runs 36 months from the first event instead. (iii) For any other kind of qualifying event, coverage runs 36 months. (iv) If a covered employee is "TAA-eligible" (a trade-adjustment-assistance recipient, as section 300bb–5(b)(4)(B) defines) when their 18- or 36-month coverage would otherwise end, that coverage keeps going until the employee stops being TAA-eligible — but never past January 1, 2014. (v) If someone becomes entitled to Medicare less than 18 months before a termination-or-reduced-hours qualifying event, the other qualified beneficiaries' (not the employee's) coverage runs until 36 months after the employee became entitled to Medicare. (vi) If a qualified beneficiary is found disabled at any point during the first 60 days of continuation coverage, the normal 18-month period becomes 29 months for everyone on that coverage — but only if the beneficiary gives notice of the disability finding, under section 300bb–6(3), before the 18 months are up. (B) End of plan: Coverage ends on the date the employer stops offering any group health plan to any employee. (C) Failure to pay premium: Coverage ends on the date it lapses because a required premium wasn't paid on time. A payment counts as on time if made within 30 days of its due date, or within a longer grace period the plan allows. (D) Group health plan coverage or medicare entitlement: Coverage ends on the date, after the person elected continuation coverage, that the beneficiary first (i) gets covered under another group health plan that doesn't exclude or limit coverage for a pre-existing condition of theirs (unless that exclusion doesn't apply because of certain other federal insurance laws), or (ii) becomes entitled to Medicare. (E) Termination of extended coverage for disability: For a beneficiary found disabled during the first 60 days of coverage, extended coverage ends the month that starts more than 30 days after a later, final ruling that the person is no longer disabled. (3) Premium requirements: The plan can charge a premium for continuation coverage, but that premium cannot be more than 102% of the plan's normal cost for that coverage (or 150% after the 18th month, for people getting the disability extension). The payer can pay monthly. The plan cannot demand any premium payment sooner than 45 days after the day the person first elected continuation coverage. (4) No requirement of insurability: The plan cannot make someone prove they're insurable, or treat them worse for lacking such proof, to get continuation coverage. (5) Conversion option: When a beneficiary's continuation coverage is about to run out under paragraph (2)(A), the plan must, during the 180 days before that expiration, offer that beneficiary the chance to enroll in a conversion health plan — one generally available under the plan for people whose group coverage ends.