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COBRA

COBRA Continuation Coverage is subject to the terms of your current medical/dental plan and the federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA.)
 
ELIGIBILITY
 
If you have been covered by the Plan on the day before a qualifying event, you may be eligible for COBRA Continuation Coverage.  The following are qualifying events for such Coverage: 

Subscriber's loss of coverage because of: 

  • The termination of employment except for gross misconduct.
  • A reduction in the number of hours worked by the subscriber that causes the subscriber to become ineligible for medical/dental coverage. 

Covered Dependents loss of coverage because of: 

  • The termination of the subscriber’s coverage as explained above. 
  •  The death of the subscriber.
  • Divorce or legal separation from the subscriber.
  • The subscriber becomes entitled to Medicare.
  • A covered dependent reaches the limiting age or becomes married. 

ENROLLING FOR COBRA CONTINUATION COVERAGE
 
The administrator, acting on behalf of the Employer, shall notify you of your rights to enroll for COBRA Continuation Coverage after: 

  • The subscriber’s termination of employment, reduction in hours worked that causes the subscriber to become ineligible for medical/dental coverage, death or entitlement to Medicare coverage; or
  • The Subscriber or covered dependent notifies the Employer, in writing, within 60 days after any other qualifying event set out above. 

You have 60 days from the later of the date of the qualifying event or the date that you receive notice of the right to COBRA Continuation Coverage to enroll for such coverage.  The Employer or the administrator will send the forms that should be used to enroll for COBRA Continuation Coverage. If you do not send the enrollment form to the Employer within that 60-day period, you will lose your right to COBRA Continuation Coverage under this Plan.  If you are qualified for COBRA Continuation Coverage and receive services that would be covered services before enrolling and submitting the payment for such coverage, you will be required to pay for those services.  The Plan will reimburse you for covered services, less required member payments, after you enroll and submit the payment for coverage, and submit a claim for those covered services as set forth in this Plan.

PAYMENT
 
You must submit any payment required for COBRA Continuation Coverage to the administrator at the address indicated on your payment notice.  If you do not enroll when first becoming eligible, the payment due for the period between the date you first become eligible and the date you enroll for COBRA Continuation Coverage must be paid to the Employer  (or to the administrator, if so directed by the Employer) within 45 days after the date you enroll for COBRA Continuation Coverage.  After enrolling for COBRA Continuation Coverage, all payments are due and payable on a monthly basis as required by the Employer.  If the payment is not received by the administrator on or before the due date, coverage will be terminated, for cause, effective as of the last day for which payment was received as explained in the Plan.  The administrator may use a third party vendor to collect the COBRA payment.
 
 
COVERAGE PROVIDED
 
If you enroll for COBRA Continuation Coverage you will continue to be covered under the Plan.  The COBRA Continuation Coverage is subject to the conditions, limitations and exclusions of the Plan and the EOC.  The Plan and the Employer may agree to change the ASA and/or the EOB.  The Employer may also decide to change administrators.  If this happens after you enroll for COBRA Continuation Coverage, your coverage will be subject so such changes.
 
DURATION OF ELIGIBILITY FOR COBRA CONTINUATION COVERAGE
 
COBRA Continuation Coverage is available for a maximum of: 

  • 18 months if the loss of coverage is caused by termination of employment or reduction in hours of employment; or
  • 29 months of coverage.  If, as a qualified beneficiary who has elected 18 months of COBRA Continuation Coverage, you are determined to be disabled within the first 60 days of COBRA Continuation Coverage, you can extend your COBRA Continuation Coverage for an additional 11 months, up to 29 months.  Also, the 29 months of COBRA Continuation Coverage is available to all non-disabled qualified beneficiaries in connection with the same qualifying event.  “Disabled” means disabled as determined under Title II or XVI of the Social Security Act.  In addition, the disabled qualified beneficiary or any other non-disabled qualified beneficiary affected by the termination of employment qualifying event must: 
    • Notify the Employer or the administrator of the disability determination within 60 days after the determination of disability, and before the close of the initial 18-month coverage period; and
    • Notify the Employer or the administrator within 30 days of the date of a final determination that the qualified beneficiary is no longer disabled; or 
  • 36 months for other qualifying events.  If a covered dependent is eligible for 18 months of COBRA Continuation Coverage as described above, and there is a second qualifying event (e.g., divorce), you may be eligible for 36 months of COBRA Continuation Coverage from the date of the first qualifying event. 

TERMINATION OF COBRA CONTINUATION COVERAGE
 
After you have elected COBRA Continuation Coverage, that coverage will terminate either at the end of the applicable 18, 29 or 36 month eligibility period or, before the end of that period, upon the date that: 

  • The payment for such coverage is not submitted when due; or
  • You become covered as either a subscriber or dependent by another group health care plan, and that coverage is as good as or better than the COBRA Continuation Coverage; or
  • The ASA is terminated; or
  • You become entitled to Medicare coverage; or
  • The date that you, otherwise eligible for 29 months of COBRA Continuation Coverage, are determined to no longer be disabled for purposes of the COBRA law.