Administrative Guideline - 2421 Federal Group Health Continuation (COBRA)

QUALIFYING EVENT


A.      Employees covered under the Board's Group Health Coverage shall be offered the opportunity to continue the Group Health Coverage upon occurrence of one of the following "qualifying events":

  1. voluntary or involuntary termination of employment for reasons other than "gross misconduct"
  2. in the number of hours of employment

B.      Spouses may continue the Group Health Coverage upon occurrence of one of the following "qualifying events":

  1. termination of the covered employee's employment for any other reason other than "gross misconduct"
  2. reduction in the hours worked by the covered employee
  3. covered employee's becoming entitled to Medicare
  4. divorce or legal separation of the covered employee
  5. death of the covered employee

C.      Dependent children may continue the Group Health Coverage upon the occurrence of one of the following "qualifying events":

  1. termination of covered employee's employment for any reason other than "gross misconduct"
  2. reduction in the hours worked by the covered employee
  3. loss of "dependent child" status under the plan rules
  4. covered employee's becoming entitled to Medicare
  5. divorce or legal separation of the covered employee
  6. death of the covered employee

ELECTION


Qualified beneficiaries have a sixty (60) day period from the later of the coverage loss date or the date the notice to elect COBRA coverage is sent to elect whether to continue coverage. Once COBRA coverage is chosen, the beneficiary is required to pay for the coverage. COBRA coverage is retroactive if elected and paid for by the qualified beneficiary.

BENEFITS AVAILABLE TO QUALIFIED BENEFICIARIES


Qualified beneficiaries have the right to elect to continue coverage that is identical to the coverage provided under the plan. A covered employee or the covered employee's spouse may elect COBRA coverage on behalf of any other qualified beneficiary. Each qualified beneficiary, however, may independently elect COBRA coverage. A parent or legal guardian may elect on behalf of a minor child.

TERMINATION OF COBRA COVERAGE


Coverage for the employee and eligible dependent(s), if any, can end when:

A.      the last day of maximum coverage is reached;

B.      premiums are not paid on a timely basis;

C.      the employee ceases to maintain any group health plan;

D.      coverage is obtained with another employee group health plan that does not contain any exclusion or limitation with respect to any pre-existing condition of such beneficiary;

E.       a beneficiary is entitled to Medicare benefits.

Special rules for disabled individuals may extend the maximum periods of coverage. If a qualified beneficiary is determined under Title II or XVI of the Social Security Act to have been disabled at the time of a termination of employment or reduction in hours of employment and the qualified beneficiary properly notifies the plan administrator of the disability determination, the eighteen (18) month period is expanded to twenty-nine (29) months.

REGULAR CONVERSION OPTION


After the continuation coverage under COBRA expires, the beneficiary may be eligible for coverage under any conversion option provided under the plan.

A.      The Board will notify a qualified COBRA beneficiary of the option to enroll in a conversion plan within 180 days before the expiration date of COBRA continuation coverage.

B.      The benefits and costs of coverage available under a conversion option may differ from those offered through the group health plan.

NOTIFICATION REQUIREMENTS


A.      The Board shall:

  1. notify all covered employees and spouses of their coverage continuation rights on the date the COBRA requirements took effect. Thereafter, each employee shall be notified of this policy at the time they begin coverage under the Board's Group Health Coverage and each spouse shall be notified of this policy at the time family or spouse coverage begins under the Board's Group Health Coverage.
  2. Notification to the employee's spouse shall be deemed to serve as notice on dependent children.
  3. include information on the continuation rights in the Summary Plan Description.
  4. notify the plan administrator within thirty (30) days of the following qualifying events:

          a. death of the covered employee

          b. termination of employment or reduction in hours of the covered employee

          c. eligibility of covered employee for Medicare

          d. bankruptcy of covered employee

B.      The Plan Administrator shall:
 

  1. notify the employee of their COBRA provisions when the employee begins under the group health coverage;
  2. notify the eligible beneficiaries within fourteen (14) days of receiving the specified notification of the qualifying event of his/her right to continuation of coverage. Notifying a spouse or former spouse of an employee is considered sufficient notice to all other eligible beneficiaries living with that person.
  3. The employee, retiree, or family member should notify the plan administrator within sixty (60) days of events consisting of divorce or legal separation or a child's ceasing to be covered as a dependent under plan rules.



P.L. 99-272

Consolidated Omnibus Budget Reconciliation Act of 1984