COBRA (Consolidated Omnibus Budget Reconciliation Act) allows you or a dependent covered under medical, dental, vision and/or health care Flexible Spending Accounts benefits to continue coverage when it is lost due to any of the following qualifying status changes:
- Termination of employment (for reasons other than gross misconduct)
- A reduction in the number of hours of employment that affects benefits eligibility
- Divorce or legal separation/termination of eligible same-sex domestic partnership
- Employee’s death (for eligible dependents)
- Child ceases to be eligible for coverage
Optum Financial is the administrator of COBRA for the State System.
Customer Service available 24 hours a day, 7 days a week
1-855-687-2021
COBRA Rates Dependent Eligibility
COBRA Open Enrollment - May 6-24, 2024
Open Enrollment is your only opportunity outside of a life event to change your COBRA coverage.
If you want to remain in the same medical plan and cover the same dependents, no action is required.
To change or drop coverage, please complete the enrollment form and return to:
PassheEmployeeBenefits@passhe.edu or:
PA State System of Higher Education
Benefit Department - COBRA OE
2300 Vartan Way, Suite 207
Harrisburg, PA 17110
7/1/24 Rates Enrollment/Change Form
If you are in a retiree plan (AHCP) under COBRA, contact RetireeBenefitHelp@passhe.edu for new rates.
Qualifying Event | Length of Coverage |
Reduction in number of hours of employment | 18 months |
Termination of employment | 18 months |
Divorce, or legal separation | 36 months |
Death of covered employee | 36 months |
Loss of dependent status | 36 months |
Once you receive your packet of information from OptumFinancial, you have 60 days from the date of notice to make your COBRA benefit elections. If electing to continue your coverage, you will be retroactively covered back to the date immediately after the termination of your loss in benefits.
Premiums are due by the first of each month. Premiums will be adjusted each July 1. Please keep in mind that there is a 2% administration fee added to the premiums.
Coverage may be terminated earlier if:
- Premiums are not paid on time;
- Voluntary termination
- Coverage is obtained through another group health plan that does not have any pre-existing condition limitation or exclusion. If such coverage is obtained prior to COBRA election, the COBRA coverage may not be terminated early;
- A qualified beneficiary ceases to be disabled during the period of extended coverage.
Plan Information
Plan information varies depending on what employee group you were in as an active employee. View the pages below for the information applicable to you and your group number.
Group Numbers 025079-02, 03, 04, or 05
- PPO Plan Information
- HMO Plan Information (only applies to those previously enrolled)
Summary of Benefits and Coverage (SBC) |
Annual Notices and Disclosures |
Nonrepresented, Nurses, Security/Police |