Loss of Coverage (Active Employee Plans) - COBRA / Back

COBRA Coverage

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law that requires certain group health plans to offer employees and their covered dependents the option of continuing coverage by self-payment after Employer-paid coverage has ended.

When your Employer-paid coverage ends, you and your eligible dependents may be able to continue coverage under the Plan for up to 18, 29 or 36 months by self-payment.

You and your eligible dependents may choose to continue coverage by self-payment for up to 18 months if your Employer-paid coverage ends as a result of one of the following qualifying events:

  1. Your employment terminates as a result of resignation, layoff, firing or retirement.
  2. Your hours are reduced to less than those required for coverage under your collective bargaining agreement.
If you or your covered dependent becomes disabled (as that term is defined by Title II or XVI of the federal Social Security Act) at any time during the first 60 days after the COBRA qualifying event, coverage may be continued for up to 29 months. To qualify for this added COBRA period, you must notify the Plan Administration Office within 60 days of the disability determination from Social Security and no later than the end of your first 18 months of COBRA coverage.

The extra 11 months of COBRA coverage for Social Security disability will require a higher monthly self-payment. Contact the Plan Administration Office for the current notification forms and details.

Your Employer is required to inform the Plan Administration Office in the event of a COBRA qualifying event such as an employee's death, termination or reduction in hours.

If you decide to continue coverage under COBRA, you will be offered the same coverage that is available to active employees, except that COBRA benefits do not include life insurance (or any weekly disability coverage that may be described in your Summary of Coverage).

If you are covered by a regional plan (like an HMO that covers a limited geographic area), and you move to another area where your former Employer has an active workforce, you may be eligible to enroll in the benefit plan available to active employees in that area. However, such a transfer will not prolong your 18, 29 or 36 months of COBRA coverage.

Your dependents may continue coverage under the Plan for up to a total of 36 months if their Employer-paid coverage ends due to any of the following qualifying events:

  1. Your death.
  2. Your divorce.
  3. Your dependent child no longer qualifies as an eligible dependent as defined by the Plan (for example, the child reaches age 19).
  4. You become entitled to Medicare benefits.

If you become entitled to Medicare benefits and, within less than 18 months of the date of Medicare entitlement, terminate employment or experience a reduction in hours which results in the loss of Employer-paid coverage, your dependents will be entitled to COBRA coverage for not more than 36 months beginning with the date of your Medicare entitlement.

Important: If any of these qualifying events occurs, you or your covered dependent must notify the Plan Administration Office within 60 days of the event. Failure to so notify TBT terminates COBRA rights. The words "covered dependent" for purposes of COBRA coverage include children born to you or placed with you for adoption during the period of COBRA coverage, or a spouse if you are married during the COBRA period. You must notify the Plan Administration Office within 30 days of the birth, adoption or marriage for the dependent to have status as a covered dependent for purposes of COBRA.

You have a maximum of 60 days to elect COBRA coverage. A COBRA election form (called Notice of Qualifying Event) is in your Forms folder. If you need a form, contact the Plan Administration Office.

The COBRA election period begins on the later of the following dates:

  1. The date coverage under the Plan would otherwise end because of the qualifying event.
  2. The date the qualified beneficiary is sent notice of his or her right to elect COBRA coverage.

Family and Medical Leave Act

A leave of absence from an Employer who is subject to obligations under the federal Family and Medical Leave Act (FMLA) or the California Family Rights Act of 1991 (CFRA) does not constitute a COBRA qualifying event because the Employer remains obligated to contribute to the Plan on your behalf during the leave of absence (see page 10). Under such circumstances, benefits will continue automatically. However, if you don't return from FMLA or CFRA leave, your Employer-paid coverage will end, at which time you will be offered the option of continuing your coverage under COBRA.

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