THIS SECTION APPLIES TO ACTIVE EMPLOYEES AND THEIR DEPENDENTS ONLY
(Retirees: Please see the “Retiree Comprehensive Plan Eligibility” section)
Federal law—the Consolidated Omnibus Budget Reconciliation Act (COBRA)—gives you (the employee) and your covered dependents the right to be offered an opportunity to make self-payments for continued health care coverage if coverage is lost for certain reasons. This continued coverage is called “continuation coverage” or “COBRA coverage.” The following is an outline of the rules governing COBRA coverage. It also explains health coverage alternatives that may be available to you through the health insurance exchanges (also called the “marketplace”). If you have any questions about COBRA, call the Fund Office.
There may be other coverage options for you and your family. You can now buy coverage through the health insurance exchanges (also called the “marketplace”). In the marketplace, you could be eligible for a tax credit that lowers your monthly premiums right away, and you can see what your premium, deductibles, and out-of-pocket costs will be before you make a decision to enroll. Being eligible for COBRA does not limit your eligibility for coverage for a tax credit through the marketplace. Additionally, you may qualify for a special enrollment opportunity for another group health plan for which you are eligible (such as a spouse’s plan), even if the plan generally does not accept late enrollees, if you request enrollment within 30 days. You also may be eligible for coverage through Medicare or Medicaid.
18-MONTH MAXIMUM COVERAGE PERIOD
You and/or your eligible dependents are entitled to elect COBRA coverage and to make self-payments for the coverage for a maximum period of up to 18 months after coverage would otherwise terminate due to one of the following events (called “qualifying events”):
11-Month Extension Rule – If you or a covered dependent are disabled (as defined by Social Security for the purpose of Social Security disability payments) on the date of one of the qualifying events listed above, or if you or a covered dependent become so disabled within 60 days after an 18-month COBRA coverage period starts, the maximum coverage period will be 29 months for all COBRA eligible members of the family. The COBRA self-payment for the extra 11 months of coverage for the family may be increased. You or the disabled dependent must notify the Fund Office within 60 days of such a disability determination by Social Security and before the end of the initial 18-month period. You also must notify the Fund Office within 30 days of the date Social Security determines that you or the dependent are no longer disabled. (This 11-month extension rule does not apply to dependents during a 36-month maximum coverage period explained below.) Failure to provide timely notice of a disability will mean you cannot extend your COBRA coverage period.
36-MONTH MAXIMUM COVERAGE PERIOD
Your dependents (spouse or children) are entitled to elect COBRA coverage and to make self-payments for the coverage for up to 36 months after coverage would otherwise terminate due to one of the following events (called “qualifying events”):
MULTIPLE QUALIFYING EVENTS
If your dependents are covered under COBRA coverage under an 18-month maximum coverage period due to termination of your employment or a reduction in your hours and then a second qualifying event occurs, their COBRA coverage may be extended as follows:
Failure to provide notice of a second qualifying event will mean your dependent’s COBRA coverage period cannot be extended.
EMPLOYEE MEDICARE ENTITLEMENT
If you become entitled to Medicare while you are an active employee and then later coverage for yourself and your dependents would terminate due to termination of your employment or a reduction in hours, your dependents will be entitled to COBRA coverage for up to 36 months measured from the date of your Medicare entitlement, or 18 months measured from the date their coverage would otherwise terminate due to termination of your employment or a reduction in hours, whichever period is longer. Please advise the Fund Office if you become entitled to Medicare.
Failure to provide proper and timely notice as explained above will mean you and/or your dependent cannot elect COBRA or extend a COBRA coverage period.
You and/or your dependents will be given the opportunity to elect to make self-payments for the same medical, prescription drug, dental and vision benefits that you and/or your dependents were eligible for on the day before the qualifying event. A person (you or a dependent) electing COBRA coverage can elect to make self-payments for one of the following options:
Dependent death and AD&D benefits and employee life insurance, AD&D Insurance, and Weekly Disability Benefits are not provided under COBRA coverage.
COBRA coverage for a covered person will usually terminate at the end of the last month of the applicable maximum coverage period to which the person was entitled and for which correct and on-time payments were made. However, COBRA coverage for a covered person will terminate before the end of the applicable maximum coverage period when the first of the following events occurs:
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the Local 734 Welfare Fund, 6643 North Northwest Highway, Chicago, IL 60631, telephone (773) 594-2810. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, 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 www.dol. gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the insurance exchanges (marketplace), visit www.healthcare.gov.