The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) and Louisiana law both permit employees to continue their group health coverage if they leave the group for certain specified reasons. Except for a provision covering surviving spouses over the age of 50, Louisiana law covers only those not eligible for COBRA. According to federal law, when comparing state and federal continuation rights, employees may use the law that is most favorable to their situation.
Louisiana's continuation requirements cover all employers regardless of size (LA Rev. Stat. Sec. 22:1046). It covers hospital, surgical, and major medical plans but does not cover self-insured plans or employees covered by federal COBRA. Continuation is not available to any person:
• Who, within 31 days of termination, is or could be covered by any other group hospital, surgical, or medical coverage;
• Whose insurance terminated because of fraud; or
• Whose insurance terminated because he or she failed to pay any required contribution for the insurance.
Continuation does not have to include dental, vision care, or any other benefits provided under the group policy in addition to its hospital, surgical, or major medical benefits. The continued policy must cover all dependents covered under the group policy.
To be eligible for continuation under Louisiana law, an individual must have been covered for at least three months before the event resulting in the loss of group coverage. Individuals who lose coverage because of the following events are entitled to 12 months of continuation coverage:
• Termination of employment;
• Divorce and legal separation from the employee; or