Active Members Cobra

SELF-PAY CONTINUATION UNDER COBRA

(Active Members, Spouse, and Eligible Dependents Only).

The Consolidated Omnibus Reconciliation Act of 1986 (COBRA) requires that employees and their families covered by the Fund be offered the opportunity for a temporary extension o the welfare fund health benefits coverage (called “continuation of coverage”). The monthly premium is 102% of the group rate (or 150% of the group rate for the 19th through 29th month in the case of total disability) in certain instances where overage would otherwise terminate.

The maximum periods of coverage continuation are 18, 29 or 36 months depending upon the reason for benefit continuation. Coverage during the COBRA continuation period will terminate if the qualified beneficiary fails to make timely premium payments or becomes covered by another group health plan.

COBRA CONTINUATION FOR MEMBERS

Fund members are eligible for COBRA continuation if their benefits terminate due to any of the following qualifying events:

1. Termination of employment (including unpaid leaves of absence) for reasons other than gross misconduct, or
2. A reduction in hours of employment that results in a loss of coverage.

The maximum period of coverage is 18 months measured from the date coverage terminated.

If the member is totally disabled on the date of benefit coverage termination or within 60 days from this date, the maximum period of coverage continuation may be extended to 29 months, if the Social Security Administration has determined, in writing, that the member is totally disabled.

COBRA CONTINUATION FOR SPOUSE/DOMESTIC PARNERS/DEPENDENT CHILDREN

The spouse/domestic partner of a member has the right to choose COBRA continuation coverage if benefit coverage terminates due to any of the following qualifying events:

1. Death of the member, or
2. Termination of the member’s employment for reasons other than gross misconduct, or
3. Reduction in hours of employment that causes the loss of coverage, or
4. Divorce, legal separation, or termination of the domestic partnership with the member, or
5. The dependent child ceases to qualify as a covered dependent child under the terms of the Fund’s eligibility requirements.

If the coverage for the spouse/domestic partner ends due to member termination of employment or reduction in hours of employment, the maximum coverage continuation period is 18 months measured from the date of benefit coverage termination.

If the spouse/domestic partner is totally disabled on the date of benefit coverage termination or within 60 days from this date, the maximum period of coverage continuation may be extended to 29 months , if the Social Security Administration determined, in writing, that the spouse/domestic partner is totally disabled.

If coverage for the spouse/domestic partner ends due to member’s death, a divorce, legal separation, or termination of the domestic partnership, the maximum coverage continuation period is 36 months measured from the date of benefit coverage termination.

OTHER IMPORTANT FACTS ABOUT COBRA

If you choose COBRA continuation coverage, you are entitled to coverage that is identical to the coverage then being provided by the Fund to similarly situated members and dependents. Your coverage will be subject to the same increases and decreases in benefits as for eligible members and dependents. If any increases or decreases in benefits occur, you will be notified. There may be a corresponding increase or decrease in premium costs for the benefit changes for the next annual premium change period. Also, you must remember to notify the Fund of any changes in your address or family/marital status if you have elected continuation coverage.

COBRA CONTINUATION COVERAGE WILL END WHEN:

• The cost of continuation coverage is not paid on or before the date due; or
• The COBRA enrollee becomes eligible for Medicare; or
• The COBRA enrollee becomes covered under another health care plan; or
• This plan terminates for all members; or
• In the case of a spouse, when the spouse remarries and becomes covered under another group health plan.

NOTIFICATION RESPONSIBILITIES

Under the law, the member or eligible dependents have the responsibility to notify either their payroll secretary or the Health & Welfare Division of the Employer and the Welfare Fund within 60 days of an address change, divorce, legal separation or a child losing dependent status.

When a qualifying event occurs and provided the Security Benefits Fund has received proper notification, you and your family will be notified of your option to choose continuation coverage.

COST OF CONTINUED COVERAGE

Any person who elects to continue coverage under this Plan must pay the full cost of the coverage. Your payments for continued coverage must be received on the first day of each month.