|COBRA Coverage Information|
|All Employees, Spouses, and Dependents:
Federal law requires the Western States Health and Welfare Trust Fund of the OPEIU to offer employees and dependents the opportunity to elect a temporary extension of medical, dental, and vision coverage (called "COBRA Continuation Coverage"). This coverage is offered at group rates in certain instances where coverage under this Plan and any insured plan offered by the Board of Trustees would otherwise end. You do not have to show you are insurable to elect COBRA Continuation Coverage. However, you must pay the total premium and administrative costs for COBRA Continuation Coverage.
|This summary is intended to summarize your rights and obligations under COBRA. The Western States Health and Welfare Trust Fund of the OPEIU offers no greater COBRA rights than what the COBRA statute requires, and this summary should be construed accordingly.|
Under certain circumstances, you and/or your enrolled dependents may have the right to continue health coverage beyond the time coverage would ordinarily have ended. The following rights and obligations regarding continuation of coverage are governed by the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) as amended. In the event of any conflict between this Continuation of Coverage provision and COBRA, COBRA shall govern.
This Continuation of Coverage provision does not apply to Life, Accidental Death and Dismemberment and Short Term Disability coverages.
The enrolled employee has the right to elect continuation of coverage if he or she would otherwise lose coverage because of a reduction in hours of employment or termination of employment (for reasons other than gross misconduct).
The enrolled employee's spouse has the right to choose continuation of coverage if he or she would otherwise lose coverage for any of the following reasons:
An enrolled dependent child has the right to continuation of coverage if coverage would otherwise be lost for any of the following reasons:
If the enrolled employee is retired, his or her enrolled dependents, or his or her surviving spouse has the right to elect continuation of coverage when coverage would otherwise be lost or substantially eliminated because the employer filed a Chapter 11 (reorganization) bankruptcy.
A natural born child or a child placed for adoption with you who is properly enrolled under the terms of the Plan during the continuation period shall be considered a qualified beneficiary.
|The enrolled employee or his or her enrolled dependent has the responsibility to inform the Plan administrator in writing of a divorce, legal separation, or a child losing dependent status within 60 days of the date of the event. The employer has the responsibility to notify the Plan administrator of the employee’s death, termination of employment, reduction in hours, Medicare eligibility, or the employer's filing Chapter 11 bankruptcy.|
|Once Notification is Given|
|When the Plan administrator is notified that one of these events has happened, the plan administrator will in turn notify the employee or his or her enrolled dependent that the employee or his or her enrolled dependent has the right to elect continuation of coverage. Under this provision, the employee or his or her enrolled dependent has 60 days from the date coverage would otherwise be lost because of one of the events described previously or 60 days from the date of notification from the Plan administrator, whichever is later, to elect continuation. Failure to elect continuation within that period will cause group health plan coverage to end as it normally would under the terms of the Agreement|
|The health coverage for continuation of coverage is required to be the same as that provided to similarly situated employees and their enrolled dependents. Life, AD&D, and Weekly Income coverages are not available for continuation.|
|Making Monthly Payments|
|The employee or his or her enrolled dependent is responsible for the full cost of continuation coverage. Premium for continuation of coverage must be paid to the Plan administrator on a timely basis within 30 days of the group's premium due date. The only exception is the premium payment for the period preceding the election which may be made up to 45 days from the date of election. Premium for those on continuation must be submitted to the Plan administrator each month on a timely basis in order to maintain continuation of coverage.|
|How Long Continued Coverage Lasts|
Coverage may be continued as follows:
Notwithstanding the previous statements, in all situations, continuation under this Agreement will end for a person on the last day of the monthly premium payment period in which any of the following occurs, whichever happens first:
In addition, continuation will end on the day the Agreement terminates, or, if applicable, the day the employer withdraws from participation under the Plan. However, continuing coverage may still be available under the succeeding plan unless the employer no longer provides a group health plan for any of its employees.
|If you, your spouse, or your dependent child has any questions about COBRA Continuation Coverage, please contact the Plan Administrator.|
|All information provided on this web site is in summary and intended to provide highlights of your plans. We strongly recommend referring to the Plan booklet for complete details before making any decisions related to your eligibility, benefits and coverage.|