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COBRA Continuation Coverage

The right to 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 Health Plan when they would otherwise lose their group health coverage.

You're required to pay the full cost of coverage, plus an administrative fee of 2%, for continued mental health, chemical dependency, medical, vision, dental and prescription drug coverage for you and any eligible dependents you wish to cover when you lose eligibility for employer-paid coverage and are not eligible for any other form of extended coverage. The Administrative Office is responsible for administering COBRA Continuation Coverage. All COBRA election paperwork should be sent to the Administrative Office.

To continue coverage, you must pay the COBRA premium on a monthly basis. When you first enroll, you may choose a plan under COBRA other than the one in which you were enrolled when you lost Fund coverage, but once enrolled in a COBRA plan, you may only change your plan selection during an Open Enrollment period or following a Life Event. (See "Life Events," for more information.)

Who's Eligible For COBRA

COBRA Continuation Coverage is available to the following dependents:

If you continue your own coverage under COBRA, you may also cover your Same-Sex Spouse or Same-Sex Domestic Partner as your dependent if you pay the required premiums. However, your Same-Sex Spouse or Same-Sex Domestic Partner will have no individual COBRA rights under this coverage.

When your adult dependent child turns age 26, the Fund will send your dependent a Notice of Termination of Coverage offering him/her the option to purchase COBRA Continuation Coverage. Children of your Same-Sex Domestic Partners are not eligible for COBRA Continuation Coverage unless you (the participant) have legally adopted them prior to the qualifying event.

Qualifying Events

The following chart shows who is eligible for COBRA Continuation Coverage, under what circumstances (also known as qualifying events), and how long COBRA Continuation Coverage will last. You must notify the Administrative Office of a divorce, legal separation or a child's loss of dependent status within 60 days after the date of the qualifying event. If you do not, your qualified dependent(s) will lose their right to elect COBRA Continuation Coverage.

Who Qualifying Event Who Is Eligible For COBRA Continuation Coverage Duration Of COBRA Continuation Coverage
You
Have a reduction in earnings below the level required for eligibility (and have exhausted any extended eligibility under the Extended Coverage Program or other coverage extension options)
You and your covered dependents, excluding your Same-Sex Spouse or Same-Sex Domestic Partner
18 months*
Are disabled at the time you become eligible for COBRA or you become disabled within the first 60 days after COBRA continuation coverage begins
You and your covered dependents, excluding your Same-Sex Domestic Partner
29 months**
Die
Your covered dependents, excluding your Same-Sex Spouse or Same-Sex Domestic Partner
36 months
Become divorced or legally separated
Your covered spouse, excluding your Same-SexSpouse
36 months
Your Spouse and/or Dependent Child


Is no longer an eligible dependent (due to age limit, divorce or legal separation)
Your covered dependents, excluding your Same-Sex Spouse or Same-Sex Domestic Partner
36 months
Is no longer an eligible dependent because of your death
Your covered dependents, excluding your Same-Sex Spouse or Same-Sex Domestic Partner
36 months
Is disabled at the time COBRA Continuation Coverage begins or within the first 60 days after COBRA Continuation Coverage begins
Your covered dependents, excluding your Same-Sex Spouse or Same-Sex Domestic Partner
29 months

* 24 months if, as an active participant, you've had at least two years of earned eligibility in the last five years.
Excludes Same-Sex Domestic Partner's children unless you have legally adopted them prior to the date of the qualifying event.
** You are required to provide proof of eligibility for Social Security disability benefits for COBRA Continuation Coverage for the additional 11 months.


Once a qualifying event occurs and you notify the Administrative Office, you will receive full details about COBRA Continuation Coverage, including the cost and duration of coverage. If you decide to elect COBRA Continuation Coverage, you must notify the Administrative Office within 60 days of the notice date or the date coverage ended, whichever is later. Once you elect COBRA Continuation Coverage, you will have 45 days from the date you decided to elect COBRA Continuation Coverage to pay the initial monthly premium, retroactive to the date of the qualifying event. This 45-day grace period is required by law, and no extensions will be granted.

Premiums are billed monthly. If you fail to pay your premium within 30 days of the due date, your COBRA Continuation Coverage will be terminated and will not be reinstated. This 30-day grace period is required by law, and no extension will be granted. Premium rates are subject to an annual change.

If you do not respond to the initial COBRA notice within 60 days, you will no longer be eligible for COBRA Continuation Coverage.


Important!

All extensions of coverage and survivor coverage not specifically required by law, like all Fund benefits, are subject to amendment or termination by the Fund's Board of trustees and do not entitle your surviving dependents to a guarantee or vested rights to the Fund's benefits program.


Disability Extension of 18-Month Period of COBRA Continuation of Coverage

If you, your covered spouse or dependent children are determined to be "disabled" by the Social Security Administration at any time during the first 60 days of COBRA Continuation Coverage and you notify the Administrative Office in a timely fashion, you, your covered spouse or dependent children can receive up to an additional 11 months of COBRA Continuation Coverage, for a maximum total of 29 months. The disability must have started some time before the 60th day of COBRA Continuation Coverage and must last at least until the end of the 18-month period of COBRA Continuation Coverage.

You must notify the Administrative Office of Social Security's decision within 60 days of the date of the determination but before the end of the 18-month period of COBRA Continuation Coverage. If you fail to provide such notice within this timeframe, you will not be eligible for the disability extension. This notice should be sent to the Eligibility Department of the Administrative Office. The monthly premium must continue to be paid during the disability extension period. This extension is not available to Same-Sex Spouses or Same-Sex Domestic Partners.


Important!

Life insurance and accidental death and dismemberment benefits are not provided under COBRA continuation coverage.


Second Qualifying Event Extension of 18-Month Period of COBRA Continuation Coverage

If you, your spouse (opposite sex) or dependent children experience another qualifying event during your COBRA Continuation Coverage period, your spouse (opposite sex) and dependent children can get additional months of COBRA Continuation Coverage, up to a maximum of 36 months reduced by the number of months they were previously covered under your COBRA event. This extension is available to your spouse and dependent children if you die, divorce, legally separate or enroll in Medicare (Part A, Part B or both) after your COBRA Continuation Coverage has commenced.

The extension is not available to Same-Sex Spouses or Same-Sex Domestic Partners. The extension is available to a dependent child until they turn 26 and stop being eligible as your dependent.

Note: In all of these cases, you must make sure that the Administrative Office is notified of the second qualifying event within 60 days of the event. If you do not provide the Administrative Office with notice of a second qualifying event within the 60 day period, coverage won't continue beyond the 18 month period.

Coverage Options

You can choose from a number of plans if you elect COBRA Continuation Coverage. These are the same health plans that are one with a lower level of benefits to reduce your cost. The plan options range from the least comprehensive, for which the premiums are lowest, to the most comprehensive, for which you pay the most. You will receive complete information about your plan options and costs when you lose employer-paid coverage under the Health Fund.

When you elect COBRA Continuation Coverage, your premiums will be based on the coverage option you select. These premiums are divided into three rate levels:

  • Single coverage;
  • Two-party coverage (you and one dependent); or
  • Family coverage (you and two or more dependents).

In addition to your premium payments, you'll also pay any applicable deductibles, coinsurance The percentage of eligible expenses you're responsible for paying. or copaysA fixed dollar amount you pay for an eligible expense at the time the service is provided.. (See the Summary Of Benefits for details.)


When COBRA Continuation Coverage Ends

COBRA continuation coverage takes effect on the date of your qualifying event and continues until the earliest of the following:

  • You fail to pay the initial COBRA premium within 45 days of the date you enroll for COBRA continuation coverage;
  • You fail to pay subsequent premiums within 30 days of the due date;
  • The 18-month, 24 month, 29-month or 36-month continuation period ends;
  • With respect to the extension for disability", the date the COBRA disability ends or the date the person is no longer "disabled", whichever occurs first;
  • After electing COBRA Continuation Coverage, the date you or your dependents become covered under another group health plan, provided the other plan doesn't impose any pre-existing condition exclusions on you or your qualified dependent(s);
  • After electing COBRA Continuation Coverage, the date you or your dependents enroll in Medicare (Part A, Part B or both); or
  • The Fund no longer provides group health care coverage.


If you have questions about your COBRA Continuation Coverage, contact the Eligibility Department at the Administrative Office, or the nearest regional or district office of the U.S. Department of Labor's Employee Benefits Security Administration (EBSA). Contact information for EBSA is available through their website at www.dol.gov/ebsa.

In order to protect you and your covered dependent(s) rights to elect COBRA Continuation Coverage, you should inform the Administrative Office of any address changes for you or them. Address changes must be submitted in writing or through our website. You should keep a copy of any notices you send to and received from the Administrative Office, as well as the name of any person you speak with.


The California Continuation Benefits Replacement Act ("Cal-COBRA")

Cal-COBRA generally requires California employers (with 2 to 19 employees) that provide insured health benefits to provide up to 36 months of continuation coverage to electing individuals who lose group health coverage due to a qualifying event. In addition, Cal-COBRA also requires employers subject to Federal COBRA Continuation Coverage (20 or more employees) that provide insured health benefits to provide extended continuation coverage to electing individuals who exhaust their Federal COBRA Continuation Coverage for up to 36 months from the date that individual's Federal COBRA Continuation Coverage began.

Please note that Cal-COBRA only applies to insured health plans (such as HMOs or insured PPOs). Cal-COBRA does not apply to self-insured employee benefit plans such as this Fund. Although the Fund is subject to Federal COBRA Continuation Coverage and provides Federal COBRA Continuation Coverage to participants, the Fund does not offer any type of insured benefits, except for the Dental HMO. Accordingly, Cal-COBRA is not offered to Fund participants who exhaust their Federal COBRA Continuation Coverage.