COBRA

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) gives UC employees and their covered family members the right to temporarily continue their UC-sponsored group health coverage in certain situations (known as “qualifying events”) that would ordinarily cause the individual to lose group health coverage.

The UC has contracted with CONEXIS, a third-party vendor, to provide COBRA admistration for the UC.

If you are terminating employment:
  • After your department processes your termination of employment action in the payroll system, you will receive a COBRA application packet from CONEXIS at your home address.
  • The COBRA application packet will contain information about your medical, dental, vision, health FSA, Staywell and/or EAP continuation options.

If you are continuing employment but are losing eligibility:

  • At the time your department processes your status change action in the payroll system, your department must complete and send to the Benefits Office the Notice of Employee COBRA Qualifying Event form (UBEN109A). Upon receipt, the Benefits Office will notify CONEXIS to issue a COBRA application packet to your home address.
  • The COBRA application packet will contain information about your medical, dental, vision, and/or Staywell continuation options.

If your family member loses eligibility, you must submit a UPAY850 and UBEN109 form to the Benefits Office.

  • The UPAY850 form is completed to de-enroll the family member from your insurance plans. The UBEN109 notifies UC that a qualifying event has occurred and where to send the COBRA application packet. Upon receipt, the Benefits Office will notify CONEXIS to issue a COBRA application packet to the family member's home address.
  • The COBRA application packet will contain information about medical, dental, vision, and/or Staywell continuation options.

Once you receive the COBRA application packet, you must return the Application for COBRA Continuation form to CONEXIS by the Application Due Date as specified in the packet or you will forfeit your COBRA rights.