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."

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 booklet. 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 23).

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.

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: 

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, 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.

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.

Payment for the required premium must be made as follows:

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

2. The initial payment must be received by the Fund Office no later than the 20^th day of the month prior to the month from which you desire coverage in order to avoid possible delays in claim payments and eligibility problems.  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 calendar months from the expiration of coverage through the calendar month which ends prior to the date of the first payment.
    

3. After the initial payment is made, payments must be made monthly to continue coverage.  Monthly payments should be mailed by the 20^th day of the month preceding each coverage month.  Failure to make a monthly payment within 30 days of the beginning of the coverage month will result in termination of coverage as of the end of the period for which the last payment has been made.

If your qualifying event entitles you to 18 months of COBRA coverage and you or a covered dependent was 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.

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:

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.

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 pr 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.

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:

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