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Is Vision a Core Benefit Under COBRA?

Consolidated Omnibus Budget Reconciliation Act, or COBRA, applies to group health insurance coverage provided by an employer. It does not pertain to an individual health insurance plan you purchase on your own. If you are eligible to elect COBRA coverage, you may opt to continue vision care if your initial group plan included this coverage. Although the cost of COBRA can be expensive, it may be better than the alternative of having no insurance.

  1. Core Benefits

    • According COBRA, former employees, retirees and their spouses and dependent children are eligible for temporary continuation of health care coverage at group rates. Although generally less expensive than individual health insurance coverage, COBRA coverage costs more than group coverage for active employees. Qualified employees and family members have up to 60 days to decide whether to continue coverage. COBRA coverage applies to group health plans for employers with 20 or more employees. Core benefits usually include hospitalization and outpatient hospital care, physician services, surgery, major medical and prescription drug benefits.

    Non-Core Benefits

    • Coverage for vision and dental services is usually considered a non-core benefit under COBRA. In some states, vision and dental services are mandatory under state law. Vision coverage is then considered a core benefit. When a plan provides coverage for both core and non-core benefits, a qualified beneficiary may choose to continue the entire benefits package or select to continue only the core medical benefits. Sometimes an employer offers bundled coverage in which case non-core benefits are part of the major medical plan. Otherwise, individual coverage plans that offer vision may include dental and vision, medical and vision, or vision only. If vision is a non-core benefit, you do not have to select the coverage.

    General Guidelines

    • Under the law, an employer must offer a former or retired employee and his qualified beneficiaries the same health insurance benefits that active employees receive. The former or retired employee only has the right to waive COBRA coverage for himself. He cannot waive coverage for a qualified beneficiary. Unless insurance plans are bundled rather than offered as optional, you can select some or none of the plans under COBRA coverage. This allows you to continue vision coverage if you can afford the additional premium cost.

    Losing COBRA Coverage

    • COBRA coverage ends if you fail to pay your premiums or your policy expires. If you are age 65 or older or permanently disabled, you qualify to receive Medicare benefits, which will terminate your COBRA coverage. Your COBRA coverage will also end if your former employer goes out of business or no longer offers group health insurance as a benefit to employees. You may be able to obtain group health insurance that includes vision coverage through another employer.

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