Continuation
Coverage (COBRA)
[Faculty
Handbook Category #1]
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 http://www.dol.gov/ebsa. Addresses and phone numbers of Regional and
District EBSA Offices are available through EBSA website
COBRA
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
of employees
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:
(1) A reduction
in your hours of employment; or,
(2) The termination of your employment (for
reasons other than gross misconduct on your part).
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:
(2) A
termination of your spouse’s employment (for reasons other than gross
misconduct) or reduction in your spouse’s hours of employment;
(3) Your
spouse becomes entitled to Medicare (Part A, Part B, or both); or
(4) Divorce
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:
(1) The
death of a parent-employee;
(2) The
termination of a parent-employee’s employment (for reasons other than gross
misconduct) or reduction in a parent-employee’s hours of employment with the
college;
(3) Parents’
divorce or legal separation;
(4) A
parent becomes eligible for Medicare (Part A, Part B, or both); or
(5)
The dependent ceases to be eligible under the Plan as a
“dependent child.”
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.
Once the
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.
If your
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.
Notice Procedures
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
copy, you
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.