North Carolina Medical Society
Sentinel Benefits Consulting

Consolidated Omnibus Budget Reconciliation Act (COBRA)

Federal COBRA Continuation Law applies to employer groups that had 20 or more total employees for 50% of the business days in the preceding calendar year. This law generally allows eligible enrollees the right to continue coverage under the employer group health plan for up to 18 months after they are no longer employed by your group. Special circumstances may extend coverage up to 36 months. Stiff penalties may be imposed on groups that do not comply with this legislation.

COBRA Services

The NCMS Plan has chosen Flores & Associates to assist groups in providing COBRA compliance services. When a group initially enrolls with the NCMS Plan, and is COBRA compliant, the NCMS Plan will forward the information to Flores to set up a COBRA account. It usually takes about 1 month for the group to receive their welcome kit from Flores. The kit includes a 1,2,3 booklet, COBRA procedures manual, a rate sheet, continuant takeover forms, and COBRA notification forms.

Service Summary:

  1. Support of billing of continuants (employee or dependents)
  2. Report maintenance and forwarding of premiums to group administrators
  3. Process disability extension requests
  4. Advise groups of legal changes
  5. Provide reports to group administrators
If your group chooses not to utilize the services of Flores, your benefit administrator is responsible for tracking COBRA membership and collecting fees from members. Neither Flores, the NCMS Plan, nor BCBSNC assume any responsibility for your group’s COBRA administration if an administrator other than Flores is chosen.

State Continuation Coverage

North Carolina State Continuation allows terminated employees and members of a group that is exempt from Federal COBRA continuation to continue coverage under their employer’s group health plan when they terminate employment or lose their eligibility under the group health plan. Upon termination or other loss of eligible status, employees and their dependents have the option to continue group coverage for 18 months from the date they cease to be eligible for coverage under the group health plan.

Employees are not eligible for continuation under state law if:

  1. The employee’s insurance is terminated because he/she failed to make the appropriate contribution.
  2. The employee or his/her dependents requesting continuation are eligible for another group health benefit plan.
  3. The employee was covered less than three consecutive months prior to termination.

The member must notify the group of his/her intention to continue coverage and pay any applicable fees within 60 days following termination of eligibility. Upon receiving the notice of continuation and any applicable fees, the NCMS Plan will reinstate coverage back to the date eligibility ended. The state law continuation benefits run concurrently and not in addition to any applicable federal continuation rights.

State Continuation coverage will end after 18 months, or earlier, if:

  1. The employer ceases to provide a health benefit plan to employees. 
  2. The continuing person fails to pay the monthly fee.
  3. The continuing person obtains similar coverage under another group plan.

How To Get Started

To learn more about COBRA services through Flores or if you have questions about State Continuation Coverage contact: