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Cascade Mountains
CITIES:  Brightwood, Camp Sherman, Cascade Locks, Cascadia, Chemult, Chiloquin, Crescent, Crescent Lake, Detroit, Diamond Lake, Drew, Estacada, Fort Klamath, Gates, Gilchrist, Government Camp, Idanha, Klamath Agency, La Pine, Lakeview, McKenzie Bridge, Mill City, North Umpqua, Oakridge, Prospect, Rhododendron, Sandy, Sisters, Sunriver, Warm Springs, Welches, Westfir, Zigzag
AREAS:  Crater Lake National Park, Deshutes National Forest, Fremont National Forest, Mount Hood National Forest, Rogue River National Forest, The Three Sisters, Umpqua National Forest, Willamette National Forest, Winema National Forest

Central Oregon
CITIES:  Antelope, Arlington, Bend, Brothers, Condon, Culver, Dufur, Fossil, Grass Valley, Hampton, Lonerock, Madras, Maupin, Metolius, Mitchell, Moro, Mosier, Paulina, Post, Prineville, Redmond, Rowena, Rufus, Shaniko, Spray, The Dalles, Wasco

Northeast Oregon
CITIES:  Adams, Arlington, Athena, Baker City, Boardman, Canyon City, Condon, Cove, Dayville, Echo, Elgin, Enterprise, Fossil, Greenhorn, Haines, Halfway, Heppner, Hermiston, Huntington, Imbler, Imnaha, Irrigon, Island City, John Day, Joseph, La Grande, Lexington, Long Creek, Lostine, Medical Springs, Milton-Freewater, Monument, Mt Vernon, North Powder, Oxbow, Pendleton, Pilot Rock, Prairie City, Richland, Seneca, Summerville, Sumpter, Ukiah, Umatilla, Union, Unity, Wallowa, Weston
AREAS Hell's Canyon

Oregon Coast
North Coast
Astoria, Bay City, Beaver, Cannon Beach, Garibaldi, Gearhart, Hebo, Nehalem, Manzanita, Neahkahnie, Oceanside, Pacific City, Rockaway Beach, Seaside, Tillamook, Warrenton, Wheeler
Central Coast
Depoe Bay, Dunes City, Florence, Gleneden Beach, Lincoln City, Mapleton, Newport, Otter Rock, Reedsport, Seal Rock, Siletz, Toledo, Waldport, Winchester Bay, Yachats
South Coast

Agness, Bandon, Brookings, Charleston, Coos Bay, Coquille, Gold Beach,
Lakeside, Myrtle Point, North Bend, Port Orford, Powers, Wedderburn

Portland and Vicinity
Banks, Barlow, Beaverton, Camas, Canby, Clackamas, Clatskanie, Columbia City, Cornelius, Forest Grove, Gaston, Gresham, Happy Valley, Hillsboro, Lake Oswego, Marquam, Milwaukie, Molalla, North Plains, Oregon City, Portland, Rainier, Sandy, Scappoose, St. Helens, Tigard, Troutdale, Tualatin, Vernonia, West Linn, Wilsonville

Southeast Oregon
Adel, Adrian, Burns, Diamond, Drewsey, Frenchglen, Hines, Jordan Valley, Juntura, Lakeview, Nyssa, Ontario, Plush, Vale

Southern Oregon
CITIES Ashland, Butte Falls, Cave Junction, Canyonville, Central Point, Dillard, Drain, Eagle Point, Elkton, Glendale, Glide, Gold Hill, Grants Pass, Jacksonville, Klamath Falls, Malin, Medford, Merlin, Myrtle Creek, Oakland, Phoenix, Prospect, Riddle, Rouge River, Roseburg, Shady Cove, Sutherlin, Talent, Umpqua, White City, Winchester, Winston, Wolf Creek, Yoncalla
AREAS:  Applegate Valley, Illinois Valley


Willamette Valley
Albany, Alsea, Amity, Aumsville, Aurora, Brooks, Brownsville, Canby, Canyonville, Carlton, Corvallis, Coburg, Cottage Grove, Creswell, Culp Creek, Dallas, Dayton, Detroit, Donald, Dundee, Eugene, Falls City, Gates, Gervais, Halsey, Harrisburg, Independence, Jefferson, Junction City, Keizer, Lebanon, Lowell, Lyons, McMinnville, Mill City, Millersburg, Mt.Angel, Molalla, Monmouth, Newberg, Oakridge, Oregon City, Philomath, Salem, Scio, Scott Mills, Sheridan, Silverton, Sodaville, Springfield, Stayton, St. Paul, Sublimity, Sweet Home, Tangerit, Turner, Veneta, Walterville, Waterloo, Willamina, Woodburn, Yamhill

Cobra Financial Assistance - Government Supported

Changes to COBRA

The American Recovery and Reinvestment Act (ARRA) of 2009 was signed by President Obama on Feb. 17, 2009. This Act provides insurance payment relief for eligible individuals who were involuntarily terminated and who were otherwise eligible for continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985, commonly called COBRA. Relief also will be available to eligible individuals on Oregon continuation coverage. However, Washington state does not have continuation coverage.

Eligible individuals pay only 35 percent of their COBRA premiums and the remaining 65 percent is reimbursed to the coverage provider (usually an employer) through a tax credit. The premium period affected began on March 1, 2009. There are many details to the new law and not all involved parties are ready to begin implementing the assistance program. The following is a high-level summary of the program.

COBRA payment assistance

Generally applies to companies with 20 or more employees

Eligibility

  • COBRA-eligible individuals who were involuntarily terminated from employment between Sept. 1, 2008, and Dec. 31, 2009.
  • COBRA-eligible dependents of individuals who were involuntarily terminated from employment between Sept. 1, 2008, and Dec. 31, 2009.
  • Individuals who meet these criteria and who previously declined COBRA coverage on or after Sept. 1, 2008, will be given another chance to enroll.
  • An individual ceases to be eligible for the subsidy when the individual becomes eligible for other group health plan coverage.

Timing

  • The first premium period affected began on March 1, 2009.
  • The subsidy is generally available for up to nine months for those who remain eligible.
  • Maximum period of COBRA coverage (typically 18 months for terminations of employment) is not extended.
  • No one is eligible for the subsidy before date of enactment, which was Feb. 17, 2009.
  • Eligible individuals who pay the full monthly premium for their March or April coverage will be able to arrange a subsidy credit with the employer.

Income

  • Individuals are ineligible for the subsidy if adjusted gross income exceeds $145,000, or $290,000 for joint filers.
  • Subsidy is phased out if adjusted gross income is between $125,000 and $145,000 for individuals, or between $250,000 and $290,000 for joint filers.

What does this mean for you?

Affected individuals

Eligible individuals are obligated to pay only 35 percent of their COBRA premium beginning with the March 1, 2009, premium payment; however, the former employer may not yet be ready to administer the premium assistance. Most individuals whose coverage terminated on or after Sept. 1, 2008, will receive a notice regarding COBRA assistance in the mail within 60 days of Feb. 17, 2009. The notice will provide additional details on next steps. For more information, please review the information provided by the government by clicking on the links at the bottom of this page. If you have questions, then please call your former employer.

Employers

Eligible individuals are obligated to pay only 35 percent of their premiums as early as the period of coverage beginning March 1, 2009. You will be reimbursed the subsidized amount, 65 percent, by the government. Please review this helpful IRS question and answer regarding reimbursement. Employers are responsible for notifying affected individuals as required by law within 60 days of Feb. 17, 2009, and for paying 100 percent of all COBRA premiums to the insurer.

Producers

When communicating with employers, please discuss the fact that eligible individuals are only obligated to pay 35 percent of their premiums effective March 1, 2009. Also, it is important to alert them to the employers' responsibility of notifying affected individuals and paying 100 percent of all COBRA premiums to the insurer.

Regarding individual communication, please alert individuals to the March 1, 2009, effective date for reduced premiums and inform them that their former employer will provide them with a notice with additional information regarding next steps. Refer them to their former employers with questions.

Producers also may direct employers and individuals to the Department of Labor, Internal Revenue Service and the Oregon Insurance Division's Web sites for more information. Links to these Web sites are highlighted below.

Oregon continuation

Continuation coverage applies to companies whose insurance is based in Oregon and are not eligible for COBRA, such as those with 19 or fewer employees.

Individuals involuntarily terminated from employment between Sept. 1, 2008, and Dec. 31, 2009, and who were otherwise eligible for Oregon continuation coverage will have premium assistance available to them beginning with their March 1, 2009, premium payment. Affected individuals will receive a notice regarding premium assistance in the mail within 60 days of Feb. 17, 2009. While many of the details that apply to individuals eligible for COBRA coverage will apply to those eligible for Oregon continuation coverage, there are some important differences. For example, Oregon continuation coverage provides a maximum of six months of continuation coverage from the date that group coverage terminated. At this time, the process for providing assistance is being reviewed and refined. The written notices sent will explain the process to affected individuals and provide additional information.

Washington continuation

Washington state does not have continuation of coverage for employers who are not subject to Federal COBRA, such as those with fewer than 20 employees. Therefore, affected individuals are not able to access premium assistance.

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COBRA: Answers for Employers

 
Under the American Recovery and Reinvestment Act of 2009, certain individuals who are eligible for COBRA continuation health coverage, or similar coverage under State law, may receive a subsidy for 65 percent of the premium. These individuals are required to pay only 35 percent of the premium. The employer may recover the subsidy provided to assistance-eligible individuals by taking the subsidy amount as a credit on its quarterly employment tax return. The employer may provide the subsidy — and take the credit on its employment tax return — only after it has received the 35 percent premium payment from the individual.

Q: How will an employer be reimbursed for the COBRA subsidy that it has provided to eligible individuals?

A: The COBRA subsidy amount is reimbursed by being claimed as a credit on the Form 941. The Form 941 has been revised to allow for this credit. 

Q: How does an employer claim the credit for the COBRA subsidy? 

A: The credit is claimed on Line 12a of the January 2009 revision of the Form 941, which was posted on the IRS website on Feb. 20. In addition, the Form 941 filer also needs to include the number of individuals provided COBRA premium assistance on Line 12b.

Q: What other information relating to the COBRA subsidy must be submitted with the Form 941 besides the entries on Lines 12a and 12b?

A: No additional information relating to the COBRA subsidy is to be submitted with the Form 941, either electronically or in paper form. However, those claiming the credit must maintain supporting documentation for the credit claimed. Such documentation includes:

  • Information on the receipt, including dates and amounts, of the assistance eligible individuals’ 35% share of the premium.
  • In the case of an insured plan, copy of invoice or other supporting statement from the insurance carrier and proof of timely payment of the full premium to the insurance carrier required under COBRA.
  • In the case of a self-insured plan, proof of the premium amount and proof of the coverage provided to the assistance eligible individuals.
  • Attestation of involuntary termination, including the date of the involuntary termination (which must be during the period from September 1, 2008, to December 31, 2009), for each covered employee whose involuntary termination is the basis for eligibility for the subsidy.
  • Proof of each assistance eligible individual’s eligibility for COBRA coverage at any time during the period from September 1, 2008, to December 31, 2009, and election of COBRA coverage.
  • A record of the SSN’s of all covered employees, the amount of the subsidy reimbursed with respect to each covered employee, and whether the subsidy was for 1 individual or 2 or more individuals.
  • Other documents necessary to verify the correct amount of reimbursement.

Q: I haven't seen the legislation, but why does this belong on the Form 941?

A: The legislation as passed provides for reimbursement of the subsidy through the employment tax process, so Form 941 is the applicable form.

Q: What will happen if Line 12a ends up being larger than Line 10 on a 941 return?  Will this result in a net negative of taxes for a company? 

A: If Line 12a is larger than Line 10, Line 13 would also be larger than Line 10, resulting in an overpayment that could be applied to the next return, or requested as a refund. 

Q: Is the IRS considering any other form changes (e.g., 941X)?

A: Yes.  All appropriate forms are being revised and will be updated on the IRS.gov web site as soon as possible.

Q: Will the due date for the first-quarter Form 941 be extended? 

A: No.

Q: Will the number of assistance-eligible individuals need to be reported each quarter, whether or not there was a tax credit amount to apply?

A: Line 12b of the revised Form 941 must indicate the number of individuals who received the total COBRA subsidy reported on Line 12a of the Form 941. If there is no tax credit amount because no subsidy was provided, then the entry on Line 12b would be zero.

Q: Now that the legislation has passed, how is this going to be communicated to the employer/payroll community?

A: The IRS will continue to provide updated information through this Web site as it becomes available.

Q: Can an employer decide only to claim the credit at the end of the quarter rather than reducing its tax deposits during the quarter? 

A: Yes. The employer can decide either to offset its payroll tax deposits or claim the subsidy as an overpayment at the end of the quarter.

Q: When does the law become effective?

A:  The law became effective on the date of enactment, Feb. 17, 2009. However, under a transition rule, the regular premium amount may continue to be paid for up to two months after enactment (e.g., for March and April), and the subsidy can be provided retroactively.

Q: It was mentioned that this would be a temporary statute. How long is this change expected to be in effect? 

A: For assistance-eligible individuals, the qualifying event must occur on or before Dec. 31, 2009, and the COBRA subsidy may apply for up to nine months. 

Q: What individuals are eligible for the COBRA subsidy? 

A: An assistance-eligible individual can be any COBRA qualified beneficiary associated with the related covered employee, such as a dependent child of an employee, who is covered immediately prior to the qualifying event. The qualifying event for purposes of eligibility for the subsidy is involuntary termination of the covered employee’s employment that occurs during the period beginning Sept. 1, 2008, and ending Dec. 31, 2009. The individual must also be eligible for COBRA coverage, or similar state coverage, during this period.

Q: Is this provision for employees who involuntarily lose their jobs — or will it apply to all employees even if they leave voluntarily?

A: The credit applies only to involuntarily terminated employees and their family members who are qualified beneficiaries.

Q: Will the COBRA premium subsidy be taxable income for the individual?

A: The premium subsidy is not included in the individual’s income. However, there is a phase-out of eligibility for the subsidy, which will increase some high-income individuals’ tax liability if they receive the subsidy. The phase-out impacts individuals whose modified adjusted gross income exceeds $125,000, $250,000 for those filing joint returns. Tax liability is increased, to achieve repayment of a portion of the subsidy, for those taxpayers whose modified adjusted gross income is between $125,000 and $145,000, or $250,000 and $290,000 for those filing joint returns. If a taxpayer’s modified adjusted gross income exceeds $145,000, $290,000 for those filing joint returns, the full amount of the subsidy must be repaid as an additional tax. There is no additional tax for individuals with modified adjusted gross income less than these income levels.   
 
Q: When more than one entity may be responsible for receiving COBRA premiums, who should claim the credit?

A: The law as enacted clarifies that the person to whom the reimbursement is payable is (1) the multiemployer group health plan, (2) the employer maintaining a group health plan that is subject to Federal COBRA continuation coverage requirements or that is self-insured, or (3) the insurer providing coverage under a plan not included in (1) or (2). Only this person is eligible to offset its payroll taxes by the amount of the subsidy.

Q: Is the employer required to provide the COBRA subsidy?

A: The subsidy requirement applies to group health plans that are subject to the Federal COBRA continuation coverage requirements or to similar requirements under State law. If you are an employer with such a plan and you receive a 35 percent payment from an assistance-eligible individual, you are required to make the remaining 65 percent payment.

Q: What if the employer’s group health plan is self-insured? Do the subsidy requirements apply?

A: Yes, the subsidy requirements apply to all plans subject to the COBRA requirements, including self-insured plans. In that case, the employer must provide the COBRA coverage if the assistance eligible individual pays 35 percent of the otherwise required premium. The remaining 65 percent is treated as a payment of payroll taxes by the employer maintaining the plan.

Q: What other agencies will provide information about the COBRA subsidy?

A: Information about the COBRA subsidy will also be available through the Department of Labor and the Department of Health and Human Services, which, along with the IRS, share responsibility for the COBRA requirements.

Q: Can an employer reduce its payroll deposits during the quarter by the amount of the COBRA subsidy it provides during the quarter without incurring a Failure to Deposit penalty?

A: The amount of the COBRA subsidy the employer provides during the quarter (based on the 35 percent premium payments received from assistance eligible individuals during the quarter) will be treated as having been deposited on the first day of the quarter and applied against the employer’s deposit requirements.  Therefore, timely deposits up to the amount of the subsidy will be deemed to have been made during the quarter, regardless of the otherwise applicable due dates for deposits.  However, in some cases, the amount of the subsidy the employer provides during the quarter will be less than the total amount of the employer’s required deposits during the quarter.  In that case, the employer will be required to make timely deposits during the remainder of the quarter to make up the difference.

Example 1:  Employer’s required payroll deposits for the second quarter of 2009 total $10,000, determined without regard to the COBRA premium subsidy provided by Employer during the quarter.  Employer provides assistance eligible individuals with a total COBRA subsidy of $12,000 during the quarter, based on the 35 percent premium payments received from the individuals during the quarter, and reports the $12,000 subsidy on Line 12a of its Form 941 for the quarter.  Employer will be treated as having made a $12,000 payroll tax deposit on the first day of the quarter and thus will not be subject to a Failure to Deposit penalty for the quarter even if it reduces its deposits during the quarter by the amount of the subsidy.  Alternatively, Employer may make some or all of its required deposits during the quarter, determined without regard to the COBRA premium subsidy provided by Employer during the quarter, rather than reducing its total deposits by the subsidy.

Example 2:  Employer’s required payroll deposits for the second quarter of 2009 total $10,000, determined without regard to the COBRA premium subsidy provided by Employer during the quarter.  Employer provides assistance eligible individuals with a total COBRA subsidy of $8,000 during the quarter, based on the 35% premium payments received from the individuals during the quarter, and reports the $8,000 subsidy on Line 12a of its Form 941 for the quarter.  Employer will be treated as having made an $8,000 payroll tax deposit on the first day of the quarter and thus will not be subject to a Failure to Deposit penalty for the quarter, provided that, once the total of its required deposits exceeds $8,000, it makes its regularly required deposits for the remainder of the quarter.

Q: Will the credit amount taken impact an employer’s current “assigned” deposit frequency or future deposit frequencies? 

A: Frequency of deposits and look back periods are computed from Line 8 of Form 941, before taking into account any credits, including the COBRA credit. Therefore the COBRA credit will not affect future deposit frequency computations.

Q: If the 35 percent premiums are paid and the subsidy is provided at a point in the quarter where there are no additional federal tax deposits due for the quarter, should the employer claim the credit on the current quarter or the subsequent quarter?

A: Although an employer may reduce its payroll tax deposits during a quarter by the amount of subsidy provided during the quarter, claiming the credit on Form 941 for the quarter is not dependent on reducing deposits during the quarter.  Therefore, even if no additional deposits are due for the quarter, the employer can claim credit for the full amount of the subsidy provided during the quarter on its Form 941 for the quarter.  If the amount of the subsidy entered on Form 941 exceeds the employer’s tax liabilities for the quarter, the employer can choose to have the excess either refunded or applied to the next quarter.

Q: If the employer chooses to have the excess refunded, will the IRS send a notice before refunding the credit?

A: If the full amount of the excess is to be refunded to the employer, the IRS will not send a notice before making the refund.

Q: The questions and anwers refer to the employer. Is it always the employer that provides the subsidy and takes the credit on its Form 941? 

A: In some cases, a person other than the employer is the proper party to provide the subsidy and take the credit on its Form 941. For example, under the legislation, if the COBRA coverage is provided by a multiemployer plan, the plan provides the subsidy and is reimbursed by taking a credit on Form 941.  

Q: Will there be a means other than a quarterly Form 941 for employers (or other person if applicable) to claim credit for the COBRA subsidy provided to assistance eligible individuals? There is some information out there saying the credit can be claimed on a more frequent basis (e.g., weekly).  

A: As discussed above, an employer may reduce its payroll tax deposits during a quarter by the amount of subsidy provided during the quarter.  However, in all cases, credit for the subsidy must be claimed on the employer’s payroll tax return, whether the quarterly filed Form 941 or the annually filed Form 943 or 944. A payroll tax return is the only means to claim credit and be reimbursed for the COBRA subsidy.

Q: Will Schedule B continue to reflect the total payroll tax liabilities for the quarter, or will the liabilities reported be reduced by the COBRA subsidy credits?  

A: Schedule B is used to report an employer’s payroll tax liability for each payroll period, not the amount of the employer's payroll tax deposits. Therefore, when the employer reduces a deposit by the amount of the COBRA subsidy, this has no affect on the liabilities the employer reports on Form 941, Schedule B (or the monthly totals in Part 2 of Form 941).  The employer should still reflect on Schedule B (or in Part 2, Form 941) the total liabilities for all wages reported on Form 941.

Example:  Employer is a semi-weekly schedule depositor with a total liability of $75,000 for the payroll period ended on Feb. 27, 2009. Employer's regular deposit of $75,000 would be due on March 4, 2009. Because of a COBRA subsidy obligation of $5,000, Employer is allowed to reduce the deposit amount to $70,000, so Employer makes a timely deposit of $70,000 by March 4, 2009. When Employer completes Schedule B of Form 941 for the first quarter of 2009, Employer must enter the total liability, $75,000, on Day 27 of Month 2. As always, the total liability reported on Schedule B must equal the total taxes reported on Line 10 of Form 941. Employer will reflect the total COBRA subsidy for the quarter on Line 12a of Form 941.

Q: Is the employer required to claim the credit on Form 941 for the quarter during which the COBRA subsidy is provided to assistance eligible individuals? 

A: No. Instead of claiming the credit on Form 941 for the quarter during which the COBRA subsidy is provided, the employer may generally choose to claim the credit on Form 941 for a later quarter in the same calendar year.

Alternatively, if the employer has not claimed the credit on the original Form 941 for the quarter during which the COBRA subsidy was provided, the employer can file Form 941X for that quarter. In all cases, however, if an employer chooses to reduce its payroll tax deposits during a quarter by the amount of subsidy provided during the quarter (or during a previous quarter), it must claim the credit for that subsidy amount on Form 941 for the quarter during which its payroll tax deposits were reduced. In addition, of course, an employer may not claim credit for the same subsidy amount on Forms 941 for more than one quarter.

Q: Is there a specific date when employers can no longer take this credit?  

A: An individual can be eligible for the COBRA subsidy based on an involuntary termination of employment that occurs as late as Dec. 31, 2009 (the qualifying event), and the subsidy can apply for up to nine months of COBRA coverage, which generally begins shortly after the qualifying event.  It is therefore expected that eligibility for the subsidy will be exhausted by the end of 2010 and Form 941 for the fourth quarter of 2010 will be the last time to take the subsidy credit.

Q:Will there be anything that Payroll Service Providers will have to provide to employers and/or IRS? 

A: Payroll Service Providers need to communicate with their clients and ensure their clients maintain proper supporting documentation for the credit claimed. Such documentation includes, but is not limited to:

  • Information on the receipt, including dates and amounts, of the assistance eligible individuals’ 35 percent share of the premium.
  • In the case of an insured plan, copy of invoice or other supporting statement from the insurance carrier and proof of timely payment of the full premium to the insurance carrier required under COBRA.
  • In the case of a self-insured plan, proof of the premium amount and proof of the coverage provided to the assistance eligible individuals.
  • Attestation of involuntary termination, including the date of the involuntary termination (which must be during the period from Sept. 1, 2008, to Dec. 31, 2009), for each covered employee whose involuntary termination is the basis for eligibility for the subsidy.
  • Proof of each assistance eligible individual’s eligibility for COBRA coverage at any time during the period from Sept. 1, 2008, to Dec. 31, 2009, and election of COBRA coverage.
  • A record of the SSN’s of all covered employees, the amount of the subsidy reimbursed with respect to each covered employee, and whether the subsidy was for one individual or two or more individuals.
  • Other documents necessary to verify the correct amount of reimbursement.

This documentation must be maintained, but will not be required to be submitted to the IRS with Form 941.

Q: It might be difficult to make the April 30, 2009 deadline for filing the new Form 941. Who should we contact if we want to request an extension of time to file? 

A: No extensions are available for filing of employment tax returns.  

Q: In order to be an assistance eligible individual, must the individual actually have coverage under the group health plan at the time of the involuntary termination of employment?  

A: Yes. The individual must have actual group coverage at the time of the qualifying event, i.e., the involuntary termination of employment. The qualifying event must occur between Sept. 1, 2008, and Dec. 31, 2009, and the individual must be eligible for COBRA coverage at any time during that period.

Q: Is the COBRA benefit based on the former employee’s insurance coverage?  

A: In general, COBRA coverage is based on the same coverage that the individual had at the time of the qualifying event. However, under the COBRA subsidy provision, an employer may offer an assistance eligible individual the option of choosing other coverage that is also offered to active employees and that does not have higher premiums than the coverage the individual had at the time of the qualifying event.

Q: Is the assistance eligible individual’s share of the premium always 35 percent, or are there other elections the individual can make?  

A: The assistance eligible individual is required to pay 35 percent of the amount of the total premium for the coverage the individual elects. This percentage is fixed by statute.

Visit the Department of Labor Web site for information related to COBRA eligibility and the subsidy. Benefits Advisors are also available to assist you at 1-866-444-3272.
 

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ARRA COBRA Subsidy

Frequently Asked Questions for Employers

- 1 -

This FAQ document represents our interpretation based on the information

available at the time of its creation. However, it should not be construed as legal

advice or counsel. Modifications may be made as additional clarifications and

guidance become available.

1. EFFECTIVE DATE

What is the effective date?

The American Recovery and Reinvestment Act (ARRA) was effective February 17,

2009, and measures many of its timeframes from that date. For instance, the COBRA

subsidy provisions are effective for a plan as of the plan’s first billing period on or after

that date (so March 1, 2009, for most plans).

2. OVERVIEW

What do the major COBRA subsidy provisions do?

Provide a 65% subsidy for COBRA and qualifying state continuation premiums for up

to 9 months for “assistance-eligible individuals.” The subsidy is “fronted” by the

employer, multiemployer plan, or insurer and recovered from the federal government

via a payroll tax credit.

Provide a special COBRA election period for individuals involuntarily terminated from

employment between September 1, 2008, and February 16, 2009, who didn’t elect

COBRA or elected it but no longer had it on February 17, 2009. Furthermore, some

states have adopted or are considering adopting corresponding special election

periods with regard to their state continuations.

Require new and revised notices related to the subsidy and special election period.

3. DEFINITIONS

Which plans are affected?

ARRA covers most health plans that are subject to COBRA or similar continuation

coverage laws. This includes: insured and self-funded plans; state and municipal plans

that are subject to continuation under the Public Health Service Act; plans under the

Federal Employee Health Benefits Program; and plans subject to state continuation laws

similar to COBRA. Medical plans (including dental, vision, and/or prescription only plans)

are eligible for subsidy, but flexible spending arrangements are not.

Which state continuation laws are qualified for the subsidy?

A definition has not been provided, but Oregon state continuation under ORS 743.610

and Utah mini-COBRA under UCA §§31A-22-722 and 722.5 are likely similar to COBRA.

Washington and Idaho do not have subsidy-qualifying state continuation laws.

ARRA COBRA Subsidy

Frequently Asked Questions for Employers

- 2 -

What defines an “assistance-eligible individual?”

To be an assistance-eligible individual (AEI), an individual must be either:

(a) an employee involuntarily terminated from employment between September

1, 2008, and December 31, 2009, and eligible for COBRA or similar state

continuation during that period, or

(b) such an employee’s spouse or child who was enrolled through him or her on

the day before the involuntary termination.

An individual who is eligible for another group health plan or Medicare is not an AEI. If a

child is born to or placed for adoption with a former employee AEI after the involuntary

termination qualifying event, that child is also a qualified beneficiary and an AEI. Some

employees, though entitled to receive the subsidy, will have to refund some or all of it on

their next year’s federal income taxes because their adjusted gross income is over

certain levels ($250,000 for joint filers; $125,000 for others). Employers are not required

to track or calculate this. AEIs can waive the subsidy, but any waiver is irrevocable.

What about domestic partners?

The subsidy is not available for domestic partners, even if they can be included on

COBRA or state continuation coverage. This may complicate recovering the subsidy

from the federal government.

What does “involuntarily terminated” mean?

No definition has been provided to date, but a little guidance exists. Layoff, firing, and

other involuntary discharges are likely included. According to new U.S. Department of

Labor (DOL) FAQs, this includes “being told not to come back to work until further

notice.” A reduction of hours or furlough under which an employment relationship

remains does not appear to be an involuntary termination. Further, if you do not to offer

COBRA to employees terminated for “gross misconduct,” the new law does not appear

to change that. You must make any decision not to offer COBRA because of a

termination for gross misconduct.

4. THE SUBSIDY

When does the subsidy begin?

The subsidy begins as of the plan’s first billing period on or after February 17, 2009

(usually March 1, 2009), whether the recipient is already enrolled as an AEI on that date

or enrolls during the special election period described later in these FAQs. There is no

subsidy available for premiums related to coverage before that date.

When does the subsidy end?

The subsidy will apply for a maximum of 9 months (though unsubsidized continuation

coverage may be available beyond that). It will end earlier if:

(a) the AEI becomes eligible for (not necessarily enrolled in) another group health

plan or Medicare; or

(b) COBRA or state continuation ends for any reason (e.g., the maximum

continuation period is exhausted, premium is not paid timely, etc.).

ARRA COBRA Subsidy

Frequently Asked Questions for Employers

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AEIs have the obligation to notify you of their eligibility for other coverage and are

subject to a penalty of 110% of the subsidy amount if they fail to do so.

How does the subsidy work?

For a period of up to 9 months, AEIs who pay the 35% of their share of the COBRA or

state continuation premium will be entitled to the continued coverage. For continued

coverage before or after that time, the usual premium amounts apply. Alternatively, any

person or entity, except the AEI’s employer, may pay on the AEI’s behalf. Usually, the

AEI’s premium is calculated from 102% of the “active” premium (so 35% would be 35.7%

of that active premium). The entity “fronting” the remainder of the premium is permitted

to take a credit in the amount of the remaining 65% against its federal payroll tax (Form

941). If the credit amount is greater than the taxes due or no taxes are due, the

Department of the Treasury will directly reimburse the entity as if taxes had been

overpaid.

Note that an entity that was already subsidizing continuation premiums before ARRA

would not be able to take a credit for the amount of that subsidy, but rather only for 65%

of the amount that was actually being charged to AEIs.

For instance: if full COBRA premium is $1,000, but you already were paying

half, the subsidy would be based on the half that the qualified beneficiary

was being charged. The AEI would have to pay only $175 (35% of $500)

and you would have to pay the $825 balance, but only $325 (65% of $500)

could be recovered through the payroll tax credit.

If you provide a non-ARRA subsidy for state continuation coverage, you will need to

inform Regence and pay Regence the amount of that unrecoverable subsidy. Refer to

section 7 for additional information.

Who pays the subsidy?

In a multiemployer group health plan, the multiemployer plan pays the subsidy and

claims the payroll tax credit. In a COBRA-eligible group health plan or a self-funded plan

(whether or not COBRA-eligible), the employer pays the subsidy and claims a payroll tax

credit. In both cases, Regence will require timely payment of the full premium from the

plan or employer. In an insured plan that is not a multiemployer plan and is subject to

state continuation, Regence will front the subsidy amount and claim the payroll tax

credit. In this last type of plan, Regence will be claiming the credit and, in addition to the

usual information, you will need to provide:

Attestation of the involuntary termination of the employee, including the date of

termination

Employee Social Security Number

What if I’ve received full premium payments from AEIs already?

During the first two months after the effective date of the subsidy program, if full

payments are received, you may refund the “overpaid” 65%. Alternatively, if it is (and

remains) reasonable to believe that amount would be exhausted within 180 days, you

may provide an AEI a credit of the overpaid amount against future premiums. After the

first two months, the subsidy must be fully implemented.

ARRA COBRA Subsidy

Frequently Asked Questions for Employers

- 4 -

5. SPECIAL ELECTION PERIOD

What is the special election period and how does it work?

Employees involuntarily terminated from employment between September 1, 2008, and

February 16, 2009, who didn’t elect COBRA, or elected it but no longer had it on

February 17, 2009 (and their spouses and dependent children covered the day before

the involuntary termination), are given a second chance to elect COBRA. The special

election period began February 17, 2009, and will last until 60 days after you provide

notice of it. Under ARRA, the special election period applies only to COBRA, but some

states have taken or are considering action to extend it to their state continuations. If

special election is made, COBRA coverage is effective as of the first billing period on or

after February 17, 2009 (usually March 1, 2009). The period between the original

COBRA qualifying event and the effective date of special election is not part of a

significant break in coverage for purposes of applying a pre-existing condition waiting

period to an AEI. Eligible individuals using the special election period must start COBRA

as of March 1, 2009, and pay the corresponding premiums.

6. NOTICES

Are new or revised notices required?

Yes. Because the subsidy is a temporary provision, you may prefer to create separate

supplemental notices, rather than amending existing ones, and that is permissible.

COBRA requires a general notice to be sent to qualified beneficiaries upon the

occurrence of a qualifying event. You must send a revised general notice to all

individuals experiencing a qualifying event between September 1, 2008, and December

31, 2009, with one exception. A revised general notice does not have to be sent to a

qualified beneficiary whose qualifying event occurred between September 1, 2008 and

February 16, 2009 if the qualifying event was not an involuntary termination of

employment and you provided a general notice that was compliant with the law at that

time. The revised general notice must provide information about the subsidy and include

related forms. Department of Labor model notices are available at

http://www.dol.gov/ebsa/COBRAgeneralnoticefullversion.doc and

http://www.dol.gov/ebsa/COBRAgeneralnoticeabbreviatedversion.doc. The models

include a full version and an abbreviated version.

The full version must be used for all qualified beneficiaries with any qualifying event from

September 1, 2008, through December 31, 2009, if either:

o they haven’t been provided a general COBRA notice yet, or

o they were provided one after February 16, 2009, that did not address the

subsidy.

The abbreviated version can be used as an alternative to the full version, but only for

qualified beneficiaries who already elected and have retained COBRA coverage in

connection with a qualifying event on or after September 1, 2008. The abbreviated

version provides only the subsidy information.

ARRA COBRA Subsidy

Frequently Asked Questions for Employers

- 5 -

These notices must be mailed no later than April 18, 2009. The full version is also to be

used as your general COBRA notice hereafter for qualifying events occurring until

January 1, 2010.

You also must send notice of the available special election period to individuals who had

an involuntary termination of employment qualifying event between September 1, 2008,

and February 16, 2009, and either did not elect COBRA, or elected it but no longer had it

on February 17, 2009. A Department of Labor model of this notice is available at

http://www.dol.gov/ebsa/COBRAextendedelectionperiodnotice.doc. This notice

approximates the full general COBRA notice, providing information about the special

election opportunity, as well as the subsidy and related forms.

In addition to these notices, you may want to consider updating or supplementing the

initial COBRA notice that you provide to individuals upon enrollment in your plan to

disclose the availability of the subsidy, though doing so is not required. Because the

subsidy is temporary, Regence’s benefit booklets and certificates of creditable coverage

will not be changed at this time.

7. ADMINISTRATION, COMMUNICATION, AND COOPERATION

What information must you provide to Regence?

If your group is subject to COBRA, you will continue to use the same COBRA application

form you have always sent to Regence. You need to note on the form whether or not

the qualified beneficiary is eligible for the subsidy. Failure to do so may result in

processing delays.

If your group is subject to state continuation, you will continue to use the same form you

have always sent to Regence. You need to note on the form whether or not the qualified

beneficiary had an involuntary termination of employment that makes the qualified

beneficiary eligible for the subsidy. This information will be required in order to process

the form when the reason is termination of employment.

These forms can be downloaded, as before, from our employer website at:

www.or.regence.com/employer/forms/.

If your employee count has varied above and below the 20-employee mark from

calendar year to calendar year, it is imperative you ensure that Regence has accurate

information about whether COBRA or state continuation applies to your plan.

REMINDER: If you provide a non-ARRA subsidy for state continuation coverage, you will

need to inform Regence and pay Regence the amount of that unrecoverable subsidy.

This will prevent the payroll tax credit from being inappropriately claimed.

You must notify Regence, when you are notified, that an AEI has become eligible for

Medicare or other group coverage.

ARRA COBRA Subsidy

Frequently Asked Questions for Employers

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8. COVERAGE CHANGES

Can AEIs change from one of our health plan options to another?

COBRA qualified beneficiaries have long been able to change among health plan

options at the same times that active employees may, generally at annual renewal.

ARRA permits, but does not require, groups to allow an AEI to enroll in an option that is

different than the coverage he had at the time of his qualifying event as long as that

other coverage is: (a) no more expensive; (b) is also offered to active employees; and (c)

is not limited to only dental, vision, or counseling coverage (or any combination of those

coverages), a flexible spending arrangement, or an on-site medical clinic.

The group contract between you and Regence, however, precludes your permitting such

coverage changes without renegotiation of that contract. If such changes were allowed,

they would be expected to increase claims experience and therefore premium rates, as

well as add to administrative tasks.

9. APPEALS

What if an individual thinks he or she has been wrongly denied subsidy?

If you are a private employer subject to COBRA, the individual can appeal to the U.S.

Department of Labor. If you are a public employer, or private employer subject to state

continuation, the individual can appeal to the U.S. Department of Health and Human

Services. The relevant Department’s decision is due within 15 business days.

10. Health Coverage Tax Credit (HCTC)

How does this COBRA subsidy work with the subsidy under the HCTC?

The two do not work together; a choice must be made between them. The HCTC under

the Trade Adjustment Act is complex but, in general terms, includes a premium subsidy

available to a small category of individuals who have lost employment due to foreign

competition. HCTC-eligible individuals are notified from the IRS. The ARRA increases

the HCTC premium subsidy such that an individual may be better off taking it than the

COBRA subsidy that is the subject of these FAQs.

11. OREGON STATE CONTINUATION

What special provisions related to Oregon continuation are not mentioned above?

At the time this FAQ was composed, changes had not been made to Oregon

continuation. Oregon’s insurance regulator, however, has proposed both: (a) increasing

the maximum period that Oregon continuation is available to 9 months (from 6); and (b)

adding a special election right comparable to ARRA’s special election right for COBRA,

including a notice requirement. It appears that federal regulations also may add a notice

requirement for state continuations when they are issued. If any or all these changes

should occur, you will be required to provide Regence the information it needs to

comply.

ARRA COBRA Subsidy

Frequently Asked Questions for Employers

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12. ADDITIONAL INFORMATION

Where can I get more information?

Official guidance is available at www.dol.gov/COBRA.

For updated information from Regence, including details and changes in processes and

forms related to COBRA, state continuations, and the ARRA subsidy, visit

www.regence.com/cobra.

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May 15, 2009  Lifewise of Oregon

State Continuation Coverage and ARRA Subsidy

On April 28, 2009, Governor Ted Kulongoski signed legislation modifying the state’s existing

continuation of coverage laws, which affect employer groups with fewer than 20 employees.

The Department of Consumer and Business Services and Division of Insurance have recently

adopted rules regarding the application of the federal subsidy for state continuation of health

benefit plans. LifeWise Health Plan of Oregon is actively monitoring the activities. You can

access general information on Oregon’s implementation at:

http://www.cbs.state.or.us/ins/consumer/consumer-issues/federal-stimulus-info/federal-stimulusinfo.

html

LifeWise is in the process of notifying all employer groups with fewer than 20 employees plus

their former employees who may qualify for the subsidy. You are receiving this bulletin because

our records indicate you are the agent of record for one or more employer groups with fewer

than 20 employees. Copies of both letters are attached for your reference. While the employer

letter outlines some of the employer requirements, LifeWise is not providing and is not able to

provide legal advice. Employers should contact their legal counsel for specific obligations under

this law.

LifeWise will administer the federal subsidy for the state continuation of coverage program

through the following process:

Request from employer group, as necessary, subsidy eligibility for members currently

enrolled in state continuation to identify who was involuntarily terminated.

Send notifications to former employees who may be eligible for the subsidy informing

them of the new law, including subsidy information and extended election period.

Accommodate special open enrollment provisions allowing a member (with employer

approval) to elect a different plan with the same or less expensive premium (if available

to active employees).

Bill the employer group for 35 percent of the payment for the subsidy-eligible former

employees. Non-eligible former employees will continue to be billed for 100 percent of the

continuation of coverage payment.

Pay the remaining 65 percent and recover the subsidy via payroll tax credit.

Refund overpayments to members.

If you have additional questions, please contact your LifeWise small group sales team.

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HealthNet of Oregon, ARRA Assistance

As you know, President Obama signed the American Recovery & Reinvestment Act of 2009 (ARRA) on Feb. 17, 2009. The law provides “Assistance Eligible Individuals (AEIs) a 65 percent subsidy for COBRA and/or state-specific COBRA continuation coverage premiums for qualified beneficiaries involuntarily terminated from employment in the period from Sept.1, 2008 through Dec. 31, 2009, for up to nine months.

We want to help guide you through the COBRA/state continuation process and provide you with some sample forms and letters that we use at Health Net.

Subsidies of 65 percent of COBRA or state-specific premium will be available for up to nine months to workers who are involuntarily terminated from employment between Sept. 1, 2008 and Dec. 31, 2009. The law requires employers to pay the amount of the COBRA premium assistance subsidy and to deduct the amounts from their payroll taxes.

The Act requires that all federal COBRA subsidies be administered and recovered by the employer group. It is the group’s responsibility to identify AEIs, meet the notice requirements and administer the ongoing eligibility and premium remittance requirements of the Act.

  • Health Net will not send group or member notifications regarding the ARRA premium assistance for federal COBRA groups.
  •  Health Net will continue to bill these groups for the entire COBRA premium.
  • For Health Net's Group Pay COBRA application and attestation form, click on the attachment, Application & Attestation Form.

Oregon State Continuation Plans for Small Groups Not Subject to Federal COBRA
Recognizing the need for changes to state law to allow Oregonians to obtain the full advantage of the federal subsidy, the Oregon legislature enacted HB 2433. HB 2433 and follow-up rule-making by the Oregon Department of Consumer Business Services (DCBS) achieves the following:

  • Extends the amount of time former employees can continue coverage through the state continuation program from six months to nine months.  This gives eligible Oregonians the opportunity to receive the full nine months of premium assistance.
  • Allows an independent election of coverage by each qualified beneficiary.
  • Creates a second election opportunity for state continuation coverage for AEIs who experienced a qualifying event on or after Sept. 1, 2008 and before the effective date of HB 2433 and either did not elect or whose continuation coverage ended, e.g., lapse due to nonpayment, and/or expiration of six month coverage period.
  • Specifies that enrollees who take advantage of the second election opportunity be treated as having continuous coverage for purposes of calculating creditable coverage.
  • Insurers subject to continuation of coverage provisions are now required to provide a notice explaining state continuation of benefits directly to individuals losing group coverage, for any reason other than replacement of their group coverage, within ten days following the date of any administrative action taken by an insurer to initiate or document the loss of coverage.

ARRA Notification Mailings to Identified Members & Groups
On April 17, 2009, Health Net distributed a mailing to all members not subject to federal COBRA that had terminated coverage between Sept. 1, 2008 and March 16, 2009. This mailing included the following documents:

  • Member-specific ARRA (American Recovery and Reinvestment Act) and Oregon State Continuation Subsidy notice/letter.
  • Summary of the Continuation Coverage Premium Reduction Provisions under ARRA.
  • State Continuation Election/Premium Subsidy Attestation Application Form.

To view the above documents, click on the attachment, Sample Member Notice.

In addition, to assist employers not subject to federal COBRA, a separate mailing was distributed to groups who were identified as having terminated coverage for individuals Sept. 1, 2008 through March 16, 2009.  This mailing included the following documents:

  • Employer-specific ARRA (American Recovery and Reinvestment Act) and Oregon State Continuation Subsidy notice/letter.
  • Sample copy of member-specific ARRA (American Recovery and Reinvestment Act) and Oregon State Continuation Subsidy notice/letter.
  • Summary of the Continuation Coverage Premium Reduction Provisions under ARRA.
  • State Continuation Election/Premium Subsidy Attestation Application Form.

To view the above documents, click on the attachment, Subsidy Employer Notice. 

Members on IFP, Portability and Medicare Supplemental plans are not eligible for the subsidy.

For more information on the New COBRA Subsidy Guidelines, please visit the Health Net web site, www.healthnet.com.

 
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