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”).
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:
- The termination of employment except for gross
- A reduction in the number of hours worked by the Subscriber.
B. Covered Dependents Loss of Coverage because of:
- The termination of the Subscriber’s Coverage as
explained in subsection (a), 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 Coverage
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.
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.
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
A. Eighteen (18) months if the loss of coverage is caused
by termination of employment or reduction in hours of employment; or
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
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
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.