The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), is a federal law that requires plans to offer a temporary extension of benefits to employees and eligible dependents (qualified beneficiaries) who
would otherwise lose coverage under a plan. Qualified beneficiaries include you and each dependent who was covered under the Plan on the day before a qualifying event occurs and who would lose coverage as a result of a qualifying
event (see below). Children born, adopted, or placed for adoption have the same COBRA rights as a spouse or dependent who was covered by the Plan before the event that triggered COBRA Continuation Coverage.
Under COBRA, you may continue medical, prescription drug, dental, and vision coverage for you and/or your eligible dependents, without evidence of good health.
For Employees
As an employee, you are eligible for COBRA Continuation Coverage if you lose coverage due to:
For Dependents
Your dependents are eligible for COBRA Continuation Coverage in the event of:
Your termination of employment or reduction in the number of hours you work;
Your death;
Divorce or legal separation;
A child no longer meeting the Plan’s definition of an eligible dependent; or
Your entitlement to Medicare.
An eligible dependent includes someone you marry or gain as a dependent child during a period of continuation coverage. For additional information see page
Notification
If you and/or your dependents become eligible for COBRA Continuation Coverage due to your termination of employment, reduction in hours, Medicare entitlement, or death, your employer must notify the Fund Office within 30 days after
the occurrence.
By law, within 60 days after your dependent becomes eligible for COBRA Continuation Coverage because of legal separation, divorce, or a dependent child’s reaching the limiting age or otherwise losing dependent status, you or the
eligible dependent must notify the Fund Office that COBRA Continuation Coverage is wanted. If you or your dependent do not contact the Fund Office during the 60-day period, COBRA Continuation Coverage will not be available.
Notification should be made in writing to the Fund Office and should include the qualified beneficiary’s name, the qualifying event entitling them to COBRA Continuation Coverage, and the date of the event. Failure to
provide timely notice may prevent you and/or your dependents from obtaining or extending COBRA Continuation Coverage.
Employees, qualified beneficiaries, or any representative acting on behalf of the employee or qualified beneficiary may provide notice. Notice from one individual will satisfy the notice requirement for all related qualified
beneficiaries affected by the same qualifying event.
Within 45 days of receipt of the above notice(s), the Fund Office will send you or your dependents an election form to continue coverage with instructions or, if you are not eligible, information as to why you are not eligible to
elect this coverage. To be eligible for COBRA Continuation Coverage, you must return the completed election form to the Fund Office within 60 days after the date the Fund Office notifies you of your loss of coverage and eligibility
for COBRA Continuation Coverage. This 60-day period is referred to as an election period. If the Fund Office does not receive your completed election form within the 60-day election period, coverage will automatically terminate for
you and/or your dependents effective the original date coverage was lost. Failure to return the completed form within the time limit will also automatically terminate the right to continuation of benefits.
Type Of Coverage
If you or your eligible dependents choose COBRA Continuation Coverage, the Plan will provide coverage for medical, prescription drug, dental, and vision care, all covered in the same rate.
You or your eligible dependent would be responsible for paying the full premium cost of coverage plus administrative charges for COBRA Continuation Coverage. The cost of COBRA Continuation Coverage is determined based on Plan
experience and applicable government regulations. Your premium will be due no later than 45 days after you elect coverage. The first payment must cover, retroactively, the period of time from the date on which your coverage was lost
up through and including the current month. After that, payments are due monthly and must be continuous.
Failure to submit the initial required premium payment within the time limit specified automatically terminates the continuation of benefits and the right to continuation of benefits.
COBRA Continuation Coverage Period
Generally, you may continue coverage under COBRA for a period of up to 18 months from the date (or up to 29 months for disabled individuals, as described in the next section) you terminate employment or there is a reduction in the
number of hour you work.
Your spouse and/or dependent children may qualify to continue coverage for a period of up to 36 months under the following circumstances:
You and your spouse become divorced or legally separated;
You become entitled to Medicare;
Your child loses eligibility as a dependent; or
You die.
If COBRA Continuation Coverage is obtained after one qualifying event and a second qualifying event such as described previously occurs during the 18-month COBRA Continuation Coverage period, your spouse or dependent children would
then be eligible for additional COBRA Continuation Coverage up to a total of 36 months from the date of the qualifying event.
For example, if you are terminated and continue coverage under COBRA and then divorce six months later, you would be eligible for COBRA Continuation Coverage for a total of 18 months from the date of the qualifying event, while your
spouse and children could extend their coverage for a total of 36 months from the date of the qualifying event.
Coverage For Disabled Individuals
If the Social Security Administration determines that you or a dependent was totally and permanently disabled on the day your employment ended, or within 60 days after that, COBRA Continuation Coverage may be continued up to a
maximum of 29 months, instead of 18 months for all covered family members who have elected COBRA Continuation Coverage. For coverage to continue, you must notify the Fund Office, in writing:
You must include any documentation of your disability with your written request for extended coverage.
The cost of extended COBRA Continuation Coverage for disabled individuals is determined based on Plan experience and applicable government regulations. The premium cost of such extended coverage is greater than that of continued
coverage.
When your disability ends, you must notify the Fund Office within 30 days. Your extended coverage will end unless you are still within the initial 18-month period of continued coverage.
Electing COBRA Continuation Coverage
You or your dependents must complete the COBRA Continuation Coverage election form and send it back to the Fund Office to elect COBRA Continuation Coverage. These rules apply to the election of COBRA Continuation Coverage:
Each member of your family who would lose coverage because of a qualifying event is entitled to make a separate COBRA Continuation Coverage election.
If you do not elect COBRA Continuation Coverage for your dependents when they are entitled to COBRA Continuation Coverage, your dependents have the right to elect COBRA Continuation Coverage for themselves.
Your spouse may elect COBRA Continuation Coverage for herself or himself and any children who are covered by the Plan on the date of the qualifying event.
This provision applies if international trade adversely affects your employment. If you are certified by the U.S. Department of Labor (DOL) as eligible for benefits under the Trade Act of 1974, you may be
eligible for both a new opportunity to elect COBRA Continuation Coverage and an individual Health Insurance Tax Credit. If you and/or your dependents did not elect COBRA Continuation Coverage during your election period, but are
later certified by the DOL for Trade Act benefits, you may be entitled to an additional 60-day COBRA Continuation Coverage election period beginning on the first day of the month in which you were certified. However, in no event
would this benefit allow you to elect COBRA Continuation Coverage later than six months after your coverage ended under the Plan.
Also under the Trade Act, eligible individuals can either take a tax credit or get advance payment of 65% of premiums paid for qualified health insurance, including COBRA Continuation Coverage. If you have questions about these
tax provisions, you may call the Health Care Tax Credit Customer Contact Center toll-free at 1-866-628-4282. TTD/TTY callers may call toll-free at 1-866-626-4282. More information about the Trade Act is also available at
www.doleta.go/tradeact/2002act_index.asp The Plan Administrator may also be able to assist you with your questions.
When COBRA Continuation Coverage Ends
You lose your right to COBRA Continuation Coverage if:
The Plan no longer provides medical, prescription drug, dental, and/or vision care coverage to any participants;
You do not pay the required premium when due;
You become covered under another group medical plan. Note however, that if you have a pre-existing condition not covered by the other plan, your COBRA Continuation Coverage may be continued;
You become entitled to Medicare; or
The period of time for COBRA Continuation Coverage has expired.
