State COBRA expansion programs extend coverage to employees in firms with fewer than 20 workers who are not covered by COBRA, the federal law. Coverage under these state continuation programs may differ in duration, restrictions, and eligibility from the coverage provided to workers under the federal law.

Data as of January 2009. Data compiled through review of state laws and regulations and interviews with state health insurance regulatory staff. For more detailed information on consumer protections in any state see Georgetown University's "Consumer Guides For Getting and Keeping Health Insurance" available at http://www.healthinsuranceinfo.net/.

Data collection and analysis by researchers at the Health Policy Institute, Georgetown University.

COBRA: Consolidated Omnibus Budget Reconciliation Act of 1985. COBRA amended the Employee Retirement Income Security Act of 1974 to require temporary group continuation health insurance for employees and their dependents. The federal law applies only to employees in firms with 20 or more workers.

Maximum Duration of Continuation Coverage: Actual duration of state continuation coverage may be less depending on the qualifying event.

Rating Restrictions: Percentage of the Group Rate: Under all state continuation coverage laws, the person electing continuation coverage must pay the entire premium (employee and employer) share and, in some states, an administrative fee. The added administrative fee varies from state to state but is typically 2% of the total premium. Similar to the federal COBRA provisions, many states permit insurers to charge much higher premiums (typically 150% of the group rate) for those electing state continuation coverage because disability. These states are not reflected on the charts.

1. Maximum Duration of Continuation Coverage: Actual duration of state continuation coverage may be less depending on the qualifying event. Rating Restrictions: Percentage of the Group Rate: Under all state continuation coverage laws, the person electing continuation coverage must pay the entire premium (employee and employer) share and, in some states, an administrative fee. The added administrative fee varies from state to state but is typically 2% of the total premium. Similar to the federal COBRA provisions, many states permit insurers to charge much higher premiums (typically 150% of the group rate) for those electing state continuation coverage because of disability. These states are not reflected on the charts.
2. States without Continuation Coverage for Small Firms: Alabama, Alaska, Arizona, Delaware, Idaho, Indiana, Michigan, Montana, Pennsylvania, Virginia, Washington. In Virginia, insurers have the option of offering either continuation or conversion coverage. In Washington, insurers are required to offer employers the option of having a continuation coverage provision, however, continuation coverage is not mandated in group policies.
3. In Idaho, except extension of benefits up to 12 months for individuals that are pregnant or disabled, generally there is no continuation coverage.
4. Six states have continuation laws that extend, for certain individuals (generally 55 and older), continuation coverage to the time when the individual is eligible for Medicare. These states include Illinois, Louisiana, Maryland, Missouri, New Hampshire, Oregon, In addition, in New Mexico, group plans offered through the New Mexico Health Insurance Alliance continue coverage indefinitely.
5. In these states, group carriers have the discretion not to continue coverage for certain coverage benefits such as prescription drug coverage, dental benefits and vision benefits.
6. The New Mexico Health Insurance Alliance permits some individuals to continue to maintain Alliance coverage indefinitely. In order to be eligible an individual must have maintained Alliance group coverage for 6 months and no longer be eligible for this coverage for almost all reasons (i.e. loss of employment, loss of policy, aging off parents' policy, death, divorce). Premiums for continuation coverage through the Alliance are about 9 percent higher than typical group premiums.
7. In North Dakota, except in the case of divorce, continuation coverage lasts 39 weeks. In the case of divorce, continuation coverage can last up to 36 months and insurers are permitted to charge 102% of the group rate.
8. Oklahoma: Information applies to non-HMO plans. Longer periods of extension (3-6 months) for those undergoing treatment or pregnancy at termination of coverage. HMOs required to extend coverage through pregnancy or ongoing inpatient treatment.
9. In Oregon, in the case of separation, divorce, or death of the insured, insurers are permitted to charge 102% of the group rate.
10. In South Dakota, the premium to continue coverage after 18 months increases to 150%.