COBRA Qualifying Events

19 November 20, 2025
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COBRA Qualifying events (QEs) are the situations that cause someone to lose eligibility for their employer-sponsored health coverage. QEs determine:

  • When coverage must end
  • Whether COBRA (or state continuation) applies
  • How long continuation lasts
  • What the employer must do next (notices, timelines, elections, billing, etc.)

QEs drive both plan eligibility rules and COBRA continuation rights – they connect the two.

Note: HIPAA special enrollment events (e.g., marriage, birth, adoption, loss of other coverage) are different. HIPAA applies when someone is still eligible for the group health plan and needs mid-year enrollment or plan changes – not when coverage is lost. Those rules are covered in the HIPAA Special Enrollment Events section.

What Makes an Event a “Qualifying Event” for COBRA?

For COBRA to apply, all the following must be true:

  1. The employer is subject to federal COBRA (or state “mini-COBRA”),
  2. The employee or dependent was covered under the plan the day before the event, and
  3. A qualifying event occurs that causes a loss of eligibility under the plan.

Employee Qualifying Events

These events affect the employee and all enrolled dependents.

  1. Voluntary resignation
    • Coverage ends under the plan → COBRA applies.
  1. Involuntary termination (other than gross misconduct)
    • Gross misconduct” is extremely rare and difficult to prove. Employers should consult legal counsel before denying COBRA. Most offer COBRA continuation even when they believe misconduct occurred.
  1. Reduction in hours
    • Any change that causes a loss of eligibility, including:
      • Full-time → part-time
      • Moving to per diem or on-call (check ERISA plan documents for eligibility rules)
      • Leave of absence not protected by FMLA or other state law
  1. Medicare entitlement (in limited cases)
    • If the employee enrolls in Medicare and the plan changes or ends coverage for dependents, the dependents may have a QE. This is plan-specific, and relatively common.

Dependent-Only Qualifying Events

These QEs do not affect the employee’s own eligibility – only the dependents’.

  1. Divorce or legal separation
    Coverage must end for the former spouse as of the official date (never before).
  1. Dependent child reaches limiting age of the plan
    Age 26 for medical (dental/vision may vary). This is an ACA rule applicable to all ACA-compliant group health plans.
  1. Death of the employee
  2. Employee becomes entitled to Medicare

In many plans, dependents lose eligibility once the employee enrolls in Medicare.

Events That Are Not Qualifying Events

These do not trigger COBRA:

  • Change of insurance carriers
  • New plan year
  • Employee becomes eligible for Medicare with no change to plan coverage
  • Reduction in hours that does not cause a loss of eligibility
  • Employee moves to a new residence if the plan still covers that area

Understanding non-QEs prevents a huge amount of confusion.

Qualifying Events During Leave of Absence (LOA)

A leave of absence only becomes a QE if it causes a loss of eligibility under the employer’s plan.

When LOA Does Not Trigger a QE

There is no QE when:

  • The employee remains eligible during the leave under the plan or employer policy, and
  • Coverage continues during the leave

Examples (no QE):

  • FMLA leave when the plan maintains eligibility for the full FMLA period
  • State-protected leaves with similar eligibility protections
  • Company policy that keeps employees eligible during medical, parental, or other leaves
  • Paid LOAs where hours do not impact eligibility

In these cases, there is no loss of coverage → no COBRA.

When LOA Does Trigger a QE

An LOA becomes a QE when:

  • The employee no longer meets the plan’s eligibility rules, and
  • Coverage ends while the employee is still out on leave, and
  • The leave is not protected by a law that requires continuation of benefits

Examples (QE):

  • Non-FMLA LOA that causes the employee to drop below eligibility
  • Extended medical leave beyond the employer’s allowed eligibility window
  • Zero hours on an unpaid LOA when the plan covers “active full-time only”
  • FMLA exhausts (after 12 weeks), and the plan ends active coverage the next day

Loss of eligibility → COBRA begins.

Note: Leave laws are complex and may apply differently depending on state and circumstances. Employers should consult legal counsel to apply the right rules to their specific situation.

When Does Coverage End? (The Trigger for COBRA)

Coverage typically ends:

  • End of the month of the event (most common),
  • End of the pay period, or
  • Immediately – depending on the employer’s eligibility rules outlined in ERISA plan document.

COBRA always begins the day after coverage ends, with no gap, as long as COBRA is elected and paid on time.

Plan Termination and COBRA

COBRA continuation is only available while the employer continues to offer a group health plan. If the employer terminates the plan entirely (for example, moving all employees to an individual coverage arrangement or eliminating the medical plan), COBRA cannot continue because there is no underlying plan to continue.

If an individual requests COBRA in this situation, the employer must send a COBRA Notice of Unavailability explaining why continuation is not available.

Special Notes

State continuation

State rules may have different QEs.
Examples:

  • Some include domestic partners
  • Some extend coverage after federal COBRA ends in certain situations (e.g., Cal-COBRA)
Domestic partners

Federal COBRA does not recognize domestic partners, but state laws and carrier contracts sometimes do.

Medicare timing

Medicare can impact dependents differently under COBRA than under employer coverage. Timing matters.