Criteria for Qualifying Events (SAP Library - Benefits Administration (PA-BN))

Criteria for Qualifying Events

To collect qualified beneficiaries, the system checks HR master data records for information that indicates that a qualifying event has taken place. Only those persons who are actually enrolled in a COBRA-relevant plan lose coverage as a result of an event and become qualified beneficiaries.

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According to IRS regulations, loss of coverage occurs if a person can no longer be covered under the plan terms and conditions applicable directly before the event. Loss of coverage therefore includes increases in premiums or contributions for continuation coverage, as a result of a qualifying event. However, increases in premiums or contributions do not themselves constitute a qualifying event.

The following table shows the master data that is checked for each type of COBRA qualifying event type:

COBRA Event Type	Qualified Beneficiary	Master Data Checked
Termination of employment	Employee Spouse Child / Stepchild	Infotype Actions (0000) Checks for new record with action type and action reason as assigned to COBRA event in Customizing
Death of employee	Spouse Child / Stepchild	Infotype Actions (0000) Checks for new record with action type and action reason as assigned to COBRA event in Customizing
Reduction in working hours	Employee Spouse Child / Stepchild	Infotype Actions (0000) Checks for new record with action type and action reason as assigned to COBRA event in Customizing (for example, the action type Absence from work, with the action reasons Disability, Temporary layoff, or Military leave) or Checks for loss of eligibility triggered by changes on the Planned Working Time infotype (0007)
Employee's entitlement to Medicare	Spouse Child / Stepchild	Infotype Additional Personal Data (0077) Checks for new record with Medicare indicator set (in case the indicator is not set in the previous record)
Divorce	Spouse Child / Stepchild	Infotype Family/Related Person (0021) Checks for new subtype 10 divorced spouse
Legal separation	Spouse Child / Stepchild	Infotype Family/Related Person (0021) via infotype Family/Related Person (0106) Checks for new record with separation date
Child's loss of dependent status	Child / Stepchild	Checks for loss of eligibility triggered by changes on infotype Family/Related Person (0021) via infotype Family/Related Person (0106) Dependent eligibility can be defined in Customizing for each individual plan subject to COBRA. The following criteria can be used to determine loss of dependent status: Non-student over regular age limit Student over student age limit Student over regular age limit losing student status Marriage Starting military service Becoming financially independent
Bankruptcy of employer	Retired employee Spouse Child / Stepchild	Infotype Actions (0000) Checks for status 2 = retiree

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The qualified beneficiaries listed in the table above are those that are predefined in the standard system. You can also allow persons other than employees, spouses, or (step)children, to be COBRA qualified beneficiaries in their own right. In particular, these other persons may include domestic partners and domestic partner's children.

If you want to give other persons COBRA rights, you need to specify the events for which you want to allow coverage for each type of beneficiary. You do this in the Benefits Administration Implementation Guide, in the step COBRA ® Define COBRA Additional Qualified Beneficiary Subtypes.