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The federal law, COBRA, allows most former employees (qualified beneficiaries) to continue their health insurance coverage for 18 months, however, due to the high cost of health insurance most people are unable to afford to take advantage of COBRA. Recognizing this problem, the American Recovery and Reinvestment Act of 2009, Public Law 111-5 was enacted on February 17, 2009 and establishes an employer-provided subsidy for health insurance premiums for employees who experience a qualifying event related to an involuntarily termination of employment between September 1, 2008 and December 31, 2009. If eligible for COBRA premium assistance, the former employer pays 65% of the health insurance premium for the first 9 months of COBRA coverage. After 9 months, the qualified beneficiary is responsible for the full premium due.

Eligibility Requirements and Insurance Premium Information

• Eligibility Requirements for COBRA Premium Assistance for Employees of UW System Institutions (Revised 9/16/09)
  
  
• Combined 2009 and 2010 Insurance Premium Rate Sheets for Employees Covered under the Wisconsin Retirement System (WRS) - includes health, dental and vision premiums
  
  
• Combined 2009 and 2010 Insurance Premium Rate Sheets for Employees Covered Under the Graduate Assistant Health Insurance Plan (student assistants, employees-in-training, short-term academic staff)
  

Employee Forms

• Request for Treatment as an Assistance Eligible Individual - used by employees and/or their dependents to request treatment as an assistance eligible individual for COBRA premium assistance purposes.
  
  
• State Group Health Insurance COBRA Continuation Form (ET-2311) - PDF or Word
  
  
• Anthem DentalBlue Dental Insurance Continuation Form
  
  
• EPIC Dental & Excess Medical + EyeMed Vision Discount Continuation Form
  
  
• OptumHealth Vision Continuation Form
  
  
• Participant Notification (UWS 92) - used by employees and/or their dependents to notify employer and health, dental and vision plans that they are no longer eligible for COBRA premium assistance due to eligibility for other group health insurance and/or Medicare.

• Appeal Form - used to request review by Centers for Medicare and Medicaid Services (CMS) if you are denied COBRA premium assistance for which you believe you are eligible.

For Employers

• COBRA Premium Assistance Process for UW System Institutions - this is a step-by-step guide outlining each institution's responsibilities in regards to implementing COBRA premium assistance provisions. (Revised 10/2/09)
  
  
• COBRA Cover Letter that must be sent to employees and/or dependents who are eligible for COBRA coverage effective prior to January 1, 2010. If an employee terminates on or after the November unclassified payroll or the Nov A classified payroll, an employee who elects COBRA will have coverage effective in 2010 so the employee is NOT eligible for COBRA premium assistance. Each institution should place this letter on its own letterhead and complete the employee-specific information in the letter. (Revised 10/2/09)
  
  
• Sample of completed cover letter that institutions must send to employees and/or dependents who are eligible for COBRA in 2009.
  
  
• Cover Letter for Employees Whose COBRA Coverage is Effective in 2010 - institutions should include this cover letter with COBRA continuation forms that are sent to employees whose COBRA coverage under ALL plans will be effective in 2010. Institutions should NOT include the COBRA Premium Assistance Information Packet with this letter.
  
  
• COBRA Premium Assistance Informational Packet (PDF or Word) that institutions must send to all employees and/or dependents who are eligible for COBRA. This packet is not individualized and should be sent to employees in its current format. (Revised 9/16/09)
  
  
  • In the packet, include the rate sheet:
    
    
    • Combined 2009 and 2010 Insurance Premium Rate Sheets for Employees Covered under the Wisconsin Retirement System (WRS) - includes health, dental and vision premiums
      
      
    • Combined 2009 and 2010 Insurance Premium Rate Sheets for Employees Covered Under the Graduate Assistant Health Insurance Plan (student assistants, employees-in-training, short-term academic staff)
      
      
  • In the packet, include the appropriate COBRA election forms:
    
    
    • State Group Health Insurance COBRA Continuation Form (ET-2311) - PDF or Word
      
      
    • Anthem DentalBlue Dental Insurance Continuation Form
      
      
    • EPIC Dental & Excess Medical + EyeMed Vision Discount Continuation Form
      
      
    • OptumHealth Vision Continuation Form
      
      
• Instructions for Submitting Payment for COBRA Premium Assistance (UWS 90) - employer must send this form along with the completed Request for Treatment as an Assistance Eligible Individual to all employees who apply for and are eligible for COBRA premium assistance. Employers must also submit a copy of this form to the UW Service Center.
  
  
• Denial of Your Request as Treatment as an Assistance Eligible Individual (UWS 91) - employer must send this form along with the completed Request for Treatment as an Assistance Eligible Individual to all employees who apply for but are not eligible for COBRA premium assistance. This form should also be sent to an employee's dependent who applies for their own continuation coverage but is not eligible for COBRA premium assistance. (Revised 9/15/09)
  
  
• COBRA Tracking Document - this spreadsheet is a template to track COBRA notices sent and employees who apply for COBRA premium assistance.
  
  
• COBRA: Answers for Employers (IRS Website)

Layoff Resources

• How Layoff Impacts Your Benefits (UWS 41) - For Employees Under Minimum Retirement Age (age 55 for most employees, age 50 for protectives) (Revised 5/22/09)
  
  
• How Layoff Impacts Your Benefits (UWS 42) - For Employees At or Above Minimum Retirement Age (age 55 for most employees, age 50 for protectives) (Revised 5/22/09)
  
  
• Health Insurance Premium Payment at Layoff (UWS 40) - the employer should send this form to an employee when notified of an impending layoff. This form outlines the options an employee has regarding health insurance upon termination due to layoff (PDF or Word). (Revised 5/22/09)
  
  
• UWSA's Layoff Page

U.S. Department of Labor and IRS Resources

• Fact Sheet: COBRA Premium Reduction
  
  
• FAQs About COBRA Continuation Health Coverage for Employees
  
  
• FAQs About COBRA Continuation Health Coverage for Employers
  
  
• U.S Department of Labor webpage for COBRA Continuation Coverage Assistance Under the American Recovery and Reinvestment Act of 2009
  
  
• IRS Website Dedicated to the COBRA Premium Subsidy
  
  
• IRS Notice 2009-27: Premium Assistance for COBRA Benefits

 

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This document was last revised on November 5, 2009