Summary of Eligibility Rules

COBRA CONTINUATION OF COVERAGE PLAN

COBRA stands for the CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT of 1985.

COBRA requires that employees have the right to continue their health coverage by paying a monthly fee if they lose coverage under the Plan because of a “qualifying event.”

QUALIFYING EVENT LENGTH OF COVERAGE
EMPLOYEE Loss of eligibility due to:
termination of employment* 18 Months
reduction in hours 18 Months
voluntary resignation 18 Months
strike 18 Months
* – For reasons other than gross misconduct
SPOUSE Loss of eligibility due to:
spouse’s termination from employment* 18 Months
death of spouse 36 Months
divorce 36 Months
* – For reasons other than gross misconduct
DEPENDENT CHILD Loss of eligibility due to:
death of parent 36 Months
divorce of parents 36 Months
age 26 36 Months
parent’s eligibility for Medicare 36 Months
parent’s termination from employment* 18 Months
* – For reasons other than gross misconduct

Qualified Beneficiaries

Under the law, only “qualified beneficiaries” are entitled to COBRA continuation coverage. A qualified beneficiary is any individual who was covered under the Plan on the day before the qualifying event by virtue of being, on that day, an eligible employee or retiree, a spouse of an eligible employee or retiree, or the dependent child of an eligible employee or retiree.

If you have a newborn child, adopt a child or have a child placed with you for adoption (for whom you have financial responsibility) while your COBRA continuation coverage is in effect, you may add this child to your coverage. You must notify the Fund Manager in writing, within 60 days of the birth or placement in order to add the child to your coverage. Of course, adding a child to your COBRA coverage may cause an increase in your COBRA premiums.

A spouse who becomes your spouse during a period of COBRA continuation coverage is not a qualified beneficiary, but you may add such a spouse to your coverage during the period you remain eligible for COBRA continuation coverage.

Each of your family members has a separate right to elect COBRA continuation coverage even if you do not. Therefore, it is important that your spouse and all dependents read this section of this website. Like all qualified beneficiaries with COBRA coverage, their continued coverage depends on the timely and uninterrupted payment of premiums on their behalf.

COBRA coverage is not available if the member or dependent is covered by any other group insurance. COBRA coverage is also not available if the person has Medicare. (EXCEPTION: WIDOWS – SEE SELF-PAYMENT PLAN FOR WIDOWS, page 36 of the benefit book).

COBRA coverage is also not available to a Retired participant unless he has returned to work as an Active participant in the Plan.

Notification Responsibilities

In order for you to elect COBRA continuation coverage, the Fund Office must be notified when you experience a qualifying event.

If the qualifying event is a divorce or legal separation or a child’s losing dependent status, you or the dependent must notify the Fund Office in writing within 60 days from the date the qualifying event occurs. If you do not, your dependents will lose the right to elect COBRA continuation coverage.

Your employer will generally notify the Fund Office of other qualifying events. However, you are encouraged to notify the Fund Office when any qualifying event occurs to avoid confusion over the status of your health care.

If you are a retiree, your dependents must notify the Fund Office of a qualifying event with 60 days from the date the qualifying event occurs.

How to Elect Cobra Continuation Coverage

When the Fund Office receives notice of the qualifying event, it will send the qualified beneficiary information concerning continuation options, including the necessary COBRA election forms. Information sent to your spouse will be deemed to have also been sent to your dependent children.

You and/or your covered dependents have 60 days to make your election from the later of the following dates:

  • You would have lost coverage because of a qualifying event, or
  • You and/or your covered dependents received the election form and COBRA information.

If you and/or any of your covered dependents do not elect COBRA coverage within the 60-day period allowed, your health coverage will end and the Plan will not pay claims for services provided on and after the date your coverage terminates.

Coverage

If you elect COBRA continuation coverage, you will be entitled to the same health coverage that is provided to similarly situated participants and their family members in the Plan.

There are two different options and premiums under the COBRA extension of benefits. One has benefits for Medical and Hospital coverage only, the other option is a continuation of the Medical, Hospital, Dental, and Vision Plans that a member receives under normal Active or Retiree eligibility. The coverage is an extension of your benefits prior to loss of eligibility; therefore, if you had already satisfied the annual Deductible, a new one would not be taken.

There is no coverage for life insurance under the COBRA Plan.

If the coverage provided by the Plan is changed in any respect for employees, those changes will apply at the same time and in the same manner for everyone whose coverage is continued under COBRA.

PAYING FOR COBRA CONTINUATION COVERAGE

You are responsible for the entire cost of COBRA continuation coverage.  The Fund Office will notify you of the COBRA premium amounts that you must pay.

All payments must be made by check, cashier’s check or money order.

If you elect COBRA coverage, you must, within 45 days of your election date, submit your first payment to the Fund Office. This first payment must include payment for all months from the expiration of coverage through the current month.

After the initial payment, monthly payments must be made to continue coverage.  It is the responsibility of the qualified beneficiary to submit payments when due.

You are given a grace period of 30 days from the due date of the payment. You are not eligible during the grace period. Failure to make a monthly payment within the 30 day grace period will result in termination of coverage.  If your COBRA coverage is terminated, you CANNOT be reinstated.

COBRA CONTINUATION COVERAGE FOR DISABLED PARTICIPANTS

If your qualifying event entitles you to 18 months of COBRA coverage and you or a covered dependent were disabled at the time of the qualifying event (or becomes disabled before or during the first 60 days of continuation coverage), you and any other covered dependents may be eligible to continue your COBRA coverage at increased rates for an additional 11 months, for a total of 29 months.

For you to be eligible, the Social Security Administration must make a formal determination that you or your dependent is disabled and therefore entitled to Social Security disability income benefits. You or your dependent must notify the Fund Office of the Social Security determination of disability within 60 days from the date you received the determination and before the 18-month period expires. If the disability does not continue throughout the continuation period, you must notify the Fund Office of any later determination that you or your dependent are no longer disabled.

Coverage for your Dependents if You are Enrolled in Medicare

If you are an active employee entitled to Medicare and you experience one of the qualifying events that entitles you to 18 months of COBRA coverage (a reduction in your work hours, voluntary resignation, or termination of employment), your eligible dependents would be entitled to COBRA for a period of 18 months (29 months if the 11-month Social Security Disability extension applies) from the date of the reduction in your work hours or resignation/termination of your employment or 36 months from the date you became entitled to Medicare, whichever is longer.

If a Second Qualifying Event Occurs

If your dependents are in an 18-month COBRA coverage period because of a reduction in your work hours, your voluntary resignation or termination of your employment and one of the following qualifying events occurs, the maximum COBRA period for your dependents will switch to 36 months:

  • You get divorced or legally separate,
  • You become entitled to Medicare,
  • You die, or
  • Your child ceases to meet the Plan’s definition of an eligible dependent (in this case, only the child may extend coverage for another 18 months).

This extension is only available to those individuals who were dependents at the time of the initial qualifying event and to children who are born to, or adopted by the employee during the 18-month period of coverage. However, the extension to 36 months is not available to anyone who became the employee’s spouse following the termination or reduction of hours.

The maximum period of coverage under COBRA is 36 months, regardless of how many qualifying events occur.

Active employees are not entitled to COBRA coverage for more than a total of 18 months (unless you are entitled to additional COBRA coverage because of a disability). Even if you experience a reduction in your work hours followed by a resignation or termination of employment, the resignation or termination of employment is not treated as a second qualifying event and you may not extend your coverage.

Special COBRA Enrollment Rights

If you marry, have a newborn child, adopt a child, or have a child placed with you for adoption while you are enrolled in COBRA, you may enroll that spouse and child for coverage for the balance of the period of COBRA coverage. You must notify the Fund Office and enroll new dependents within 30 days of the marriage, birth, adoption or placement for adoption.

In addition, if you are enrolled for COBRA coverage and your spouse or dependent child loses coverage under another group health plan, you may enroll that spouse or child for coverage for the balance of the period of COBRA within 30 days after the termination of the other coverage. To be eligible for this special enrollment right, your spouse or dependent child must have been eligible for coverage under the terms of the Plan but declined when enrollment was previously offered because he/she had coverage under another group health plan or had other health insurance.

Adding a spouse or dependent child may cause an increase in the amount you must pay for COBRA continuation coverage.

TERMINATION OF COBRA CONTINUATION COVERAGE

COBRA continuation coverage will terminate on the last day of the maximum period of coverage unless it ends earlier for any of the following reasons:

  • The plan you have chosen is terminated, in which case you may have the opportunity to change to another medical plan offered under the Fund.
  • You or your dependents fail to make the monthly premium payments on time.
  • The person receiving coverage becomes covered by another group health plan (as an employee, spouse or dependent) that does not contain any exclusion or limitation regarding a pre-existing condition.
  • The person receiving the coverage becomes entitled to Medicare benefits after the date of election of COBRA.

LIFE INSURANCE UNDER COBRA PLAN

THERE IS NO COVERAGE FOR LIFE INSURANCE UNDER THE COBRA PLAN.

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