[Code of Federal Regulations]
[Title 26, Volume 17]
[Revised as of April 1, 2006]
From the U.S. Government Printing Office via GPO Access
[CITE: 26CFR54.4980B-2]

[Page 283-291]
 
                       TITLE 26--INTERNAL REVENUE
 
    CHAPTER I--INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY 
                               (CONTINUED)
 
PART 54_PENSION EXCISE TAXES--Table of Contents
 
Sec.  54.4980B-2  Plans that must comply.

    The following questions-and-answers apply in determining which plans 
must comply with the COBRA continuation coverage requirements:
    Q-1: For purposes of section 4980B, what is a group health plan?
    A-1: (a) For purposes of section 4980B, a group health plan is a 
plan maintained by an employer or employee organization to provide 
health care to individuals who have an employment-related connection to 
the employer or employee organization or to their families. Individuals 
who have an employment-related connection to the employer or employee 
organization consist of employees, former employees, the employer, and 
others associated or formerly associated with the employer or employee 
organization in a business relationship (including members of a union 
who are not currently employees). Health care is provided under a plan 
whether provided directly or through insurance, reimbursement, or 
otherwise, and whether or not provided through an on-site facility 
(except as set forth in paragraph (d) of this Q&A-1), or through a 
cafeteria plan (as defined in section 125) or other flexible benefit 
arrangement. (See paragraphs (b) through (e) in Q&A-8 of this section 
for rules regarding the application of the COBRA continuation coverage 
requirements to certain health flexible spending arrangements.) For 
purposes of this Q&A-1, insurance includes not only group insurance 
policies but also one or more individual insurance policies in any 
arrangement that involves the provision of health care to two or more 
employees. A plan maintained by an employer or employee organization is 
any plan of, or contributed to (directly or indirectly) by, an employer 
or employee organization. Thus, a group

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health plan is maintained by an employer or employee organization even 
if the employer or employee organization does not contribute to it if 
coverage under the plan would not be available at the same cost to an 
individual but for the individual's employment-related connection to the 
employer or employee organization. These rules are further explained in 
paragraphs (b) through (d) of this Q&A-1. An exception for qualified 
long-term care services is set forth in paragraph (e) of this Q&A-1, and 
for medical savings accounts in paragraph (f) of this Q&A-1. See Q&A-6 
of this section for rules to determine the number of group health plans 
that an employer or employee organization maintains.
    (b) For purposes of Sec. Sec.  54.4980B-1 through 54.4980B-10, 
health care has the same meaning as medical care under section 213(d). 
Thus, health care generally includes the diagnosis, cure, mitigation, 
treatment, or prevention of disease, and any other undertaking for the 
purpose of affecting any structure or function of the body. Health care 
also includes transportation primarily for and essential to health care 
as described in the preceding sentence. However, health care does not 
include anything that is merely beneficial to the general health of an 
individual, such as a vacation. Thus, if an employer or employee 
organization maintains a program that furthers general good health, but 
the program does not relate to the relief or alleviation of health or 
medical problems and is generally accessible to and used by employees 
without regard to their physical condition or state of health, that 
program is not considered a program that provides health care and so is 
not a group health plan. For example, if an employer maintains a spa, 
swimming pool, gymnasium, or other exercise/fitness program or facility 
that is normally accessible to and used by employees for reasons other 
than relief of health or medical problems, such a facility does not 
constitute a program that provides health care and thus is not a group 
health plan. In contrast, if an employer maintains a drug or alcohol 
treatment program or a health clinic, or any other facility or program 
that is intended to relieve or alleviate a physical condition or health 
problem, the facility or program is considered to be the provision of 
health care and so is considered a group health plan.
    (c) Whether a benefit provided to employees constitutes health care 
is not affected by whether the benefit is excludable from income under 
section 132 (relating to certain fringe benefits). For example, if a 
department store provides its employees discounted prices on all 
merchandise, including health care items such as drugs or eyeglasses, 
the mere fact that the discounted prices also apply to health care items 
will not cause the program to be a plan providing health care, so long 
as the discount program would normally be accessible to and used by 
employees without regard to health needs or physical condition. If, 
however, the employer maintaining the discount program is a health 
clinic, so that the program is used exclusively by employees with health 
or medical needs, the program is considered to be a plan providing 
health care and so is considered to be a group health plan.
    (d) The provision of health care at a facility that is located on 
the premises of an employer or employee organization does not constitute 
a group health plan if--
    (1) The health care consists primarily of first aid that is provided 
during the employer's working hours for treatment of a health condition, 
illness, or injury that occurs during those working hours;
    (2) The health care is available only to current employees; and
    (3) Employees are not charged for the use of the facility.
    (e) A plan does not constitute a group health plan subject to COBRA 
if substantially all of the coverage provided under the plan is for 
qualified long-term care services (as defined in section 7702B(c)). For 
this purpose, a plan is permitted to use any reasonable method in 
determining whether substantially all of the coverage provided under the 
plan is for qualified long-term care services.
    (f) Under section 106(b)(5), amounts contributed by an employer to a 
medical savings account (as defined in section 220(d)) are not 
considered part of a group health plan subject to COBRA.

[[Page 285]]

Thus, a plan is not required to make COBRA continuation coverage 
available with respect to amounts contributed by an employer to a 
medical savings account. A high deductible health plan does not fail to 
be a group health plan subject to COBRA merely because it covers a 
medical savings account holder.
    Q-2: For purposes of section 4980B, what is the employer?
    A-2: (a) For purposes of section 4980B, employer refers to--
    (1) A person for whom services are performed;
    (2) Any other person that is a member of a group described in 
section 414(b), (c), (m), or (o) that includes a person described in 
paragraph (a)(1) of this Q&A-2; and
    (3) Any successor of a person described in paragraph (a)(1) or (2) 
of this Q&A-2.
    (b) An employer is a successor employer if it results from a 
consolidation, merger, or similar restructuring of the employer or if it 
is a mere continuation of the employer. See paragraph (c) in Q&A-8 of 
Sec.  54.4980B-9 for rules describing the circumstances in which a 
purchaser of substantial assets is a successor employer to the employer 
selling the assets.
    Q-3: What is a multiemployer plan?
    A-3: For purposes of Sec. Sec.  54.4980B-1 through 54.4980B-10, a 
multiemployer plan is a plan to which more than one employer is required 
to contribute, that is maintained pursuant to one or more collective 
bargaining agreements between one or more employee organizations and 
more than one employer, and that satisfies such other requirements as 
the Secretary of Labor may prescribe by regulation. Whenever reference 
is made in Sec. Sec.  54.4980B-1 through 54.4980B-10 to a plan of or 
maintained by an employer or employee organization, the reference 
includes a multiemployer plan.
    Q-4: What group health plans are subject to COBRA?
    A-4: (a) All group health plans are subject to COBRA except group 
health plans described in paragraph (b) of this Q&A-4. Group health 
plans described in paragraph (b) of this Q&A-4 are referred to in 
Sec. Sec.  54.4980B-1 through 54.4980B-10 as excepted from COBRA.
    (b) The following group health plans are excepted from COBRA--
    (1) Small-employer plans (see Q&A-5 of this section);
    (2) Church plans (within the meaning of section 414(e)); and
    (3) Governmental plans (within the meaning of section 414(d)).
    (c) The COBRA continuation coverage requirements generally do not 
apply to group health plans that are excepted from COBRA. However, a 
small-employer plan otherwise excepted from COBRA is nonetheless subject 
to COBRA with respect to qualified beneficiaries who experience a 
qualifying event during a period when the plan is not a small-employer 
plan (see paragraph (g) of Q&A-5 of this section).
    (d) Although governmental plans are not subject to the COBRA 
continuation coverage requirements, group health plans maintained by 
state or local governments are generally subject to parallel 
continuation coverage requirements that were added by section 10003 of 
COBRA to the Public Health Service Act (42 U.S.C. 300bb-1 through 300bb-
8), which is administered by the U.S. Department of Health and Human 
Services. Federal employees and their family members covered under the 
Federal Employees Health Benefit Program are covered by generally 
similar, but not parallel, temporary continuation of coverage provisions 
enacted by the Federal Employees Health Benefits Amendments Act of 1988. 
See 5 U.S.C. 8905a.
    Q-5: What is a small-employer plan?
    A-5: (a) Except in the case of a multiemployer plan, a small-
employer plan is a group health plan maintained by an employer (within 
the meaning of Q&A-2 of this section) that normally employed fewer than 
20 employees (within the meaning of paragraph (c) of this Q&A-5) during 
the preceding calendar year. In the case of a multiemployer plan, a 
small-employer plan is a group health plan under which each of the 
employers contributing to the plan for a calendar year normally employed 
fewer than 20 employees during the preceding calendar year. See Q&A-6 of 
this section for rules to determine the number of plans that an employer 
or employee organization maintains. The

[[Page 286]]

rules of this paragraph (a) are illustrated in the following example:

    Example. (i) Corporation S employs 12 employees, all of whom work 
and reside in the United States. S maintains a group health plan for its 
employees and their families. S is a wholly-owned subsidiary of P. In 
the previous calendar year, the controlled group of corporations 
including P and S employed more than 19 employees, although the only 
employees in the United States of the controlled group that includes P 
and S are the 12 employees of S.
    (ii) Under Sec.  1.414(b)-1 of this chapter, foreign corporations 
are not excluded from membership in a controlled group of corporations. 
Consequently, the group health plan maintained by S is not a small-
employer plan during the current calendar year because the controlled 
group including S normally employed at least 20 employees in the 
preceding calendar year.

    (b) An employer is considered to have normally employed fewer than 
20 employees during a particular calendar year if, and only if, it had 
fewer than 20 employees on at least 50 percent of its typical business 
days during that year.
    (c) All full-time and part-time common law employees of an employer 
are taken into account in determining whether an employer had fewer than 
20 employees; however, an individual who is not a common law employee of 
the employer is not taken into account. Thus, the following individuals 
are not counted as employees for purposes of this Q&A-5 even though they 
are referred to as employees for all other purposes of Sec. Sec.  
54.4980B-1 through 54.4980B-10--
    (1) Self-employed individuals (within the meaning of section 
401(c)(1));
    (2) Independent contractors (and their employees and independent 
contractors); and
    (3) Directors (in the case of a corporation).
    (d) In determining the number of the employees of an employer, each 
full-time employee is counted as one employee and each part-time 
employee is counted as a fraction of an employee, determined in 
accordance with paragraph (e) of this Q&A-5.
    (e) An employer may determine the number of its employees on a daily 
basis or a pay period basis. The basis used by the employer must be used 
with respect to all employees of the employer and must be used for the 
entire year for which the number of employees is being determined. If an 
employer determines the number of its employees on a daily basis, it 
must determine the actual number of full-time employees on each typical 
business day and the actual number of part-time employees and the hours 
worked by each of those part-time employees on each typical business 
day. Each full-time employee counts as one employee on each typical 
business day and each part-time employee counts as a fraction, with the 
numerator of the fraction equal to the number of hours worked by that 
employee and the denominator equal to the number of hours that must be 
worked on a typical business day in order to be considered a full-time 
employee. If an employer determines the number of its employees on a pay 
period basis, it must determine the actual number of full-time employees 
employed during that pay period and the actual number of part-time 
employees employed and the hours worked by each of those part-time 
employees during the pay period. For each day of that pay period, each 
full-time employee counts as one employee and each part-time employee 
counts as a fraction, with the numerator of the fraction equal to the 
number of hours worked by that employee during that pay period and the 
denominator equal to the number of hours that must be worked during that 
pay period in order to be considered a full-time employee. The 
determination of the number of hours required to be considered a full-
time employee is based upon the employer's employment practices, except 
that in no event may the hours required to be considered a full-time 
employee exceed eight hours for any day or 40 hours for any week.
    (f) In the case of a multiemployer plan, the determination of 
whether the plan is a small-employer plan on any particular date depends 
on which employers are contributing to the plan on that date and on the 
workforce of those employers during the preceding calendar year. If a 
plan that is otherwise subject to COBRA ceases to be a small-employer 
plan because of the addition during a calendar year of an employer that 
did not normally employ fewer

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than 20 employees on a typical business day during the preceding 
calendar year, the plan ceases to be excepted from COBRA immediately 
upon the addition of the new employer. In contrast, if the plan ceases 
to be a small-employer plan by reason of an increase during a calendar 
year in the workforce of an employer contributing to the plan, the plan 
ceases to be excepted from COBRA on the January 1 immediately following 
the calendar year in which the employer's workforce increased.
    (g) A small-employer plan is generally excepted from COBRA. If, 
however, a plan that has been subject to COBRA (that is, was not a 
small-employer plan) becomes a small-employer plan, the plan remains 
subject to COBRA for qualifying events that occurred during the period 
when the plan was subject to COBRA. The rules of this paragraph (g) are 
illustrated by the following examples:

    Example 1. An employer maintains a group health plan. The employer 
employed 20 employees on more than 50 percent of its working days during 
2001, and consequently the plan is not excepted from COBRA during 2002. 
Employee E resigns and does not work for the employer after January 31, 
2002. Under the terms of the plan, E is no longer eligible for coverage 
upon the effective date of the resignation, that is, February 1, 2002. 
The employer does not hire a replacement for E. E timely elects and pays 
for COBRA continuation coverage. The employer employs 19 employees for 
the remainder of 2002, and consequently the plan is not subject to COBRA 
in 2003. The plan must nevertheless continue to make COBRA continuation 
coverage available to E during 2003 until the obligation to make COBRA 
continuation coverage available ceases under the rules of Sec.  
54.4980B-7. The obligation could continue until August 1, 2003, the date 
that is 18 months after the date of E's qualifying event, or longer if E 
is eligible for a disability extension.
    Example 2. The facts are the same as in Example 1. The employer 
continues to employ 19 employees throughout 2003 and 2004 and 
consequently the plan continues to be excepted from COBRA during 2004 
and 2005. Spouse S is covered under the plan because S is married to one 
of the employer's employees. On April 1, 2002, S is divorced from that 
employee and ceases to be eligible for coverage under the plan. The plan 
is subject to COBRA during 2002 because X normally employed 20 employees 
during 2001. S timely notifies the plan administrator of the divorce and 
timely elects and pays for COBRA continuation coverage. Even though the 
plan is generally excepted from COBRA during 2003, 2004, and 2005, it 
must nevertheless continue to make COBRA continuation coverage available 
to S during those years until the obligation to make COBRA continuation 
coverage available ceases under the rules of Sec.  54.4980B-7. The 
obligation could continue until April 1, 2005, the date that is 36 
months after the date of S's qualifying event.
    Example 3. The facts are the same as in Example 2. C is a dependent 
child of one of the employer's employees and is covered under the plan. 
A dependent child is no longer eligible for coverage under the plan upon 
the attainment of age 23. C attains age 23 on November 16, 2005. The 
plan is excepted from COBRA with respect to C during 2005 because the 
employer normally employed fewer than 20 employees during 2004. 
Consequently, the plan is not obligated to make COBRA continuation 
coverage available to C (and would not be obligated to make COBRA 
continuation coverage available to C even if the plan later became 
subject to COBRA again).

    Q-6: How is the number of group health plans that an employer or 
employee organization maintains determined?
    A-6: (a) The rules of this Q&A-6 apply in determining the number of 
group health plans that an employer or employee organization maintains. 
All references elsewhere in Sec. Sec.  54.4980B-1 through 54.4980B-10 to 
a group health plan are references to a group health plan as determined 
under Q&A-1 of this section and this Q&A-6. Except as provided in 
paragraph (b) or (c) of this Q&A-6, all health care benefits, other than 
benefits for qualified long-term care services (as defined in section 
7702B(c)), provided by a corporation, partnership, or other entity or 
trade or business, or by an employee organization, constitute one group 
health plan, unless--
    (1) It is clear from the instruments governing an arrangement or 
arrangements to provide health care benefits that the benefits are being 
provided under separate plans; and
    (2) The arrangement or arrangements are operated pursuant to such 
instruments as separate plans.
    (b) A multiemployer plan and a nonmultiemployer plan are always 
separate plans.
    (c) If a principal purpose of establishing separate plans is to 
evade any requirement of law, then the separate

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plans will be considered a single plan to the extent necessary to 
prevent the evasion.
    (d) The significance of treating an arrangement as two or more 
separate group health plans is illustrated by the following examples:

    Example 1. (i) Employer X maintains a single group health plan, 
which provides major medical and prescription drug benefits. Employer Y 
maintains two group health plans; one provides major medical benefits 
and the other provides prescription drug benefits.
    (ii) X's plan could comply with the COBRA continuation coverage 
requirements by giving a qualified beneficiary experiencing a qualifying 
event with respect to X's plan the choice of either electing both major 
medical and prescription drug benefits or not receiving any COBRA 
continuation coverage under X's plan. By contrast, for Y's plans to 
comply with the COBRA continuation coverage requirements, a qualified 
beneficiary experiencing a qualifying event with respect to each of Y's 
plans must be given the choice of electing COBRA continuation coverage 
under either the major medical plan or the prescription drug plan or 
both.
    Example 2. If a joint board of trustees administers one 
multiemployer plan, that plan will fail to qualify for the small-
employer plan exception if any one of the employers whose employees are 
covered under the plan normally employed 20 or more employees during the 
preceding calendar year. However, if the joint board of trustees 
maintains two or more multiemployer plans, then the exception would be 
available with respect to each of those plans in which each of the 
employers whose employees are covered under the plan normally employed 
fewer than 20 employees during the preceding calendar year.

    Q-7: What is the plan year?
    A-7: (a) The plan year is the year that is designated as the plan 
year in the plan documents.
    (b) If the plan documents do not designate a plan year (or if there 
are no plan documents), then the plan year is determined in accordance 
with this paragraph (b).
    (1) The plan year is the deductible/limit year used under the plan.
    (2) If the plan does not impose deductibles or limits on an annual 
basis, then the plan year is the policy year.
    (3) If the plan does not impose deductibles or limits on an annual 
basis, and either the plan is not insured or the insurance policy is not 
renewed on an annual basis, then the plan year is the employer's taxable 
year.
    (4) In any other case, the plan year is the calendar year.
    Q-8: How do the COBRA continuation coverage requirements apply to 
cafeteria plans and other flexible benefit arrangements?
    A-8: (a)(1) The provision of health care benefits does not fail to 
be a group health plan merely because those benefits are offered under a 
cafeteria plan (as defined in section 125) or under any other 
arrangement under which an employee is offered a choice between health 
care benefits and other taxable or nontaxable benefits. However, the 
COBRA continuation coverage requirements apply only to the type and 
level of coverage under the cafeteria plan or other flexible benefit 
arrangement that a qualified beneficiary is actually receiving on the 
day before the qualifying event. See paragraphs (b) through (e) of this 
Q&A-8 for rules limiting the obligations of certain health flexible 
spending arrangements.
    (2) The rules of this paragraph (a) are illustrated by the following 
example:

    Example: (i) Under the terms of a cafeteria plan, employees can 
choose among life insurance coverage, membership in a health maintenance 
organization (HMO), coverage for medical expenses under an indemnity 
arrangement, and cash compensation. Of these available choices, the HMO 
and the indemnity arrangement are the arrangements providing health 
care. The instruments governing the HMO and indemnity arrangements 
indicate that they are separate group health plans. These group health 
plans are subject to COBRA. The employer does not provide any group 
health plan outside of the cafeteria plan. B and C are unmarried 
employees. B has chosen the life insurance coverage, and C has chosen 
the indemnity arrangement.
    (ii) B does not have to be offered COBRA continuation coverage upon 
terminating employment, nor is a subsequent open enrollment period for 
active employees required to be made available to B. However, if C 
terminates employment and the termination constitutes a qualifying 
event, C must be offered an opportunity to elect COBRA continuation 
coverage under the indemnity arrangement. If C makes such an election 
and an open enrollment period for active employees occurs while C is 
still receiving the COBRA continuation coverage, C must be offered the 
opportunity to switch from the indemnity arrangement to the HMO (but not 
to the life

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insurance coverage because that does not constitute coverage provided 
under a group health plan).

    (b) If a health flexible spending arrangement (health FSA), within 
the meaning of section 106(c)(2), satisfies the two conditions in 
paragraph (c) of this Q&A-8 for a plan year, the obligation of the 
health FSA to make COBRA continuation coverage available to a qualified 
beneficiary who experiences a qualifying event in that plan year is 
limited in accordance with paragraphs (d) and (e) of this Q&A-8, as 
illustrated by an example in paragraph (f) of this Q&A-8. To the extent 
that a health FSA is obligated to make COBRA continuation coverage 
available to a qualified beneficiary, the health FSA must comply with 
all the applicable rules of Sec. Sec.  54.4980B-1 through 54.4980B-10, 
including the rules of Q&A-3 in Sec.  54.4980B-5 (relating to limits).
    (c) The conditions of this paragraph (c) are satisfied if--
    (1) Benefits provided under the health FSA are excepted benefits 
within the meaning of sections 9831 and 9832; and
    (2) The maximum amount that the health FSA can require to be paid 
for a year of COBRA continuation coverage under Q&A-1 of Sec.  54.4980B-
8 equals or exceeds the maximum benefit available under the health FSA 
for the year.
    (d) If the conditions in paragraph (c) of this Q&A-8 are satisfied 
for a plan year, then the health FSA is not obligated to make COBRA 
continuation coverage available for any subsequent plan year to any 
qualified beneficiary who experiences a qualifying event during that 
plan year.
    (e) If the conditions in paragraph (c) of this Q&A-8 are satisfied 
for a plan year, the health FSA is not obligated to make COBRA 
continuation coverage available for that plan year to any qualified 
beneficiary who experiences a qualifying event during that plan year 
unless, as of the date of the qualifying event, the qualified 
beneficiary can become entitled to receive during the remainder of the 
plan year a benefit that exceeds the maximum amount that the health FSA 
is permitted to require to be paid for COBRA continuation coverage for 
the remainder of the plan year. In determining the amount of the benefit 
that a qualified beneficiary can become entitled to receive during the 
remainder of the plan year, the health FSA may deduct from the maximum 
benefit available to that qualified beneficiary for the year (based on 
the election made under the health FSA for that qualified beneficiary 
before the date of the qualifying event) any reimbursable claims 
submitted to the health FSA for that plan year before the date of the 
qualifying event.
    (f) The rules of paragraphs (b), (c), (d), and (e) of this Q&A-8 are 
illustrated by the following example:

    Example. (i) An employer maintains a group health plan providing 
major medical benefits and a group health plan that is a health FSA, and 
the plan year for each plan is the calendar year. Both the plan 
providing major medical benefits and the health FSA are subject to 
COBRA. Under the health FSA, during an open season before the beginning 
of each calendar year, employees can elect to reduce their compensation 
during the upcoming year by up to $1200 per year and have that same 
amount contributed to a health flexible spending account. The employer 
contributes an additional amount to the account equal to the employee's 
salary reduction election for the year. Thus, the maximum amount 
available to an employee under the health FSA for a year is two times 
the amount of the employee's salary reduction election for the year. 
This amount may be paid to the employee during the year as reimbursement 
for health expenses not covered by the employer's major medical plan 
(such as deductibles, copayments, prescription drugs, or eyeglasses). 
The employer determined, in accordance with section 4980B(f)(4), that a 
reasonable estimate of the cost of providing coverage for similarly 
situated nonCOBRA beneficiaries for 2002 under this health FSA is equal 
to two times their salary reduction election for 2002 and, thus, that 
two times the salary reduction election is the applicable premium for 
2002.
    (ii) Because the employer provides major medical benefits under 
another group health plan, and because the maximum benefit that any 
employee can receive under the health FSA is not greater than two times 
the employee's salary reduction election for the plan year, benefits 
under this health FSA are excepted benefits within the meaning of 
sections 9831 and 9832. Thus, the first condition of paragraph (c) of 
this Q&A-8 is satisfied for the year. The maximum amount that a plan can 
require to be paid for coverage (outside of coverage required to be made 
available due to a disability extension) under Q&A-1 of Sec.  54.4980B-8 
is 102 percent of the applicable premium. Thus, the maximum amount that 
the health FSA can require to be paid for

[[Page 290]]

coverage for the 2002 plan year is 2.04 times the employee's salary 
reduction election for the plan year. Because the maximum benefit 
available under the health FSA is 2.0 times the employee's salary 
reduction election for the year, the maximum benefit available under the 
health FSA for the year is less than the maximum amount that the health 
FSA can require to be paid for coverage for the year. Thus, the second 
condition in paragraph (c) of this Q&A-8 is also satisfied for the 2002 
plan year. Because both conditions in paragraph (c) of this Q&A-8 are 
satisfied for 2002, with respect to any qualifying event occurring in 
2002, the health FSA is not obligated to make COBRA continuation 
coverage available for any year after 2002.
    (iii) Whether the health FSA is obligated to make COBRA continuation 
coverage available in 2002 to a qualified beneficiary with respect to a 
qualifying event that occurs in 2002 depends upon the maximum benefit 
that would be available to the qualified beneficiary under COBRA 
continuation coverage for that plan year. Case 1: Employee B has elected 
to reduce B's salary by $1200 for 2002. Thus, the maximum benefit that B 
can become entitled to receive under the health FSA during the entire 
year is $2400. B experiences a qualifying event that is the termination 
of B's employment on May 31, 2002. As of that date, B had submitted $300 
of reimbursable expenses under the health FSA. Thus, the maximum benefit 
that B could become entitled to receive for the remainder of 2002 is 
$2100. The maximum amount that the health FSA can require to be paid for 
COBRA continuation coverage for the remainder of 2002 is 102 percent 
times 1/12 of the applicable premium for 2002 times the number of months 
remaining in 2002 after the date of the qualifying event. In B's case, 
the maximum amount that the health FSA can require to be paid for COBRA 
continuation coverage for 2002 is 2.04 times $1200, or $2448. One-
twelfth of $2448 is $204. Because seven months remain in the plan year, 
the maximum amount that the health FSA can require to be paid for B's 
coverage for the remainder of the year is seven times $204, or $1428. 
Because $1428 is less than the maximum benefit that B could become 
entitled to receive for the remainder of the year ($2100), the health 
FSA is required to make COBRA continuation coverage available to B for 
the remainder of 2002 (but not for any subsequent year).
    (iv) Case 2: The facts are the same as in Case 1 except that B had 
submitted $1000 of reimbursable expenses as of the date of the 
qualifying event. In that case, the maximum benefit available to B for 
the remainder of the year would be $1400 instead of $2100. Because the 
maximum amount that the health FSA can require to be paid for B's 
coverage is $1428, and because the $1400 maximum benefit for the 
remainder of the year does not exceed $1428, the health FSA is not 
obligated to make COBRA continuation coverage available to B in 2002 (or 
any later year). (Of course, the administrator of the health FSA is 
permitted to make COBRA continuation coverage available to every 
qualified beneficiary in the year that the qualified beneficiary's 
qualifying event occurs in order to avoid having to determine the 
maximum benefit available for each qualified beneficiary for the 
remainder of the plan year.)

    Q-9: What is the effect of a group health plan's failure to comply 
with the requirements of section 4980B(f)?
    A-9: Under section 4980B(a), if a group health plan subject to COBRA 
fails to comply with section 4980B(f), an excise tax is imposed. 
Moreover, non-tax remedies may be available if the plan fails to comply 
with the parallel requirements in ERISA, which are administered by the 
Department of Labor.
    Q-10: Who is liable for the excise tax if a group health plan fails 
to comply with the requirements of section 4980B(f)?
    A-10: (a) In general, the excise tax is imposed on the employer 
maintaining the plan, except that in the case of a multiemployer plan 
(see Q&A-3 of this section for a definition of multiemployer plan) the 
excise tax is imposed on the plan.
    (b) In certain circumstances, the excise tax is also imposed on a 
person involved with the provision of benefits under the plan (other 
than in the capacity of an employee), such as an insurer providing 
benefits under the plan or a third party administrator administering 
claims under the plan. In general, such a person will be liable for the 
excise tax if the person assumes, under a legally enforceable written 
agreement, the responsibility for performing the act to which the 
failure to comply with the COBRA continuation coverage requirements 
relates. Such a person will be liable for the excise tax notwithstanding 
the absence of a written agreement assuming responsibility for complying 
with COBRA if the person provides coverage under the plan to a similarly 
situated nonCOBRA beneficiary (see Q&A-3 of Sec.  54.4980B-3 for a 
definition of similarly situated nonCOBRA beneficiaries) and the 
employer or plan administrator submits a

[[Page 291]]

written request to the person to provide to a qualified beneficiary the 
same coverage that the person provides to the similarly situated 
nonCOBRA beneficiary. If the person providing coverage under the plan to 
a similarly situated nonCOBRA beneficiary is the plan administrator and 
the qualifying event is a divorce or legal separation or a dependent 
child's ceasing to be covered under the generally applicable 
requirements of the plan, the plan administrator will also be liable for 
the excise tax if the qualified beneficiary submits a written request 
for coverage.

[T.D. 8812, 64 FR 5174, Feb. 3, 1999, as amended by T.D. 8928, 66 FR 
1849, Jan. 10, 2001]