Benefits - Local 813 Insurance Trust Fund

 
Notice of Continuation Coverage Rights Under COBRA

Introduction

You are receiving this notice because you are covered under a group health plan (the “Plan”). This notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of group health coverage under the Plan. This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it.

The right to elect COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”). COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group heath coverage.

This notice gives only a summary of your continuation coverage rights under the Plan. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description (SPD) or contact the Plan Administrator.

What is COBRA Continuation Coverage?

COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage is offered to each person who is a “qualified beneficiary.” You, your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.

If you are an employee, you will become a qualified beneficiary if you lose coverage under the Plan because one of the following qualifying events happens:

1. Your hours of employment are reduced; or
2. Your employment ends for any reason other than your gross misconduct.

If you are the spouse of an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because any of the following qualifying events happens:

1. Your spouse dies;
2. Your spouse’s hours of employment are reduced;
3. Your spouse's employment ends for any reason other than his or her gross misconduct;
4. You become divorced or legally separated from your spouse; or
5. Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both).

Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because any of the following qualifying events happens:

1. The parent-employee dies;
2. The parent-employee’s hours of employment are reduced;
3. The parent-employee’s employment ends for any reason other than gross misconduct;
4. The parents become divorced or legally separated;
5. The parent-employee becomes entitled to Medicare benefits (under Part A, Part B, or both); or
6. The child stops being eligible for coverage under the Plan as a “dependent child.”

Children who are born to or placed for adoption with a covered employee during the period of the employee’s continuation coverage also are qualified beneficiaries entitled to COBRA continuation coverage. Once the newborn or adopted child is enrolled in continuation coverage pursuant to the Plan's rules, the child will be treated like all other qualified beneficiaries with respect to the same qualifying event. The maximum coverage period for such a child is measured from the same date as for other qualified beneficiaries with respect to the same qualifying event (and not from the date of the child’s birth or adoption).

When is COBRA Coverage Available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction in hours of employment, death of the employee, or the employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both), your employer must notify the Plan Administrator of the qualifying event.

You Must Give Notice of Some Qualifying Events

For all other qualifying events (i.e., divorce or legal separation of the employee and spouse, or a dependent child losing eligibility for coverage as a dependent child), you (or your family member) must notify the Plan Administrator no later than 60 days after the later of the date the qualifying event occurs or the date of the loss of coverage due to the qualifying event. The notice must be in writing and must be sent to the Plan Administrator. Your written notice must include: (i) the name of the employee, (ii) the name(s) of the qualified beneficiary (ies), (iii) the type of qualifying event, and (iv) the date on which the event occurred.

The employee or family member can provide notice on behalf of themselves as well as other family members affected by the qualifying event.

How is COBRA Coverage Provided?

Once the Plan Administrator is notified that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.

How Long Does COBRA Continuation Coverage Last?

COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, the employee's becoming entitled to Medicare benefits (under Part A, Part B, or both), your divorce or legal separation, or a dependent child's losing eligibility as a dependent child, COBRA continuation coverage lasts for up to a total of 36 months. When the qualifying event is the end of employment or reduction of the employee's hours of employment, COBRA continuation coverage generally lasts for only up to a total of 18 months. However, if the qualifying event is the end of employment or reduction of the employee’s hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months).

However, there are two ways in which an 18-month period of COBRA continuation coverage can be extended.

1. Disability Extension of 18-month Period of Continuation Coverage
    
   If you or anyone in your family covered under the Plan is determined by the Social Security Administration (SSA) to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. Written notice of the SSA Disability determination (along with a copy of the SSA Award) must be sent to the Plan Administrator at the Fund Office no later than the end of the first 18 months of continuation coverage. Your written notice must include: (i) the covered employee’s name, (ii) the qualified beneficiary’s(ies’) name(s), (iii) the name of the person who has been determined to be disabled by SSA, and (iv) the date of the determination. Notice from one individual will satisfy the notice requirement for all related qualified beneficiaries affected by the same qualifying event.
    
   If the SSA determines that the individual is no longer disabled, this extended period of COBRA coverage will end as of the last day of the month that begins more than 30 days after the SSA has determined that the individual is no longer disabled. The disabled individual or a family member is required to notify the Fund Office within 30 days of any such determination.
    
2. Second Qualifying Event Extension of 18-month Period of Continuation Coverage
    
   If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the Plan. This extension may be available to the spouse and any dependent children receiving continuation coverage if the employee or former employee dies, gets divorced or legally separated, becomes entitled to Medicare benefits (under Part A, Part B, or both) or if the dependent child stops being eligible under the Plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.

Early Termination of Continuation Coverage

The law provides that continuation coverage may be cut short prior to the expiration of the applicable 18, 29 or 36 month period for any of the following five reasons:

1. The group health coverage provided to you is terminated (and the Plan Sponsor is not required by COBRA to provide you with other group health coverage that it maintains, if any);
2. The premium for continuation coverage is not timely paid (within the applicable grace period);
3. The individual first becomes, after electing COBRA coverage, covered under another group health plan (as an employee or otherwise) that does not contain any preexisting condition exclusion or limitation applicable to the individual;
4. The individual becomes entitled to Medicare (under Part A, Part B, or both) after electing COBRA coverage; or
5. Coverage has been extended for up to 29 months due to disability and there has been a final determination by the Social Security Administration that the individual is no longer disabled. In this case, coverage will end as of the month that begins more than 30 days after the date of such final determination. You are required to notify the Plan Administrator within 30 days of any such final determination.

Continuation coverage may also be terminated for any reason the Plan would terminate coverage of a participant or beneficiary not receiving continuation coverage (such as fraud).

If You Have Questions

Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under ERISA, including COBRA, HIPAA, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA's website.)

Keep Your Plan Informed of Address Changes

In order to protect your family's rights, you should keep the Plan Administrator informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.

Plan Contact Information

The name of the Plan is: Local 813 Insurance Trust Fund.

You may contact the Fund Office for more information about the Plan and COBRA continuation coverage:

Local 813 Insurance Trust Fund
45-18 Court Square, Suite 600
Long Island City, NY 11101
(718) 937-7150.