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COBRA participant information


If you are signing up for COBRA benefits, consult the COBRA Benefits Guide. The following PDF is available here, or hard copies can be obtained by contacting the HR Service Center.

2024 Premiums

Medical- Healthy Savings Plan:

  • Self only: $484.50
  • Self and spouse: $1,065.90
  • Self and child(ren): $1,056.72
  • Self, spouse and child(ren): $1,715.64

Medical- Custom Network Plan:

  • Self only: $606.90
  • Self and spouse: $1,335.18
  • Self and child(ren): $1,322.94
  • Self, spouse and child(ren): $2,148.12

Medical- PPO Plan:

  • Self only: $831.30
  • Self and spouse: $1,828.86
  • Self and child(ren): $1,811.52
  • Self, spouse and child(ren): $2,942.70

Dental Base Plan:

  • Self only: $31.67
  • Self and spouse: $63.34
  • Self and child(ren): $76.87
  • Self, spouse and child(ren): $108.54

Dental Buy Up Plan:

  • Self only: $42.53
  • Self and spouse: $85.02
  • Self and child(ren): $122.94
  • Self, spouse and child(ren): $167.52


  • Self only: $5.16
  • Self and spouse: $10.28
  • Self and child(ren): $11.22
  • Self, spouse and child(ren): $17.76

Employee Assistance Program (EAP)

  • All coverage levels: $0.94

* "Self" may be a former employee, a spouse, a sponsored adult dependent, a widow/er, a surviving sponsored adult dependent, an ex-spouse, an ex-sponsored adult dependent, or a child.

Please Note: The premium rates shown above are applicable during the initial COBRA continuation period. Premiums for extended COBRA coverage (totally disabled individuals and certain surviving or divorced spouses) are higher and may be obtained from ASI Cobra. 

Continuation of Medical Plan coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

Federal law requires the plan to offer covered employees and dependents the opportunity to continue coverage when it ends for certain specified reasons. This law is called the Consolidated Omnibus Budget Reconciliation Act of 1985 — COBRA. The following provisions outline the requirements for continued coverage in accordance with the law. These provisions apply only to the extent that the required period of continued coverage has not already been provided under other plan provisions.

Eligibility for continued coverage

An employee and covered dependents may continue coverage for up to 18 months if coverage ends because of either a reduction in the number of hours worked or termination of employment for any reason other than gross misconduct.

Dependents may continue their coverage under the group plan for up to 36 months if their coverage ends for any of the following reasons:

  • Divorce or legal separation from the employee.
  • The death of the employee.
  • The dependent child reaches the limiting age or otherwise ceases to qualify as a dependent under the plan.

These periods of continued coverage begin on the date of the event that caused loss of coverage; for instance, the date you leave the University or the date a dependent becomes ineligible.

In no event will more than a total of 36 months of continued coverage be provided to any individual, even if more than one of the above events occur.

Continued coverage ends automatically if any of the following occurs:

  • The cost of continued coverage is not paid on or before the date it is due.
  • An individual becomes covered under another group plan unless coverage under that other plan is limited due to the individual's pre-existing condition.
  • An individual becomes entitled to Medicare.
  • The plan terminates for all employees.
  • The applicable maximum coverage period ends.

Extension of maximum coverage period

  • Disabled individuals — An exception applies if an employee or a dependent is determined to be totally disabled during the first 60 days of continued coverage due to reduction in hours worked or termination of employment. The maximum coverage period for the disabled individual will be 29 months, rather than 18 months. To be eligible for the extended period, the disabled individual must meet the definition of disability under the Social Security Act and notify the University during the first 18 months of continued coverage and within 60 days after the date of determination of disability has been made by Social Security. (The disabled individual is required to notify the University within 30 days after any final determination by the Social Security Administration that the individual is no longer disabled.)
  • Divorced or widowed spouses at least age 55 — Coverage can continue beyond the COBRA period if the continuation coverage under the plan expires when a divorced or widowed spouse is at least age 55. Coverage can continue for the spouse and eligible dependents until the spouse reaches age 65.

Application for continued coverage

When the university's human resources office is notified that one of these events has happened, you will be sent an election form notifying you of the conditions that apply to continued coverage.

However, in the event you become divorced or legally separated, or when your dependent child no longer qualifies as a covered dependent under the plan, you or your covered spouse or your covered child must notify the HR Service Center within 60 days. If you fail to do this, your dependent's rights to continued coverage will be forfeited.

Continued coverage is not automatic. You must submit the completed election form within 60 days from the later of the following dates:

  • The date you cease to be eligible under the group plan.
  • The date you receive the election form.

Cost of continued coverage

Any person who elects to continue coverage under the plan must pay on a monthly basis the total of that coverage plus any additional amount permitted by law. Your first payment for continued coverage must be made within 45 days of the date you sign the election form. Your payment must be sufficient to pay the applicable costs retroactive to the day following the event which caused coverage to end.

Benefits under continued coverage

Continued coverage will be exactly the same medical coverage you or your dependent would have been entitled to if your employment or his or her dependent status had not changed. Any future changes in the benefits or cost of coverage for the plan also will apply to you. A dependent child you acquire while covered by these provisions will also be entitled to coverage. The conversion privilege is available when the maximum period of continued coverage ends.

Forms and guides

Reviewed 2024-03-12


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