Continuation of Coverage

COBRA Premium Schedule  |  COBRA Health Benefits Enrollment Form

If you take a leave of absence without pay (LAWP), or leave University service, or if one of your dependents becomes ineligible to continue coverage under the University Health Benefits Program, you or your dependent may be eligible to continue health benefits coverage under a variety of regulations.

If you are on a short term LAWP (two pay periods or less for employees who are paid bi-weekly), you must continue all benefits and you will be billed by the Employee Benefits Division for your missed premiums. You will be sent a bill for 100% of the premium because you are not eligible, during a short term LAWP, to receive the University subsidy.

If your short term LAWP is due to a job-related accident or injury or approved family medical leave, you are entitled to a University subsidy and are responsible for the employee share of the premium only. Contact the Office of Employee Benefits and request a staff member to return the no-pay bill to the State Employee Benefits Division along with a copy of the first report of accident or injury or family medical leave approval, a retroactive adjustment form, and your check for your share of the premiums.

If you are on leave of absence without pay for more than two bi-weekly pay periods (including employees on suspension pending charges for removal), your leave is considered a long-term LAWP. If you are on an approved long-term LAWP, you may elect to continue or discontinue health insurance for the duration of the LAWP.

You must complete a COBRA/LAWP enrollment form and submit it to the Office of Employee Benefits. This form should be completed as soon as you know you will miss two pay periods or more. The form will not be accepted any later than 60 days after the effective date of the LAWP.

You may continue any or all health benefits options, and you may reduce your coverage level when enrolling for LAWP benefits. Otherwise, you are subject to the same limitations in changing coverage as an active employee.

When enrolled in LAWP, the employee is responsible for 100% of the premium unless the LAWP is due to a job-related accident or injury or approved family medical leave. An employee on long term LAWP due to a job-related accident or injury or family medical leave is entitled to the University subsidy. In this case, the Office of Employee Benefits must have the Fiscal Officer complete the applicable section of the COBRA/LAWP Enrollment Form. You will be billed by the Employee Benefits Division for the appropriate amount due.

Note: If you discontinue your coverage during a long-term LAWP, you may not re-enroll if you return to University service within the same year that you took your leave of absence.

Under the provisions of the Federal Consolidated Omnibus Budget Reconciliation Act (COBRA), you, or your departments may elect to continue health benefits (medical, prescription, vision, and dental) when certain qualifying events occur.


To enroll in COBRA, you must complete and sign a COBRA/LAWP Enrollment Form and return it to the Employee Benefits Division within 60 days of the qualifying event. You will then be billed by the Employee Benefits Division for Continuation
of Coverage premiums. These bills are in the form of pre-printed coupons
for each month of coverage. The COBRA participant must certify that the participant is not covered, and is not eligible to be covered, under another group health plan.

Conversion Privilege:

When Active, LAWP or COBRA eligibility ends, and you
have exhausted the continuation of coverage options available as described
above, you may be eligible to convert your coverage to a non-group health
insurance policy, billed directly through the health care