COBRA Law Summaries
Rhode Island, COBRA Law Summaries
Rhode Island's health care continuation law is codified in the General Laws of Rhode Island at Title 27, Chapter 19.1, Section 27-19.1-1 and Chapter 20.4, Section 27-20.4-1.
DEFINITIONS
“Carrier” means any insurance company which is the insurer of the group hospital, surgical or medical plan or the medical or health service plan corporation which provides the group service plan contract, either of which an employer provides for its employees (Sec. 27-19.1-1(g), as amended by Ch. 244 (H. 5707) and Ch. 285 (S. 816), L. 2003, effective July 17, 2003).
“Group hospital, surgical, or medical plan” includes any service plan contract of a medical or health service plan corporation (Sec. 27-19.1-1(g), as amended by Ch. 244 (H. 5707) and Ch. 285 (S. 816), L. 2003, effective July 17, 2003).
COVERAGE
For purposes of fulfilling any employer obligations under the Consolidated Omnibus Budget Reconciliation Act of 1985, a domestic partner shall be deemed a dependent of an employee (Sec. 36-12-2.4, as added by Ch. 189 (H. 7804), L. 2005, effective June 28, 2006).
EXCEPTIONS
Rhode Island's health care continuation law does not apply to an employee who is employed in the construction industry or to an employer if its employees are participants in and the employer is a contributor to a multiemployer welfare plan (Sec. 27-19.1-1(h), as amended by Ch. 244 (H. 5707) and Ch. 285 (S. 816), L. 2003, effective July 17, 2003).
WHAT THE EMPLOYER MUST DO
Whenever the employment of an insured member of a group hospital, surgical, or medical insurance plan is terminated because of involuntary layoff or death, or as a result of the workplace ceasing to exist, or the permanent reduction in size of the workforce, the benefits of the plan may be continued as provided in this section for a period of up to 18 months from the termination date of the insured member, but in any event not to exceed the shorter of the period which represents the period of continuous employment preceding termination with the employer under whose contract the member is insured or the time from the termination date of the insured member until the member, surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan, becomes employed by another group and eligible for benefits under another group plan (Sec. 27-19.1-1(a), as amended by Ch. 244 (H. 5707) and Ch. 285 (S. 816), L. 2003, effective July 17, 2003).
The extended coverage for the period defined in Sec. 27-19.1-1(a) above shall be available to the terminated member, the surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan, at the same monthly premium rate or subscription fee for the group in which he or she was previously a member or at a monthly premium rate or subscription fee as may be in effect from time to time for the same group subsequent to his or her qualification under Sec. 27-19.1-1(a). The terminated member, the surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan, shall not be required to pay more than a monthly premium rate or subscription fee per month at one time (Sec. 27-19.1-1(b), as amended by Ch. 244 (H. 5707) and Ch. 285 (S. 816), L. 2003, effective July 17, 2003).
The involuntarily laid off member or other member qualifying under Sec. 27-19.1-1(a) above, the surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan, may elect to continue participation in the group plan within 30 days after the member's qualification under Sec. 27-19.1-1(a). The involuntarily laid off member, or the surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan shall be responsible for the payment of monthly premiums rates or subscription fees directly to the carrier of the surgical, hospital, or medical insurance plan, or the group plan's agent or insurance producer, throughout the extended coverage period, if the member had been covered under a group plan consisting of 50 members or less. Those leaving group plans with more than 50 members shall be responsible directly to the employer for the payment of monthly premiums rates or subscription fees, or directly to the carrier if the workplace ceases to exist. The terminated member, the surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan, shall not be required to pay more than a monthly premium rate or subscription fee per month at one time (Sec. 27-19.1-1(c), as amended by Ch. 244 (H. 5707) and Ch. 285 (S. 816), L. 2003, effective July 17, 2003).
After timely receipt of the monthly premium rate or subscription fee from the qualifying member, the surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan, if the employer fails to make payment to the carrier with the result that coverage is terminated, the employer shall be liable for benefits to the same extent as the carrier would have been liable if coverage had not been terminated. "Timely receipt" of the monthly premium payment means the employer's receipt of the monthly premium rate or subscription fee for the extended coverage from the qualifying member, or the surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan within the dates or by the date indicated by the employer as a requirement of this chapter at the time of the election of the extended coverage. This subsection shall not apply to an employer whose workplace ceases to exist (Sec. 27-19.1-1(d), as amended by Ch. 244 (H. 5707) and Ch. 285 (S. 816), L. 2003, effective July 17, 2003).
Upon termination of the extended coverage period, the qualifying member, the surviving spouse of a deceased member, and any other dependent(s) of the member who were covered under the plan shall be entitled to exercise any option which is provided in the group plan to elect a converted policy (Sec. 27-19.1-1(e), as amended by Ch. 244 (H. 5707) and Ch. 285 (S. 816), L. 2003, effective July 17, 2003).
Extended election period for mini-COBRA coverage. Any individual otherwise qualified for Rhode Island mini-COBRA coverage on or after September 1, 2008, who declined to elect coverage within the normal timeframe may elect to resume coverage no later than May 1, 2009. Coverage elected under the extended election provision would commence as of March 1, 2009 (Sec. 27-19.1-1(i), as amended by H 6099 and RI S 843, enacted and effective April 9, 2009).
Former spouses.- In the event of a final judgment of divorce, where one party was at the time of the entry of the judgment for divorce a member of a health plan providing family coverage, or a member of an HMO, or any similar health plan, the person who was the spouse of the party prior to the divorce may remain eligible for continuing benefits under the plan and HMO without additional premium or examination if the order is included in the judgment when entered. The eligibility shall continue as long as the original member is a participant in the plan or HMO and until either one of the following shall take place: (1) the remarriage of either party to the divorce, or (2) until a time as provided by the judgment for divorce. If the person who was the spouse of a member of a plan or HMO becomes eligible to participate in a comparable plan or HMO through his or her own employment, the continuation of the original plan coverage shall cease. Any final decree continuing family health insurance shall require both the member and the spouse to notify the insurer promptly of any remarriage (Sec. 27-20.4-1(a)).
The person who was the spouse and remains eligible for continuing benefits under the provisions described just above or any custodial guardian of an insured minor child of the original member, having paid for covered medical costs subject to reimbursement, shall be reimbursed directly by the insurer upon the filing of the claim. The insurer shall not require that the claim be filed through the insured member, but must allow for direct filing (Sec. 27-20.4-1(b)).
POSTING
All employers who provide their employees a group hospital, surgical, or medical insurance plan shall post a conspicuous notice to the employees of their options under the provisions of this chapter (Sec. 27-19.1-1(f), as amended by Ch. 244 (H. 5707) and Ch. 285 (S. 816), L. 2003, effective July 17, 2003).
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