Continuation Coverage (COBRA)
Under a federal law that is commonly known as COBRA (Public Law 99-272, Title X), most employers sponsoring “group health plans” are required to offer employees and their families the opportunity for a temporary extension of health coverage (called “continuation coverage”) in certain instances where coverage under the plan would otherwise end. The health care reimbursement portion of the Flexible Benefits Plan, the Medical Plan and Employee Assistance Plan (“EAP”) qualify as “group health coverage” for purposes of COBRA (each a “COBRA plan”). This notice generally explains COBRA continuation coverage, when it becomes available to you and your family, and what you need to do to protect the right to receive it. This notice gives only a summary of your COBRA continuation coverage rights. Both you and your spouse should take the time to read this notice carefully.
Questions concerning each COBRA plan or your COBRA
continuation rights should be addressed to the Plan Administrator, using the
contact information at the end of this Summary Plan Description. The Plan Administrator is
Continuation coverage under the health care reimbursement
portion of the Flexible Benefits Plan
If you have questions about your rights under ERISA, including COBRA, HIPAA, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) or visit the EBSA website at Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA website .
continuation coverage is a continuation of plan coverage when coverage would
otherwise end because of a life event known as a “qualifying event.” Specific qualifying events are listed later
in this notice. After a qualifying
event, COBRA continuation coverage must be offered to each person who is a
“qualified beneficiary.” A qualified
beneficiary is someone who will lose coverage under the Plan because of a
qualifying event. Depending on the type of qualifying event, employees, spouses
or former spouses of employees, and dependent children
Sometimes, filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event. If a proceeding in bankruptcy is filed with respect to the college, and that bankruptcy results in the loss of coverage of any retired employee covered under a COBRA plan, the retired employee is a qualified beneficiary with respect to the bankruptcy. The retired employee's spouse, surviving spouse, and dependent children will also be qualified beneficiaries if bankruptcy results in the loss of their coverage under the COBRA plan.
If you are an employee of the college covered by a COBRA plan you have a right to choose this continuation coverage if you lose your group health coverage under the COBRA plan because of either of the following reasons:
If you are the spouse of an employee covered by a COBRA plan, you have the right to choose continuation coverage for yourself if you lose group health coverage under the COBRA plan for any of the following reasons:
or legal separation from your spouse. If an employee cancels coverage for his or her spouse in anticipation
of a divorce or legal separation, and a divorce or legal separation later
occurs, then the divorce or legal separation will be considered a qualifying
event even though the ex-spouse lost coverage earlier. If the ex-spouse notifies the administrator
within 60 days after the divorce or legal separation and can establish that the
employee cancelled the coverage earlier in anticipation of the divorce or legal
separation, then the COBRA coverage
In the case of an employee’s dependent child who is covered by a COBRA plan (including a child born to or placed for adoption with a covered employee during the COBRA continuation period and alternate recipients under QMCSOs), he or she has the right to continuation coverage if group health coverage under the COBRA plan is lost for any of the following reasons:
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been timely notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the employee, or enrollment of the employee in Medicare (Part A, Part B, or both), or commencement of a proceeding in bankruptcy with respect to the employer, the employer must notify the Plan Administrator of the qualifying event within 30 days of any of these events.
For the other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator. The Plan requires you to notify the Plan Administrator in writing within 60 days after the later of the qualifying event or the loss of coverage using the procedures specified below. If these procedures are not followed or if the notice is not provided in writing to the Plan Administrator during the 60-day notice period, any spouse or dependent child who loses coverage will NOT BE OFFERED THE OPTION TO ELECT CONTINUATION COVERAGE.
Plan Administrator receives timely notice that a qualifying event has
occurred, COBRA continuation coverage will be offered to each of the qualified
beneficiaries. Each qualified
beneficiary will have an independent right to elect COBRA continuation
coverage. Covered employees
For each qualified beneficiary who timely elects COBRA continuation coverage, COBRA continuation coverage will begin on the date of the qualifying event. If you or your spouse or dependent children do not elect continuation coverage within the 60-day election period, YOU WILL LOSE YOUR RIGHT TO ELECT CONTINUATION COVERAGE.
COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, enrollment of the employee in Medicare (Part A, Part B, or both), your divorce or legal separation, or a dependent child losing eligibility as a dependent child, COBRA continuation coverage lasts for up to 36 months.
When the qualifying event is the end of employment or reduction of the employee’s hours of employment due to a military leave that qualifies under the Uniformed Services Employment and Reemployment Rights Act (“USERRA”), COBRA continuation coverage lasts for up to 24 months.
When the qualifying event is the end of employment or reduction of the employee’s hours of employment, COBRA continuation coverage lasts for up to 18 months. There are three ways in which this 18-month period of COBRA continuation coverage could be extended.
If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family can receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. You must make sure that the Plan Administrator is notified in writing of the Social Security Administration’s determination within 60 days after the date of determination and before the end of the 18-month period of COBRA continuation coverage. The Plan requires you to follow the procedures specified below, entitled “Notice Procedures.” In addition, your notice must include the name of the disabled qualified beneficiary, the date that the qualified beneficiary became disabled, and the date that the Social Security Administration made its determination. Your notice must also include a copy of the Social Security Administration’s determination. If these procedures are not followed, or if the notice is not provided in writing to the Plan Administrator within the required period, then there will be no disability extension of COBRA continuation coverage.
family experiences another qualifying event while receiving 18 months of COBRA
continuation coverage, the spouse and dependent children in your family can get
up to 18 additional months of COBRA continuation coverage, up to a maximum of
36 months, if notice of the second qualifying event is given properly to the
Plan. This extension
If a qualifying event that is the employee’s termination of employment or reduction of hours, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, then the maximum coverage period for the spouse and dependent children will end 36 months after the date the employee became entitled to Medicare (but the covered employee’s maximum coverage period will be 18 months). For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA continuation for his spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months).
If, while you are a Qualified Beneficiary receiving continuation coverage under COBRA, a child is born to you or you adopt a child, you must notify the Plan Administrator in writing within 30 days of the birth or adoption to add that child to your continuation coverage. The Plan requires you to follow these procedures specified below, entitled “Notice Procedures.” IF YOU FAIL TO PROPERLY NOTIFY THE PLAN ADMINISTRATOR, YOU MAY NOT BE ABLE TO ADD THE CHILD TO YOUR CONTINUATION COVERAGE.
Any notice that you provide must be in writing. Oral notice, including notice by telephone, is not acceptable. To provide notice to the Plan Administrator you must mail your notice to the Human Resources Department at this address:
(For the most recent information, check the Plan’s most recent Summary
Plan Description. If you do not have a
If mailed, your notice must be postmarked no later than the last day of the required notice period. Any notice you provide must state the name of the Plan, the name and address of the employee covered under the Plan, and the name(s) and address(es) of the qualified beneficiary(ies). Your notice must also name the qualifying event and the date it happened. If the qualifying event is a divorce, your notice must include a copy of the divorce decree.
In order to protect your family's rights, you should keep the Plan Administrator informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.