COBRA Eligibility Calculator

Consolidated Omnibus Budget Reconciliation Act — Group Health Plan Coverage Analysis

Employer Information

Fill in the employer details below. These fields are for recordkeeping purposes only and do not affect the calculation.

Employer / Plan Sponsor Name

Plan Effective / Renewal Date

Prepared By

Date Completed

Employer Type — Select One

Private-Sector State / Local Government Federal Government (COBRA exempt) Church Plan (COBRA exempt)

1 Step 1 — Total Employee Count (FTE)

Enter your total company headcount for the prior calendar year — not just employees enrolled on the health plan. Full-time employees count as 1.00 FTE each. Part-time employees count as a fraction: average weekly hours ÷ 40.

Employee Group	Number of Employees	Avg Hours/Week	FTE Count
Full-time employees		40 hrs (fixed)	0.00
TOTAL FTE COUNT			0.00

Example: 15 full-time employees + 10 part-time employees averaging 20 hrs/week = 15 + (10 × 20/40) = 15 + 5 = 20.00 FTE — meets the threshold.

Total FTE Count

0.00

COBRA Threshold

≥ 20

FTE Test

AWAITING INPUT

2 Step 2 — Business Days Test (Prior Calendar Year)

For each month of the prior calendar year, enter (A) total business days and (B) how many of those days your company had 20 or more total employees. A month passes if (B) is more than 50% of (A).

Months Passing Test

0 / 12

AWAITING INPUT

The overall test passes if more than 6 of the 12 months pass.

3 Step 3 — Final COBRA Determination

All three criteria must be met for Federal COBRA to apply.

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Criterion 1 — Covered employer type Sponsored by a private-sector or state/local government employer.

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Criterion 2 — 20 or more FTE employees From Step 1 above.

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Criterion 3 — 20+ employees on more than 50% of business days From Step 2 above.

This tool is for general informational purposes only and does not constitute legal advice. Consult legal counsel for guidance specific to your situation. Questions? (888) 964-8646 • korusins.com