COBRA Glossary

Certificate of
Creditable Coverage

A written certificate issued by a group health plan or health insurance issuer that shows an individual’s creditable coverage (see definition below) under the plan. A certificate must be issued automatically and free of charge when an individual loses coverage under a plan, when an individual is entitled to elect COBRA continuation coverage, and when an individual loses COBRA continuation coverage. A certificate must also be provided free of charge upon request while the individual has health coverage or within 24 months after their coverage ends. ERISA § 701(e) and 29 CFR 2590.701-5.
 

Creditable Coverage

Health coverage of an individual under: a group health plan, (including while on COBRA continuation coverage), health insurance coverage, Medicare, Medicaid, a state health benefits risk pool, a public health plan, and certain other health programs. ERISA § 701(c) and 29 CFR 2590.701-4.
 

ERISA
(Employee Retirement
Income Security Act
of 1974)

ERISA is a federal law that regulates employee benefit plans, such as group health plans, that private sector employers, employee organizations (such as unions), or both, offer to their workers and families.
 

Enrollment Date

The first day of coverage or, if there is a waiting period, the first day of the waiting period. For individuals who enroll when first eligible, the enrollment date is often the first day of employment. ERISA § 701(b)(2) and 29 CFR 2590.701-2.
 

Genetic Information

Information about genes, gene products and inherited characteristics that may derive from the individual or a family member. This includes information regarding carrier status and information derived from laboratory tests that identify mutations in specific genes or chromosomes, physical medical examinations, family histories and direct analysis of genes or chromosomes. 29 CFR 2590.701-2.
 

Group Health Plan

An employee benefit plan established or maintained by an employer or by an employee organization (such as a union), or both, to the extent that the plan provides medical care to employees or their dependents directly or through insurance, reimbursement or otherwise. ERISA § 733(a) and 29 CFR 2590.701-2.
 

Health Insurance Issuer

An insurance company, insurance service, or insurance organization, (including a health maintenance organization), that is required to be licensed to engage in the business of insurance in a State and that is subject to State law that regulates insurance. ERISA § 733(b)(2) and 29 CFR 2590.701-2.
 

Late Enrollee

An individual who enrolls in a group health plan on a date other than on either the earliest date on which coverage can begin under the plan terms or on a special enrollment date (see definition below). Under HIPAA, a late enrollee may be subject to a maximum pre-existing condition exclusion of up to 18 months. 29 CFR 2590.701-3(a)(iii) and (iv).
 

Pre-existing
Condition Exclusion

A limitation or exclusion of benefits for a condition based on the fact that the condition was present before the first day of coverage. A pre-existing condition exclusion may be applied to the condition only if the requirements of ERISA section 701 and 29 CFR 2590.701-3 through 2590.701-5 are met.
 

Special Enrollment

Special enrollment allows certain individuals who are otherwise eligible for coverage to enroll in the plan, regardless of the plans’s regular enrollment dates. Special enrollment rights may be triggered upon loss of eligibility for other coverage (including loss of employer contributions toward other coverage), marriage, birth of a child, adoption, and placement for adoption. ERISA § 701(f) and 29 CFR 2590.701-6.
 

Waiting Period

The period that must pass before an employee or dependent is eligible to become covered under the terms of a group health plan. If a employee or dependent enrolls as a late enrollee or on a special enrollment date, any period before the late or special enrollment is not a waiting period. ERISA § 701(b)(4) and 29 CFR 2590.701-2.