Pennsylvania COBRA and Mini-COBRA Guide for 2025

COBRA ensures that employees and families of employees still have access to employer-provided healthcare benefits for a limited period of time under specific circumstances and life-changing events.

The general purpose behind state-specific COBRA laws is so that employees of smaller businesses that are not covered by federal COBRA are still guaranteed continuation of coverage.

PA Mini-COBRA Overview

When employees experience what is known as a qualifying event, COBRA ensures that he to she has access to continued coverage for a certain period of time.

PA Mini-COBRA is a Pennsylvania law that extends COBRA coverage to small businesses, specifically businesses with 2-19 employees. Mini-COBRA allows eligible employees and his or her dependents to purchase health insurance through a former employer for up to nine months after coverage would otherwise end.

PA Mini-COBRA Eligibility Requirements

To qualify for mini-COBRA coverage, the employees and dependents must have been continuously insured under a group policy, or a similar policy it replaced, for the three consecutive months leading up to the qualifying event.

There are certain people that are not eligible for Pennsylvania Mini-COBRA. Continuation coverage is not available for anyone who:

• Is covered or is eligible for coverage under Medicare
• Fails to verify ineligibility for employer-based group health insurance as an eligible dependent
• Is covered or could be covered by any other insured or uninsured group health coverage arrangement under which the person was not covered immediately prior to such termination. (This does not include Medical Assistance, also known as Medicaid, or CHIP, the Children’s Health Insurance Program. If a person is eligible for either of those programs, but not enrolled, that does not prevent the person from being eligible for Mini-COBRA)

PA Mini-COBRA Qualifying Events

A qualifying event is an event that results in the loss of health insurance coverage for a covered employee, spouse, or eligible dependent. Depending on the particular person, qualifying events may differ.

Employees

Qualified employees working for qualified employers must experience one of the following qualifying events in order to qualify for Pennsylvania Mini-COBRA coverage:

• Termination of employment (either voluntary or involuntary, but not for the employee’s gross misconduct)
• Reduction of hours
• Divorce or legal separation
• Covered employee’s eligibility for Medicare
• Bankruptcy of the employer

Spouses

Spouses of qualified employees working for qualified employers must experience one of the following qualifying events in order to qualify for Pennsylvania Mini-COBRA coverage:

• Death of the covered employee
• Termination of employment (either voluntary or involuntary, but not for the employee’s gross misconduct)
• Reduction of hours
• Divorce or legal separation
• Covered employee’s eligibility for Medicare
• Bankruptcy of the employer

Dependent Children

Dependent children of qualified employees working for qualified employers must experience one of the following qualified events in order to qualify for Pennsylvania Mini-COBRA coverage:

• Death of covered employee
• Termination of employment (either voluntary or involuntary, but not for the employee’s gross misconduct)
• Reduction of hours
• Divorce or legal separation
• Covered employee’s eligibility for Medicare
• Dependent child ceasing to be dependent
• Bankruptcy of the employer

How to Apply for PA Mini-COBRA

Employers must notify the plan administrator, the covered employee, and the insurer of a mini-COBRA-qualifying event within 30 days of the event. This Notice must include information on electing mini-COBRA. In addition, the administrator must inform the insurer of the employee’s, spouse’s, or dependent child’s mini-COBRA election within 14 days.

If an employee has chosen continuation of coverage, his or her eligible dependent must inform the plan administrator about the decision to continue coverage within 30 days of receiving notice of the qualifying event.

Who Pays for PA Mini-COBRA?

The mini-COBRA coverage is generally paid by the employee, the employee's spouse, or the employee's dependent child. The plan can charge for up to 105% of the total premium for the mini-COBRA coverage.

Pennsylvania COBRA Compliance Management

It’s a challenge for many businesses to ensure compliance in the state of Pennsylvania . The most common and efficient way to ensure compliance without investing too many company resources is to simply seek help from an HR and payroll service provider.

Contact one today to learn more about how seeking help from a Pennsylvania payroll and HR company can help you better manage your business, or to get help with HR and payroll services in your area, contact us today.