COBRA Law Summaries

COBRA Law Summaries

South Carolina, COBRA Law Summaries

South Carolina's health care continuation law is codified in the Code of Laws of South Carolina 1976 at Title 38, Chapter 71, Section 38-71-770.

DEFINITIONS

“Employees” means employees of a single employer, the officers, managers, and employees of the employer and of subsidiary or affiliated corporation of a corporate employer and the individual proprietors, partners, and employees of individuals and firms the business of which is controlled by the insured employer through stock ownership, contract, or otherwise. The term employees also includes retired employees (Sec. 38-71-710).

“Employer” may include any municipal corporation or the officers of any unincorporated municipality or any department of the municipal corporation or unincorporated municipality (Sec. 38-71-710).

“Group sickness and accident insurance” is a policy or contract which combines the coverage of group accident insurance and of group health insurance (Sec. 38-71-710).

COVERAGE

South Carolina's health care continuation law covers all employers maintaining group health policies issued for delivery in South Carolina (Sec. 38-71-770).

EXCEPTIONS

South Carolina's health care continuation law does not apply to any policy which provides benefits for other than hospital, surgical, major medical, or which provides benefits for specific diseases or accidental injuries only (Sec. 38-71-770).

PROCEDURES

An employer must offer continuation coverage to employees who have been continuously covered by the group policy for six months and whose coverage is terminated for any reason except for nonpayment of premium. An employee is not eligible for continuation coverage if the employee is:

1. eligible for other group coverage providing similar benefits,

2. eligible for Medicare, or

3. entitled under federal law to continuation coverage for more than six months

(Sec. 38-71-770).

Notification of the right to continue coverage must be included in each certificate of coverage. Additionally, upon termination, the employer must clearly and meaningfully advise an employee of the right to continue coverage (Sec. 38-71-770).

WHAT THE EMPLOYER MUST DO

South Carolina's health care continuation law requires an employer to offer continuation coverage to employees who have been continuously covered by the group policy for six months (Sec. 38-71-770).

Eligibility requirements.- Employees who have been continuously covered by the group policy for six months are eligible on the termination of coverage for any reason except for nonpayment of premium. An employee is not eligible for continuation coverage if the employee is:

1. eligible for other group coverage providing similar benefits,

2. eligible for Medicare, or

3. entitled under federal law to continuation coverage for more than six months

(Sec. 38-71-770).

Disability of dependent child.- If a group health plan specifies that a dependent child's coverage must terminate upon that child's attainment of a specified age, the attainment of that age will not operate to terminate the coverage of the child while the child is incapable of self-sustaining employment by reason of mental or physical disability and chiefly dependent upon the employee for support and maintenance. Proof of disability and dependency must be furnished by the employee within 31 days of the child's attainment of the specified age and thereafter, as required by the insurer, but not more frequently than annually after the two-year period following the child's attainment of the specified age (Sec. 38-71-780).

Duration of coverage.- Continuation coverage will last for the fractional policy month remaining at termination plus six additional policy months (Sec. 38-71-770).

Premiums.- The employee must pay the entire group premium, including any portion normally paid by the former employer (Sec. 38-71-770).

NOTICE

A notification of the right to continue coverage must be included in each certificate of coverage. Additionally, upon termination, the employer must clearly and meaningfully advise an employee of the right to continue coverage (Sec. 38-71-770).