Consolidated Omnibus Budget Reconciliation Act (COBRA)
Medical Benefits Continuance Provisions
Medical Benefits as used in this provision means major medical and
prescription drug benefits provided under the Plan on an expense-incurred basis.
Continuation
of Group Medical Benefits
-
You may elect to continue medical benefits for yourself and your eligible
dependents for as long as eighteen (18) months from the day your eligibility
ends because:
-
your employer terminates (other than due to gross misconduct) or
-
you no longer satisfy the requirements for hours worked.
-
You or your dependents may elect to continue medical benefits for yourself
and/or your dependents for an additional eleven (11) months following the
original eighteen (18) month period if eligibility ends due to total
disability on the date of or within sixty (60) days of the Qualifying Event
and Social Security Disability Benefits have been awarded. Proof of
total disability must be provided to the Fund Office prior to the expiration
of the eighteen (18) month continuation period described above.
-
Your eligible spouse and/or any eligible dependent children may elect to
continue medical benefits for as long as thirty-six (36) months from the day
eligibility ends because:
-
you die;
-
you become entitled to Medicare benefits;
-
you and your spouse are legally separated;
-
your marriage is ended by divorce; or
-
a child is no longer an eligible dependent.
You are responsible for notifying the Fund Office when medical benefits end
in accordance with 3(c), 3(d) or 3(e) above.
The Fund Office will send you or your dependent written notice of the right
to continue medical benefits. The Fund Office must receive you or your
dependent's written request to continue medical benefits by the later of:
-
Sixty (60) days after the day medical benefits end; or
-
Sixty (60) days after the notice is received.
Continued coverage may only begin on the day after medical benefits under
the Plan ends. You or your dependents must pay the required premium,
including any retroactive premium, from the day the coverage would have
otherwise ended. The premiums must be paid to the Fund Office within the
forty-five (45) days after the day continued coverage is elected. The
Fund Office will inform you or your dependent of the monthly premium to be
paid.
-
Continued medical benefits will end at midnight on the earliest of:
-
the day the Fund ceases to provide any group health plan;
-
the day premium is due and unpaid;
-
the day the covered person, after the date of the COBRA election, first
becomes covered under another group plan that does not contain a
pre-existing conditions limitation or such limitation is not applicable to
the covered person due to the absence of a pre-existing condition.
(A plan's pre-existing conditions limitation period will be reduced by
each month that you or your family had continuous health coverage
(including COBRA) with no break in coverage greater than sixty-three (63)
days. When your coverage ends, you will receive certification of the
duration of your COBRA coverage. This provision applies individually
to each COBRA beneficiary.);
-
the day a covered person again becomes covered under the Plan;
-
the day a covered person, after the date of the COBRA election, is
entitled to benefits under Medicare;
-
the day medical benefits have been continued for the period of time
provided in 1, 2 or 3 above;
-
the date the Social Security Disability Award is revoked (which entitled
the person to continue coverage beyond the eighteen (18) month continuance
period); or
-
the first of the month for which the premium payment is rejected by that
person's bank for insufficient funds.
NOTES: In the event more than one (1) continuation provision applies,
the periods of continued coverage will run concurrently up to a maximum of
thirty-six (36) months.
Any period of continued eligibility for surviving spouses of deceased
participants provided by the Plan will not reduce the period of continuation
mandated under this provision.
|
