6.2 Florida COBRA and State Continuation Rights

Two Continuation Systems

When group health coverage would otherwise end, a qualified beneficiary can keep the same plan temporarily by paying the premium themselves. Florida residents fall under one of two laws based on employer size.

COBRA does not apply to employers under 20 employees, the federal government, or certain church plans. Self-funded small-employer plans are exempt from Florida's insurance-based state continuation, which is one reason small businesses are nudged toward fully insured products.

COBRA Qualifying Events and Duration

The maximum continuation period depends on the qualifying event and who lost coverage.

Extensions

• Disability extension: if the SSA deems any qualified beneficiary disabled within the first 60 days of an 18-month period, all beneficiaries may extend to 29 months (an extra 11 months).
• Second qualifying event: a second event during an 18-month period can extend a dependent to 36 months total.

Exam tip: 18 months = employee-side events (termination, reduced hours). 36 months = family-side events (death, divorce, Medicare, child aging out).

Notice, Election, and Payment Deadlines

COBRA runs on a chain of strict clocks; missing any of them forfeits the right.

Employer / Plan Administrator Duties

Qualified Beneficiary Duties

Premiums

The critical counseling point: the 102% figure is built on the full premium — employer share plus employee share — not just the payroll deduction the employee used to see. A worker paying $120/month at work may face $700+/month on COBRA.

Florida State Continuation

For fully insured groups under 20 employees, Florida s. 627.6692 provides parallel continuation:

Exam tip: Florida mini-COBRA election is only 30 days, shorter than federal COBRA's 60 days — a frequent distractor.

When Continuation Ends and How It Interacts

Termination Triggers

COBRA vs. Medicare

If a person already has Medicare when they elect COBRA, COBRA is generally secondary to Medicare. A worker cannot be forced to take COBRA in place of Medicare. Enrolling in COBRA instead of timely Medicare can create lifelong Part B late-enrollment penalties, so producers should flag the Medicare special enrollment period.

Producer Counseling Checklist

When a client is COBRA-eligible, walk through every alternative:

1. Calculate the true cost — 102% of the full premium, not the old payroll share.
2. Compare the ACA Marketplace — loss of job-based coverage is a special enrollment event, and premium tax credits may make a Marketplace plan far cheaper than COBRA.
3. Check a spouse's plan — special enrollment opens within 30 days.
4. Evaluate Medicaid / Florida Healthy Kids if income now qualifies.
5. Watch the deadlines — 60 days to elect, 45 to pay first premium, 30-day grace thereafter.

Exam tip: Electing COBRA is irrevocable for the month paid, but a beneficiary can drop COBRA later to take a Marketplace plan only during open enrollment or a qualifying event — not whenever they like.

Conversion at the End of Continuation

When the maximum continuation period finally runs out, the qualified beneficiary is not automatically uninsured. If the underlying group health contract includes a conversion privilege, Florida lets the person convert to an individual health policy at the end of COBRA or state continuation without proving insurability, much like the 31-day group life conversion right covered in Section 6.1. The converted health plan is individually rated at attained age and is often more expensive than the group rate, but it guarantees a fallback for someone who cannot pass underwriting.

Because ACA individual plans are now guaranteed-issue, most clients exiting COBRA simply move to a Marketplace plan during their special enrollment window rather than convert — but the conversion right still exists and the exam may test it as the answer for a client who missed Marketplace enrollment.

Who Is a 'Qualified Beneficiary'

COBRA rights run only to a qualified beneficiary — a person covered under the group plan the day before the qualifying event. This includes the covered employee, the spouse, and dependent children, and it also includes a child born to or adopted by the covered employee during the COBRA period. A new spouse married after the qualifying event may be added to the electing beneficiary's COBRA coverage but is not an independent qualified beneficiary, so the new spouse cannot continue COBRA on their own if the original beneficiary drops it.

Worked example. Maria is laid off (18-month event) and elects COBRA for herself and her two children. Six months later she gives birth; the newborn is automatically a qualified beneficiary entitled to the remaining COBRA months. If Maria then dies in month 10, that death is a second qualifying event for the children, extending their continuation to a full 36 months from the original event — not a fresh 36-month clock. Candidates who restart the clock at 36 from the death miss this.

Florida-Specific Counseling Traps

• Florida mini-COBRA (under-20 groups) gives only a 30-day election window and runs 18 months at up to 115% of the group rate — both numbers differ from federal COBRA (60 days, 102%/150%, up to 36 months).
• COBRA covers health benefits (medical, dental, vision, prescription, and health FSAs in limited cases) — it does not continue group life or disability coverage; those follow their own conversion provisions.
• An employee terminated for gross misconduct has no COBRA right at all — a fact pattern the exam uses to make all the duration numbers irrelevant.

Exam tip: COBRA = health only, never life or disability. Mini-COBRA = 30 days / 115% / 18 months. Gross misconduct = no continuation.