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Group Insurance Plan Continuation Rights
Coordination Between Continuation Sections
A covered person may be eligible to continue his group health benefits under this plan's "Federal Continuation Rights" section and under other continuation sections of this plan at the same time. If he chooses to continue his group health benefits under more than one section, the continuations: (a) start at the same time; (b) run concurrently; and (c) end independently, on their own terms.
A covered person covered under more than one of this plan's continuation sections: (a) will not be entitled to duplicate benefits; and (b) will not be subject to the premium requirements of more than one section at the same time.
CGP-3-R-COC-87 B240.0044
AN IMPORTANT NOTICE ABOUT CONTINUATION RIGHTS
The following "Federal Continuation Rights" section may not apply to the employer's plan. The employee must contact his employer to find out if: (a) the employer is subject to the "Federal Continuation Rights" section, and therefore; (b) the section applies to the employee.
CGP-3-R-NCC-87 B240.0064 If your employer chooses to use the services of COBRA Administrative Services (CAS), the procedures you and your dependents must follow to elect COBRA continuation and to pay premiums are different from the procedures you must follow in absence of such choice. Please ask your employer which set of procedures you must follow.
CGP-3-R-CAS-94 B235.0048
Important Notice This section applies to dental, hospital, major medical, prescription drug, and surgical coverages only. In this section, these coverages are referred to as group health benefits".
This section does not apply to coverages which apply to loss of life, or to loss of income due to disability. These coverages cannot be continued under this section.
Under this section, "qualified continuee" means any person who, on the day before any event which would qualify him or her for continuation under this section, is covered for group health benefits under this plan as: (a) an active, covered employee; (b) the spouse of an active, covered employee; or (c) the dependent child of an active, covered employee. Any person who becomes covered under this plan during a continuation provided by this section is not a qualified continuee.
"COBRA Administrative Services" (CAS) means the company that administers COBRA for you.
Conversion Continuing the group health benefits does not stop a qualified continuee from converting some of these benefits when continuation ends. But, conversion will be based on any applicable conversion privilege provisions of this plan in force at the time the continuation ends.
If Your Group Health Benefits End If your group health benefits end due to your termination of employment or
reduction of work hours, you may elect to continue such benefits for up to 18 months, if you were not terminated due to gross misconduct.
The continuation: (a) may cover you and any other qualified continuee; and
(b) is subject to "When Continuation Ends".
Extra Continuation For Disabled Qualified Continuees If a qualified continuee is determined to be disabled under Title II or Title XVI
of the Social Security Act on the date his or her group health benefits would
otherwise end due to your termination of employment or reduction of work
hours, he or she may elect to extend his or her 18 month continuation period explained above for up to an extra 1 1 months.
To elect the extra 1 1 months of continuation, the qualified continuee must give either your employer or, if applicable, COBRA Administrative Services (CAS) written proof of Social Security's determination of his or her disability before the earlier of: (a) the end of the 18 month continuation period; or (b) 60 days after the date the qualified continuee is determined to be disabled. If, during this extra 1 1 month continuation period, the qualified continuee is determined to be no longer disabled under the Social Security Act, he or she must notify your employer or, if applicable, CAS within 30 days of such determination, and continuation will end, as explained in "When Continuation Ends".
This extra 1 1 month continuation is subject to "When Continuation Ends".
An additional 50% of the total premium charge also may be required from the qualified continuee by your employer or, if applicable, by CAS during this extra 1 1 month continuation period.
CGP-3-R-COBRA-94-1 B235.0049 If you die while insured, any qualified continuee whose group health benefits
would otherwise end may elect to continue such benefits. The continuation can last for up to 36 months, subject to "When Continuation Ends".
CGP-3-R-COBRA-90-2 B235.0037 If your marriage ends due to legal divorce or legal separation, any qualified
continuee whose group health benefits would otherwise end may elect to continue such benefits. The continuation can last for up to 36 months, subject to "When Continuation Ends".
If A Dependent Loses Eligibility If a dependent child's group health benefits end due to his or her loss of
dependent eligibility as defined in this plan, other than your coverage ending, he or she may elect to continue such benefits. However, such dependent child must be a qualified continuee. The continuation can last for up to 36 months, subject to "When Continuation Ends".
Concurrent Continuations If a dependent elects to continue his or her group health benefits due to your
termination of employment or reduction of work hours, the dependent may elect to extend his or her 18 month or 29 month continuation period to up to 36 months, if, during the 18 month or 29 month continuation period, the dependent becomes eligible for 36 months of group health benefits due to any of the reasons stated above.
The 36 month continuation period starts on the date the 18 month or 29 month continuation period started, and the two continuation periods will be deemed to have run concurrently.
If You Become Entitled to Medicare If a dependent elects to continue his or her group health benefits due to your
termination of employment or reduction of work hours, the dependent may
elect to extend his or her 18 month or 29 month continuation period for another 36 months, if, during the 18 month or 29 month continuation period, the dependent becomes eligible for 36 months of group health benefits due to your entitlement to Medicare.
The 36 month continuation period starts on the date the employee becomes entitled to Medicare.
The Qualified Continuees's Responsibilities A person eligible for continuation under this section must notify your
employer or, if applicable, CAS, in writing, of: (a) your legal divorce or legal
separation from your spouse; or (b) the loss of dependent eligibility, as defined in this plan, of an insured dependent child.
Such notice must be given to your employer or, if applicable, CAS within 60 days of either of these events.
CGP-3-R-COBRA-94-3 B235-0051 If your employer does not elect to use CAS to administer COBRA, your
employer must notify the qualified continuee, in writing, of: (a) his or her right to continue this plan's group health benefits; (b) the monthly premium he or she must pay to continue such benefits; and (c) the times and manner in which such monthly payments must be made.
Such written notice must be given to the qualified continuee within 14 days of: (a) the date a qualified continuee's group health benefits would otherwise end due to your death, your termination of employment or reduction of work hours, or your entitlement to Medicare; or (b) the date a qualified continuee notifies your employer, in writing, of your legal divorce or legal separation from your spouse, or the loss of dependent eligibility of an insured dependent child.
If your employer does elect to use CAS to administer COBRA, your employer must notify CAS within 30 days of an event which would qualify a covered person for continued coverage. Within 14 days of its receipt of this information, CAS will notify the qualified continuee of: (a) his or her right to continue this plan's group health benefits; (b) the monthly premium he or she must pay to continue such benefits; and (c) the times and manner in which such monthly payments must be made.
Your Employer's Liability Your employer will be liable for the qualified continuee's continued group
health benefits to the same extent as, and in place of, us, if: (a) your employer fails to remit a qualified continuee's timely premium payment on time to us, or, if applicable, to CAS, thereby causing the qualified continuee's continued group health benefits to end; or (b) your employer or, if applicable, CAS fails to notify the qualified continuee of his or her continuation rights, as described above.
Election of Continuation To continue his or her group health benefits, the qualified continuee must
give your employer or, if applicable, CAS written notice that he or she elects to continue. This must be done by the later of: (a) 60 days from the date a qualified continuee receives notice of his or her continuation rights from your employer or, if applicable, CAS as described above; or (b) the date coverage would otherwise end. And the qualified continuee must pay his or her first month's premium in a timely manner.
The subsequent premiums must be paid to your employer or, if applicable, to CAS, by the qualified continuee, in advance, at the times and in the manner specified by your employer or, if applicable, by CAS. No further notice of when premiums are due will be given.
The monthly premium will be the total rate which would have been charged for the group health benefits had the qualified continuee stayed insured under the group plan on a regular basis. It includes any amount that would have been paid by your employer. Except as explained in "Extra Continuation for Disabled Qualified Continuees", an additional charge of two percent of the total premium charge may also be required by your employer or, if applicable, by CAS.
If the qualified continuee fails to give your employer or, if applicable, CAS notice of his or her intent to continue, or fails to pay any required premiums in a timely manner, he or she waives his or her continuation rights.
Grace In Payment of Premiums A qualified continuee's premium payment is timely if, with respect to the first
payment after the qualified continuee elects to continue, such payment is made no later than 45 days after such election. In all other cases, such premium payment is timely if it's made within 31 days of the specified due date.
When Continuation Ends A qualified continuee's continued group health benefits end on the first of the
following:
(a) with respect to continuation upon your termination of employment or reduction of work hours, the end of the 18 month period which starts on the date the group health benefits would otherwise end;
(b) with respect to a disabled qualified continuee who has elected an additional 1 1 months of continuation, the earlier of: (1) the end of the 29 month period which starts on the date the group health benefits would otherwise end; or (2) the first day of the month which coincides with or next follows the date which is 30 days after the date on which a final determination is made that a disabled qualified continuee is no longer disabled under Title II or Title XVI of the Social Security Act;
(c) with respect to continuation upon the employee's death, the employee's legal divorce or legal separation, or the end of an insured dependent's eligibility, the end of the 36 month period which starts on the date the group health benefits would otherwise end;
(d) with respect to a dependent whose continuation is extended due to your entitlement to Medicare, the end of the 36 month period which starts on the date you become entitled to Medicare;
(e) the date the group plan ends;
(f) the end of the period for which the last premium payment is made;
(g) the date he or she becomes covered under any other group health plan which contains no limitation or exclusion with respect to any pre-existing condition of the qualified continuee;
(h) the date he or she becomes entitled to Medicare.
CGP-3-R-COBRA-94-4 B235.0052
If conversion is available, the applicant must apply to us in writing and pay the required premium. This must be done within 31 days of the date the applicant's continued group health benefits end. We don't ask for proof of insurability. The converted policy takes effect on the date the applicant's continued group health benefits end. If the applicant is a minor or incompetent, the person who cares for and supports the applicant may apply for him.
The converted policy will be renewable and will comply with the laws of the place the applicant lived when he or she applied. But, it won't provide exactly the same benefits the applicant had under the group plan. Write to us for details.
The premium for the converted policy will be based on: (a) the policy the applicant selects; (b) the risk and rate class, under the group plan, of the people to be covered; and (c) the ages of the people to be covered, as of the date the converted policy takes effect.
A covered person may also convert in certain other situations. Read this plan's group health conversion section for details. But, at no time can a person be covered under more than one converted health policy.
CGP-3-R-COBRA-94-5 B235-0053
Important Notice This section applies to hospital, surgical, and major medical coverages only. In this section these coverages are referred to as "group health benefits".
This section does not apply to coverages which apply to loss of life, loss of income due to disability, prescription drug expense, or dental expense.
With respect to the coverages listed above, continued coverage will be the same as provided to dependents covered under the group plan on a regular basis.
Subject to the following provisions, continued coverage will be provided without evidence of insurability.
Conversion Continuing the group health benefits does not stop the dependent from converting some of these benefits when continuation ends. But, conversion will be based on any applicable conversion privilege provisions of this plan in force when the continuation ends.
If A Dependent Loses Eligibility Subject to "When This Continuation Ends", an insured dependent may elect
to continue this plan's group health benefits for up to 36 months, if he loses his eligibility for such benefits due to: (a) the severance of his family relationship to you; (b) your retirement; or (c) your death.
But, such dependent must: (a) have been an insured dependent under this plan for at least 12 consecutive months immediately prior to the date his group health benefits would otherwise end; or (b) be an insured infant under age one.
The Dependent's Responsibilities To continue his group health benefits, the dependent must notify the
employer of the severance of his family relationship to you. Such notice must be given within 15 days of such event.
The Employer's Responsibilities The employer must notify the dependent, in writing, of: (a) his right to
continue this plan's group health benefits; (b) the monthly premium he must pay to continue such benefits; and (c) the times and manner in which such monthly payments must be made.
Such written notice must be given to the dependent immediately upon: (a) your death; (b) your retirement; or (c) the employer's receipt of notice of the severance of a family relationship. The notice must include a continuation election form.
Employer Liability The employer will be liable for the dependent's continued group health benefits to the same extent as, and in place of, us, if: (a) the employer fails to notify the dependent of his continuation rights as described above; or (b) the employer fails after the timely receipt of the dependent's premium payment, to pay us on behalf of such dependent, thereby causing the dependent's continued group health benefits to end.
Election of Continuation To continue the group health benefits, the dependent must give the employer
written notice that he elects to continue. And, he must pay the first month's premium. The dependent must do this within 60 days of the severance of the dependent's family relationship to you, your retirement, or your death.
Premiums must be paid to the employer, in advance, at the times and in the manner specified by the employer.
The monthly premium will be the total rate which would have been charged for the group health benefits had the dependent stayed insured under the group plan on a regular basis. It includes any amount which would have been paid by the employer. The employer may also charge a $5.00 administrative fee to be paid to him.
The dependent waives his continuation rights if he fails to give the employer written notice of his intent to continue, or he fails to pay any required premium in a timely manner.
When This Continuation Ends A dependent's continued group health benefits end on the first of the following: (a) the date which is 36 months from the date his group health benefits would otherwise end; (b) the end of the period for which the last premium payment is made; or (c) the date he becomes eligible for similar coverage under another group plan or program.
CGP-3-R-DCC-TX-89 B240.0094 |