3421 AdmGuide_Federal Group Health Continuation (COBRA)

Qualifying Event
 
    A. Employees covered under the Board of Education's Group Health Coverages shall be offered the opportunity
        to continue the Group Health Coverages upon occurrence of one of the following
 
    B. "qualifying events":
 
            1. Voluntary or involuntary termination of employment for reasons other than "gross misconduct"
 
            2. Reduction in the number of hours of employment
 
    C. Spouses may continue the Group Health Coverages upon occurrence of one of the following "qualifying
        events":
 
            A. Termination of the covered employee's employment for any other reason other than "gross misconduct"
 
            B. Reduction in the hours worked by the covered employee
 
            C. Covered employee's becoming entitled to Medicare
 
            D. Divorce or legal separation of the covered employee
 
            E. Death of the covered employee
 
    D. Dependent children may continue the Group Health Coverages 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 Coverages and each spouse shall be notified of this policy at the time family or
                spouse coverage begins under the Board's Group Health Coverages.
 
                Notification to the employee's spouse shall be deemed to serve as notice on dependent children.
 
            2. Include information on the continuation rights in the Summary Plan Description;
 
            3. 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
                coverages;
 
            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.
 
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
 
Approved/Adopted:  July 13, 2009
Revised:  August 29, 2011
ĉ
Shari Weinstock,
Aug 31, 2011, 9:09 AM