Cobra
Federal law, known as COBRA, requires that most employers sponsoring group health plans offer employees and their families the opportunity for a temporary extension of health coverage (called “continuation coverage”) at group rates in certain instances where coverage under the plan would otherwise end. The following information is intended to inform you, in a summary fashion, of your rights and obligations under the continuation coverage provisions of the law. Please notify your spouse and eligible dependents of this continuation of coverage option.
Eligibility and Length of Coverage
“Qualified Beneficiary” may be an employee, spouse, or children. Qualified Beneficiary shall also include newborn children or adopted children who may be added to the plan after the original effective date of coverage.
Continuation up to 18 months
(for employee and/or spouse and/or eligible dependent children) due to:
- Employee’s reduction in hours of employment (including disability)
- Employee’s termination of employment (for reasons other than the employee’s gross misconduct)
Continuation up to 36 months
(for spouse and/or eligible dependent children) due to:
- Death of the employee
- Divorce or legal separation of the employee and spouse
- The employee becomes entitled to Medicare
- Child no longer meets the plan’s definition of a “dependent”
Possible extension of 18-month period due to disability:
If the Social Security Administration determines that you were disabled at any time during the first 60 days of continuation of coverage and you inform your employer before the end of the 18-month period, your coverage may be extended up to 29 months. The 29-month “Disability Extension” also applies to non-disabled family members covered under COBRA. The qualified beneficiary must notify the Employer within 30 days of any final determination that he/she is no longer disabled. To receive the additional 11 months of coverage, you must provide written documentation from the Social Security Administration (SSA) determining disability status in the initial 18 month time frame and within 60 days of the date that SSA makes its determination.
Possible extension of 18-month or 29-month period due to multiple qualifying event:
If, during the initial 18 months, another event takes place that also entitles you to coverage, coverage may be extended. The 36-month time frame is calculated from the employee’s original COBRA start date. In no case may the total amount of continued coverage last beyond 36 months from the date of the event that originally made a qualified beneficiary eligible to elect coverage. If a second “qualifying event” occurs, the affected individual has 60 days to provide written notification to the Employer. If this notification is not received within the 60-day time frame, the extension to 36 months will be denied.
When Continuation Coverage Ceases
Continuation coverage may cease for any of the following reasons. (Note: The GISD Health Plan does not offer conversion if you lose group health coverage.)
- GISD no longer provides group health coverage to any of its employees;
- the premium for continuation coverage is not paid in a timely fashion;
- a qualified beneficiary becomes covered under another group health plan – unless that plan contains any exclusions or limitations with respect to any pre-existing conditions the qualified beneficiary may have;
- you become entitled to Medicare;
- you extended your coverage for up to 29 months due to your disability and there has been a final determination that you are no longer disabled; in this case, continuation of coverage will also cease for non-disabled family members
- your have reached the end of the maximum allowable months under COBRA
Notification & Election of Coverage
GISD must inform a qualified beneficiary of his/her right to continuation coverage within 14 days of the qualifying event or within 14 days of notice by a qualified beneficiary. Any notification to an employee who is a qualified beneficiary is treated as notification to the covered spouse. Notification to the covered spouse is deemed notification to the covered dependent. The qualified beneficiary has 60 days from the later of the loss of coverage or the day on which notification is sent to elect continuation coverage. If continuation coverage is not elected within the 60-day time period, your insurance coverage will end.
A qualified beneficiary must notify GISD within 60 days of the following qualifying events:
- divorce or legal separation
- dependent child becoming ineligible
- disability determination by Social Security
- Medicare entitlement
Also, the employer must be notified in writing of any change in address.
Type of Coverage
If you choose continuation of coverage, the employer is required to offer qualified beneficiaries coverage, which as of the time coverage is being provided, is identical to the coverage provided under the plan to similarly situated employees or family members.
You Pay Premiums
You must pay the full premium (your portion plus GISD’s portion) for your continuation coverage plus a 2% administrative charge. Premiums are due in full the first of the month for that month of coverage. If your premium payment is not delivered or postmarked within the 30-day grace period, your coverage will be terminated back to the last day for which we received a full premium payment. If an election is made after the qualifying event, the plan will permit payment for continuation coverage during the period preceding the election to be made within 45 days of the date of the election.