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.
 
  Qualifying Events
 

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:

  • the enrolled employee dies;
  • termination of the enrolled employee's employment (for reasons other than gross misconduct) or reduction in the enrolled employee's hours of employment;
  • dissolution of marriage or legal separation from the enrolled employee; or
  • the enrolled employee becomes entitled to Medicare.

An enrolled dependent child has the right to continuation of coverage if coverage would otherwise be lost for any of the following reasons:

  • the enrolled employee dies;
  • termination of the enrolled employee's employment (for reasons other than gross misconduct) or reduction in the enrolled employee's hours of employment;
  • dissolution of marriage or legal separation from the enrolled employee; or
  • the enrolled employee becomes entitled to Medicare; or.
  • the child loses eligibility as a dependent under the Plan.

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.

 
  Notification Responsibilities
  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
 
  Available Coverage
  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:

  • For termination of employment or reduction of hours, continuation may last for up to 18 months.  However, there is one exception.  It applies when a qualified beneficiary is determined by the Social Security Administration to have been disabled at any time during the first 60 days of continuation coverage.  In that situation, each qualified beneficiary may have up to a total of 29 months of continuation, but only if the Social Security Administration makes the determination within the first 18 months of that continuation period and the qualified beneficiary notifies the plan administrator both within that 18-month period and within 60 days of the determination.  Thereafter, if there is a final determination of nondisability, the qualified beneficiary must so notify the plan administrator within 30 days.  The extended continuation will end the month that begins more than 30 days from the final determination that the qualified beneficiary is no longer disabled.

  • For Chapter 11 bankruptcy, continuation may last for the lifetime of the covered retiree or the surviving spouse of a retiree.  On the death of the retiree, any of his or her covered dependents may continue coverage for an additional 36 months.

  • For death, dissolution of marriage, or the covered employee's legal separation, continuation may last for up to 36 months.

However, there is a special Oregon statute (applicable to insurance policies issued in Oregon to employers of 20 or more employees) that allows a spouse who is age 55 or over at the time coverage would otherwise end due to the death, dissolution of marriage, or legal separation to remain covered beyond 36 months until covered by another group health plan or until age 65, whichever happens first.  Covered dependent children of the spouse may remain covered with the spouse beyond 36 months as long as they are otherwise eligible under the Agreement.

  • For an enrolled dependent child ceasing to be eligible as a dependent under the Plan, continuation may last for up to 36 months.

  • If the covered employee becomes entitled to Medicare thereby causing a loss of coverage for covered dependents, continuation will last for up to 36 months.

  • In the case of multiple qualifying events (a qualifying event followed by one or more qualifying events), a qualified beneficiary shall upon proper notice to the plan administrator of the succeeding qualifying event, continue for up to 36 months from the date the original continuation began.  However, if an active enrolled employee with covered dependents becomes entitled to Medicare, the period of continuation for his or her covered dependents for any subsequent qualifying event may be continued until the later of:

    •  36 months from the date of Medicare entitlement; or

    • the end of any other continuation period to which an enrollee is entitled.

 
  Termination
 

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:

  • premium for a person on continuation of coverage is not paid to the Plan administrator on a timely basis;

  • after electing continuation a person becomes covered under any other group plan.  However, coverage under another plan will not cause continuation to end so long as the other plan excludes or limits coverage for a preexisting condition of a qualified beneficiary in accordance with federal law;

  • after electing continuation of coverage a person becomes entitled to Medicare (except when the individual is on continuation due to a Chapter 11 bankruptcy); or

  • the applicable period of continuation of coverage ends.       

 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.

 
  Other Information
  If you, your spouse, or your dependent child has any questions about COBRA Continuation Coverage, please contact the Plan Administrator.