For a disability extension to be available, the following criteria must occur:
1) The qualifying event must be attributed to termination of employment or a reduction in hours; and
2) A qualified beneficiary must be considered disabled by the Social Security Administration at any time during the first 60 days of COBRA coverage; and
3) The qualified beneficiary must notify the plan administrator of the disability determination within 60 days after the latest of a) the date of the Social Security disability determination, b) the date of the qualifying event, c) the date of the loss of coverage associated with the qualifying event, or d) the date the qualified beneficiary is informed of the requirement to provide notice of a disability, such as through the COBRA Initial Notice or a Summary Plan Description (SPD); and
4) The qualified beneficiary must provide notice to the plan administrator before the end of the 18-month period following the qualifying event.
Although the primary purpose of the extension of coverage is to allow the disabled qualified beneficiary to remain on COBRA until they are eligible for Medicare, the disability extension applies to all qualified beneficiaries. That means all family members who had coverage at the time of the qualifying event are eligible to receive an extra 11 months of COBRA coverage, not just the disabled family member. This is true even if the disabled family member does not elect COBRA because the extension applies independently to each of the qualified beneficiaries. This is confirmed in Treas. Reg ยง54.4980B-8 Q/A-1(b), Example 2.
During the first 18 months of COBRA coverage that are attributed to a loss of coverage because of termination of employment or a reduction in hours, the plan administrator may charge qualified beneficiaries up to 102% of the plan premium. During the 11-month disability extension, the plan administrator may charge qualified beneficiaries up to 150% of the plan premium.
It should be noted that a disability extension is not the only way that the maximum duration of COBRA coverage can be extended. For example, there could be secondary qualifying events that occur, but those topics are not addressed in this article.
