COBRA’s Interaction With HSAs, HRAs and FSAs

The Consolidated Omnibus Budget Reconciliation Act of 1985, better known as COBRA, became law on April 7, 1986. The law provides for continuation of health coverage from an employer-sponsored group health plan after an employee experiences a qualifying event like a job termination or reduction in hours or a personal life change like a divorce or a dependent turning age 26. Even though the rules for COBRA have been in place for more than 30 years, there are still questions that arise related to employee benefit plans.

COBRA’s Interaction With HSAs, HRAs and FSAs

COBRA generally applies to plans covering 20 or more employees and affects private and public sector employers. In addition, many states require employers with fewer than 20 employees to offer a “mini-COBRA” plan with many similar features to the federal COBRA requirements. 

In recent years, plan sponsors may have questions about the interaction of COBRA with account-based plans like health savings accounts (HSAs), health reimbursement arrangements (HRAs) and flexible spending accounts (FSAs). While there have been regulatory changes in 2020 that affect COBRA, the below Q&As still apply to questions about how COBRA interacts with HSAs, HRAs, and FSAs.

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Health Savings Accounts (HSAs):

Q. If an employee elects COBRA, can he or she still contribute to an HSA?

A. Yes. Employees can contribute to an HSA if they are still covered by an HSA qualified, high deductible health plan.

Q. Our company sponsors an HSA contribution for all active employees. If an employee elects COBRA, is the employer still required to make their contribution?

A. No. The employer is not required to continue the contribution after the employee terminates. The HSA itself is not a medical plan and is not covered by COBRA.

Q. If an employee elects COBRA, can HSA funds be used to pay for COBRA premiums?

A. Yes. The premiums for health care continuation coverage under COBRA are considered an eligible medical expense, and payment of the premiums can be made using HSA funds.

Health Reimbursement Arrangements (HRAs):

Q. Our company offers an HRA. If an employee terminates, are we required to offer COBRA for the HRA? If so, how do we know how much to charge for the premium?

A. The HRA is considered to be a self-insured medical plan, so the employer is required to extend COBRA rights.

At the beginning of each plan year, the employer should calculate a reasonable premium for the HRA, for both single and family coverage. The Internal Revenue Service (IRS) has defined two methods for determining the COBRA premium:  the actuarial method and the past-cost method. Also, many employers rely on their third-party administrator (TPA) or insurance company to assist with calculating the premium amount.

Q. If an employee elects COBRA and had an unused balance in his or her HRA, what happens to the balance?

A. The employee must have access to the unused balance and any additional accruals provided to similarly situated employees, less any year-to-date reimbursements.

Q. If an employee elects COBRA, can the HRA funds be used to pay for COBRA premiums?

A. Generally, yes, if the plan is set up to accommodate this. It’s always a good idea to confirm with the plan administrator or TPA and refer to the summary plan description (SPD).

[Related Reading: Medicare and COBRA Coordination During COVID-19]

Flexible Spending Accounts (FSAs)

Q. Our company offers an FSA. If an employee terminates, are we required to offer COBRA for the FSA? 

A. Yes. The FSA is considered to be a medical plan, so COBRA rights must be extended.

Q. Why would an employee want to continue the FSA when electing COBRA?

A. Employees who have a balance in their FSA and then terminate employment may want to continue the plan so that they do not have to forfeit their accumulated funds. If they continue to pay premiums and incur expenses before the end of the plan year, they can claim their reimbursement.

Q. If an employee elects COBRA, can FSA funds be used to pay COBRA premiums?

A. No. COBRA premiums cannot be paid with either a traditional FSA or a Limited-Purpose FSA.

Learn More

Enroll today in the International Foundation e-learning courses:

To review more on COBRA, the Department of Labor (DOL) has published two comprehensive guides, one for employers and one for employees.  Two IRS publications may also be handy to have: IRS Publication 969 and IRS Notice 2002-45.

Anne Newhouse, CEBS
Anne Newhouse, CEBS
Information/Research Specialist at the International Foundation of Employee Benefit Plans

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