COBRA Coverage
If eligibility under the Trust terminates due to one of the following Qualifying Events, Employees and Dependents who were covered by the health care plans on the day before the Qualifying Event have the right to continue health coverage (medical, prescription drug, vision care and dental benefits), under a federal law known as “COBRA”:
- Lay-off or covered hours of employment reduced;
- Termination of employment due to quit or discharge, for reasons other than gross misconduct;
- Disability (which results in termination of employment or loss of coverage due to your reduced hours);
- Leave of absence;
- Retirement;
- Death of spouse or parent (in the case of a Dependent);
- Your divorce or legal separation;
- Loss of status as a Dependent child; or
- The Employee’s entitlement to Medicare (in the case of a Dependent) if it results in a loss of the Dependent’s group health coverage.
Employees and Dependents will be required to pay for the continued health coverage at group rates, which are higher than the group rates for Employees who are employed under the Collective Bargaining Agreement.
If employment has been reduced or terminated (items 1 through 5 above), you and your Dependents are entitled to 18 months of continued coverage under the Trust from the date of the Qualifying Event. Each of the other listed events (items 6 through 9) entitles eligible Dependents to 36 months of continued coverage (maximum continuation period allowed) from the date of the Qualifying Event. If the Dependent has continued coverage because of the Employee’s termination or reduction in hours (items 1 through 5 above), the Dependent may extend coverage from 18 months (29 if disabled as described below) up to a maximum of 36 months if a second Qualifying Event (items 6 through 9) occurs during the first 18 (or 29) month coverage period.
If you, the Employee, become entitled to Medicare (even if that event is not a Qualifying Event), the maximum period of coverage for your Dependents for such event, or for any subsequent Qualifying Event is the 36-month period beginning on the date the Employee becomes entitled to Medicare.
Although domestic partners are not entitled to COBRA coverage, they will be eligible for continued coverage through the Trust provided they meet the COBRA requirements. Please contact the Trust Administration Office for more information regarding continued coverage for a domestic partner.
Extended Continuation Coverage for Disabled Individuals
If you are entitled to 18 months of continuation coverage, AND if you are determined to be disabled under the terms of the Social Security Act at any time during the first 60 days of COBRA continuation coverage, you are eligible for up to an additional 11 months of continuation coverage AFTER the expiration of the 18 month period. To qualify for this additional period of coverage, you must notify the Trust Administration Office within 60 days after you receive a determination of disability from Social Security Administration, provided notice is given before the end of the initial 18 months of continuation coverage. You must also notify the Trust within 30 days of the final Social Security determination indicating you are no longer disabled. During the additional 11 months of continuation coverage, your premium will be approximately 50% higher than it was during the first 18 months. However, if you, the disabled individual, do not elect COBRA coverage, the cost for electing Dependents will not be more than was permitted to be charged in the first 18 months of continuation coverage
Cost COBRA Continuation Coverage
As previously mentioned, the coverage required by law is available only at your own expense. If you or your Dependent(s) elect to continue coverage, the full cost, plus an administrative charge, if applicable, will be charged.
Life and Accidental Death and Dismemberment Benefits are not included under the COBRA Continuation of Coverage law. Dental coverage need not be continued; however, dental coverage must be either continued at an additional cost along with the Trust’s other health care coverage (medical, prescription drug and vision benefits), or rejected.
Election of COBRA Continuation Coverage
You or your Dependents must elect to continue coverage within 60 days following receipt of a COBRA notice and election form from the Trust Administration Office advising of COBRA continuation of coverage, or within 60 days following the date Employee or Dependent coverage would terminate, whichever is later.
If the Qualifying Event is divorce or legal separation from the Employee or a child’s loss of Dependent status, the Employee or Dependent must notify the Trust Administration Office within 60 days after the later of the date of the applicable Qualifying Event or the date coverage under the group health plan would otherwise end. Group health coverage would otherwise end as of the date of the Qualifying Event unless COBRA continuation coverage is elected.
The initial premium, which must include premiums due from the date your eligibility would have terminated, must be paid to the Trust Administration Office within 45 days following submission of the COBRA election form.
You or your Dependents are also responsible for sending in payments for required monthly premiums in full and on the premium due date, as established by the Trust Administration Office. If any premiums are not received within 30 days of the due date, eligibility for the COBRA continuation of coverage will terminate.
COBRA continuation coverage is only available to Employees and/or Dependents who were covered under the health plans on the day before the Qualifying Event, except that a child who is born to or placed for adoption with the covered Employee during the period of COBRA continuation coverage will also be eligible, provided that the covered Employee elects COBRA continuation coverage for himself during the election period and elects coverage for the child within 30 days of the child’s birth or placement for adoption.
Termination of COBRA Continuation of Coverage
Eligibility for COBRA continuation of coverage will terminate on the first day of the month following the occurrence of any one of the events listed below:
- Failure to remit the required premium payment in full and on time (not later than 30 days following the due date established by the Trust Administration Office, or no later than 45 days following submission of the initial COBRA election form).
- You or your eligible Dependents receive coverage, as an Employee or as a Dependent, under any other group health plan, provided, however, that if the successor group health plan excludes coverage for a pre-existing condition, you may continue COBRA coverage as long as the successor plan’s pre-existing condition applies to you (but not beyond the end of the maximum COBRA coverage period as described above).
- You or your Dependents become entitled to and are receiving Medicare benefits;
- The date the Trust ceases to provide group health coverage to any Employees.
- You or your Dependents have continued coverage for additional months due to a disability, and there has been a final determination by social security that you or your Dependents are no longer disabled. (In this case, coverage ends on the first of the month that begins more than 30 days after the Social Security Administration makes a final determination that you or your Dependent are no longer disabled or at the end of the applicable 18 or 36 month maximum coverage period described above, whichever occurs last).
- You reach the end of your maximum COBRA continuation coverage period as described above.
- Termination of Plan.
If you have elected coverage under a region-specific plan (such as a region-specific HMO) and you relocate to an area not covered by that plan, alternative coverage may not be available. If the Trust offers other coverage to Employees that is available in, or can be executed to, your new location, you may elect to receive that coverage (some restrictions apply). However, COBRA continuation coverage will not be provided to you if none of the coverages offered to Employees are available in the area to which you relocate.
NOTE: Once COBRA continuation of coverage terminates, you or your Dependents (if eligible) may have the right to convert health insurance (medical only) to conversion coverage under the Right to Convert health insurance provisions provided by one of the health maintenance organizations. You must check the appropriate HMO Evidence of Coverage booklet for details regarding Conversion to Individual Plan Coverage.
Extension of COBRA Deadlines During Coronavirus Outbreak Period
On May 4, 2020, the Internal Revenue Service and Department of Labor adopted an emergency regulation that extends certain COBRA deadlines during the coronavirus “Outbreak Period.” The Outbreak Period runs from March 1, 2020 until sixty (60) days following the announced end of the National Emergency (or another date determined by the federal government in a future notice). Any deadlines for electing COBRA coverage or for making your first payment for COBRA are suspended until 60 days after the end of the COVID-19 national emergency.
The extension of the above deadlines does not extend the maximum period of COBRA coverage to which you are entitled.
If you elect COBRA, claims for covered expenses will be paid retroactive to the first date of your COBRA coverage, for every month for which you have paid the full premium due.
Examples:
1) Terry loses coverage on December 31, 2019 due to a reduction of hours and received a COBRA election notice on January 15, 2020. Terry did not elect COBRA coverage by March 15, 2020, which was the deadline under the normal COBRA election rules. The 15-day portion of his COBRA election window that falls within the Outbreak Period (March 1-March 15) is disregarded. Terry’s COBRA election period will now end fifteen (15) days after the end of the Outbreak Period.
2) John loses coverage due to a reduction of hours and received a COBRA election notice on April 1, 2020. John’s COBRA election period will end sixty (60) days after the end of the Outbreak Period. Until John elects COBRA coverage, the health plan will inform providers that John does not currently have coverage but will have coverage retroactively if he elects COBRA coverage during his election period and timely pays his COBRA premium covering the month of service (see 3(a), below).
3) Susan was receiving COBRA coverage on April 1, 2020. More than 45 days had passed since Susan had elected COBRA. Susan made a timely March COBRA premium payment but has not made any payments since then. As of August 1, 2020, Susan has made no premium payments for April, May, June or July. For purposes of this example, assume that the Outbreak Period ends on July 30, 2020. Susan’s premium payments for four months (April through July) are due by August 29, 2020.
a) The health plan will pay for benefits and services retroactively only if Susan pays the COBRA premium by August 29, 2020. Until Susan pays the retroactive COBRA premium(s), the health plan will inform providers that Susan does not currently have coverage but will have coverage retroactively if she pays her COBRA premiums covering the month of service.
b) If Susan only submits payment equivalent to two months’ premiums by August 29, 2020, benefits and services provided on or before May 31, 2020 would be covered but the plan would not be obligated to pay for benefits or services that occurred after May 2020.
Please call the Plan Administrative Office at (800) 924-1226 if you have any questions or need another copy of your COBRA election forms.