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COBRA

Conversion or Continuation of Health Care Coverage

Should your coverage under the Erlanger Health System (EHS) Group Plan terminate, you have the right to continue coverage.  This right is referred to as “Continuation Coverage” and may occur for a limited time subject to 42 U.S.C. 300bb-1 et.  Seq. (the “COBRA Law”).

Eligibility
If you have been covered by the EHS Group Plan on the day before a qualifying event, you and your dependents may be eligible for COBRA Coverage.  The following are qualifying events for such Coverage:

A. Subscribers Loss of Coverage because of:

  1. The termination of employment except for gross misconduct.
  2. A reduction in the number of hours worked by the Subscriber.

B. Covered Dependents Loss of Coverage because of:

  1. The termination of the Subscriber’s Coverage as explained in subsection (a), above.
  2. The death of the Subscriber.
  3. Divorce or legal separation from the Subscriber.
  4. The Subscriber becomes entitled to Medicare.
  5. A covered Dependent reaches the limiting age or becomes married.

Enrolling for COBRA Coverage
You have sixty (60) days from the later of the date of the qualifying event or the date that you receive this notice to enroll for COBRA Coverage.  The form used to enroll for COBRA Coverage will be mailed.  If you do not send the enrollment form back to the EHS Group Benefits Analyst within the sixty (60) day period, you will lose your right to COBRA Coverage.  If you are qualified for COBRA Coverage and receive services that would be covered services, before enrolling and paying the premium for such coverage, you will be required to pay for those services.  The COBRA Plan will reimburse you for covered services, less required member payments, after you enroll and pay the premium for coverage, and submit a claim for those covered services.

Premium Payment
You must pay any premium required for COBRA Coverage to EHS. If you do not enroll when first becoming eligible, the premium due for the period between the date you first become eligible and the date you enroll for COBRA Coverage must be paid to EHS within 45 days after the date you enroll for COBRA Coverage. After enrolling for COBRA Coverage, all premiums are due and payable on a monthly basis (by the 1st of each month). If the premium is not received by EHS on or before the due date, coverage will be terminated, for cause, effective as of the last day for which premium was received as explained in the Termination of Coverage Section.

Coverage Provided
If you enroll for COBRA Coverage, you will continue to be covered under the EHS Group Agreement.  The COBRA Coverage is subject to the conditions, limitations and exclusions of the EHS Group Agreement.  The BCBS Plan and EHS Group may agree to change the EHS Group Agreement.  If this happens after you enroll for COBRA Coverage, your coverage will be subject to such changes.

Duration of Eligibility for COBRA Coverage
COBRA Coverage is available for a maximum of:
A. Eighteen (18) months if the loss of coverage is caused by termination of employment or reduction in hours of employment; or 
B. Thirty-six (36) months for other qualifying events.  If, as a covered dependent who is eligible for eighteen (18) months of COBRA Coverage under subsection a, you have a second qualifying event (e.g. divorce), you may be eligible for 36 months of COBRA Coverage from the date of the first qualifying event.  As a limited exception to subsection a, above, if you, as the subscriber, were disabled, as defined by the Federal COBRA Law, at the time of that qualifying event, and you notify the EHS Benefits Analyst of that fact during the eighteen (18) month COBRA Coverage period, you will be eligible for an additional eleven (11) months of COBRA Coverage (i.e., a total of twenty-nine (29) months of coverage).

Termination of COBRA Coverage
COBRA Coverage will terminate either at the end of the applicable eighteen (18), twenty-nine (29) or thirty-six (36) month eligibility period or, before the end of that period, upon the date that:
A. The premium for such coverage is not paid when due; or
B. You become covered by another group health care plan as either a subscriber or dependent, that does not exclude or limit coverage of your pre-exiting condition, if any; or
C. The EHS Group Agreement is terminated; or
D. You become entitled to Medicare coverage; or
E. The date that a disabled member, who is otherwise eligible for twenty-nine (29) months of COBRA Coverage, is determined to no longer be disabled for purposes of the COBRA Law.