Form 11-5. COBRA Coverage Election Form (Federal Family and Medical Leave)

FMLA leave itself is not considered a COBRA qualifying event. Generally, a qualifying event does occur if: (1) an employee, spouse or dependent child is covered on the day before the first day of FMLA leave (or becomes covered during the FMLA leave) under the employer's group health plan; (2) the employee does not return to work at the end of the FMLA leave; and (3) the employee, spouse or dependent child—without COBRA coverage—would lose coverage under the plan before the end of the maximum coverage period.

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