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Home > Health Plan > COBRA
CONTINUATION OF COVERAGE (COBRA) Some plans do not include every benefit mentioned. Refer to your plan booklet to verify which benefits are included in your plan.
In compliance with the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), the Health Plan offers you and
your eligible dependents the opportunity to continue health
coverage by making self-payments when coverage would otherwise end.
You may elect to continue coverage for Medical Benefits only or Medical, Dental and Vision Benefits. Life Insurance,
Accidental Death and Dismemberment (AD&D) Benefits and Income Protection Benefits cannot be continued.
If you have any questions regarding COBRA, contact the Billing Department at the Benefits
Fund Office.
To qualify for COBRA coverage, you or your eligible dependent
must experience a qualifying event.
A qualifying event for you is:
For an eligible dependent, a qualifying event may be:
If you or your eligible dependent have a qualifying event, you need to notify the Benefits Fund Office within 60 days.
Notice procedures are described below.
If you have a newborn child, adopt a child or have a child placed with you for adoption (for whom you have financial
responsibility) while your COBRA continuation coverage is in effect, you may add this child to your coverage if you were
eligible for Dependent Coverage when you elected COBRA coverage. You must submit an original, certified birth certificate
issued by the appropriate governmental agency. In the case of adoption, you must submit legal documentation indicating the
initiation and/or finalization of the adoption process.
If you get married while your COBRA coverage is in effect, you may add your spouse to your coverage if you were eligible
for Dependent Coverage when you elected COBRA coverage. A copy of your marriage license may be required by the
Benefits Fund Office.
Proof of good health is not required to obtain COBRA coverage.
Continuation Coverage Period
The COBRA coverage period depends on the type of qualifying event that caused loss of eligibility under the Plan.
Generally, COBRA coverage will remain in effect for a period of 18 months (or up to 29 months for
disabled individuals, as described below) if the qualifying event is:
COBRA coverage will continue for a maximum period of 36 months if the qualifying event is:
Extension of Coverage Period for a Second Qualifying Event
If your family experiences a second qualifying event while receiving 18 months of COBRA coverage because of a reduction
in the number of hours you work or termination of employment, your
eligible dependents can get up to 18 additional months of COBRA
coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the Benefits Fund Office.
This extension is available to your eligible dependents if one of the following events occurs and would have caused the
eligible dependent to lose coverage under the Plan if the first qualifying event had not occurred:
Coverage for Disabled Individuals
If you or any of your eligible dependents are disabled (as
determined by Social Security) at the time or within 60 days of the date your employment ends or your hours are reduced,
COBRA coverage can be extended an additional 11 months, to a maximum period of 29 months. The extension applies to the
disabled person and any other covered family members. For coverage to continue, the Benefits Fund Office must be
properly notified:
Any period of extended coverage during disability provided at no cost will reduce the period allowed for COBRA coverage by
a period equal to the extended coverage.
Proof of disability must be given. The premium payment for this extended coverage may be higher than that for COBRA
coverage.
The Benefits Fund Office must also be notified within 30 days of any subsequent determination by Social Security that the
disabled individual is no longer disabled.
Termination of COBRA Coverage
Once COBRA coverage is elected, it will stay in effect until the earliest of the following:
Note: If you or your eligible dependent become covered under another group health plan that has a pre-existing
condition limitation or exclusion of coverage period, COBRA coverage provided under this Plan will remain in effect until the
pre-existing condition waiting period is satisfied. However, in no event will COBRA remain in effect longer than the maximum
period to which the individual is entitled.
COBRA Premium Payments
After the Benefits Fund Office receives your form electing COBRA coverage, you will be mailed a statement showing the
amount due. You will then have 45 days from the date of election to pay the full amount due. COBRA coverage will not be
effective until full payment is made.
When you elect COBRA coverage, you must make your COBRA payments on time in order to keep your coverage in effect.
If you are late with your payments, your coverage will be terminated. You will receive more information regarding premium
amounts and due dates after you experience a qualifying event.
Premium payments must be sent to the Benefits Fund Office at: 1300 Higgins Road, Suite 300, Park Ridge, IL 60068-5713.
The Benefits Fund Office has the capability to collect your monthly COBRA payment directly from your bank account
through electronic transfer. You may wish to consider this option. Don't let a late or lost COBRA check jeopardize your
coverage.
You can download and print the Authorization Agreement for Electronic Transfer of
Payments for COBRA or you can contact the Billing Department at the Benefits
Fund Office to request the form.
COBRA Notice Procedures
General Notice of Continuation Coverage. An initial general notice describing COBRA rights will be given to you
(and your spouse if you are married) when you become covered under the Plan and will contain the information required by
COBRA. The Benefits Fund Office may provide this notice in a summary plan description ("SPD") furnished in accordance
with the paragraph below.
The general notice will be provided no later than 90 days after you become covered under the Plan. If, on the basis of the
most recent information available to the Benefits Fund Office, you and your spouse reside at the same location, and your
spouse becomes covered under the Plan on or after the date you become covered (but not later than the date on which the
notice required by this section is required to be provided to the participant), the Benefits Fund Office may mail you and your
spouse a single notice or SPD.
Notice of Qualifying Events. If the qualifying event that occurs is the termination of employment or reduction of
hours of employment, your death or entitlement to Medicare benefits, the employer must notify the Benefits Fund Office of
the qualifying event. However, you or another family member should notify the Benefits Fund Office if any of these qualifying
events occurs to assure that you receive COBRA election materials as soon as possible.
If you or your eligible dependent have a qualifying event or second qualifying event that is a divorce or legal separation or a
dependent child's loss of eligibility for coverage as a dependent, you need to notify the Benefits Fund Office in writing within
60 days. You may be asked to provide verification in the form of a copy of your divorce decree, certified copy of your
marriage certificate, etc. You or your eligible dependent will be ineligible for COBRA coverage or extended COBRA
coverage (in the case of a second qualifying event) if you or your dependent fail to timely notify the Benefits Fund Office.
You must promptly notify the Benefits Fund Office if you and your spouse become divorced. If you fail to do so and your
former spouse continues to claim or receive benefits under the Plan, you and your spouse can be subject to loss of benefits,
lawsuits and criminal charges. In addition, it is your responsibility to understand your marital status and to inform the Benefits
Fund Office when a qualifying event has occurred.
As noted above, you must also notify the Benefits Fund Office of a disability determination before the 18-month period ends
and within 60 days of the date of disability. In addition, the Benefits Fund Office must be notified within 30 days of any
subsequent determination by Social Security that the disabled individual is no longer disabled.
The notice of a qualifying event or disability determination must be in writing and must include sufficient information to enable
the Plan Administrator to determine the following information:
A notice that does not contain all of the required information will not be considered notice of a qualifying event. If you do not
timely provide all of the information necessary to meet the content requirements, you will lose the right to elect or extend
continuation coverage.
Notice of Right to Elect COBRA Coverage. Once notified, the Benefits Fund Office will mail you the necessary forms
to enable you to elect the COBRA coverage. When you receive the forms, you will have 60 days from the date of the Benefits
Fund Office’s notification letter in which to elect or decline COBRA coverage. You or your eligible dependent will be ineligible
for COBRA coverage if you do not timely elect COBRA coverage.
This notice will be written in a manner calculated to be understood by the average Plan participant and shall contain the
information required by COBRA. The notice will be provided by first class mail no later than 14 days after the Benefits Fund
Office receives notice that a qualifying event has occurred.
If, on the basis of the most recent information available to the Benefits Fund Office, you and your spouse reside at the same
location, the Benefits Fund Office may provide a single notice addressed to both you and your spouse.
The Benefits Fund Office may provide notice to a dependent child by furnishing a single notice to you or your spouse if, on
the basis of the most recent information available, the dependent child resides at the same location as the parent to whom the
notice is provided.
Notice of Unavailability of COBRA Coverage. If the Benefits Fund Office receives notice of a qualifying event,
determination of disability by the Social Security Administration or second qualifying event and determines that the individual
is not entitled to continuation coverage under COBRA, the Benefits Fund Office will give the individual an explanation of why
he or she is not entitled to continuation coverage.
The notice will be provided by first class mail no later than 14 days after the Benefits Fund Office receives notice that a
qualifying event has occurred.
Notice of Early Termination of COBRA Coverage. The Benefits Fund Office will provide notice to each qualified
beneficiary if continuation coverage will terminate before the end of the maximum period of continuation coverage.
The notice will be written in a manner calculated to be understood by the average Plan participant and will include the
following information:
The notice will be furnished by the Benefits Fund Office as soon as practicable after its decision that continuation coverage
shall terminate.
Address Changes
To protect your family's rights, you should keep the Benefits Fund Office informed of any
address changes of family members.
More Information
This notice may not contain all information about your rights under the Plan. If you have any questions or need more
information, contact the Billing Department at the Benefits Fund Office.
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