COBRA Continuation Coverage

If you lose coverage under the Plan, you may be entitled to Continuation of Coverage benefits under COBRA.

COBRA Continuation Coverage Rules

If one of the following events (known as a Qualifying Event) occurs, you and your eligible Dependents (excluding Registered Domestic Partners) have the right to temporarily continue health coverage that was in effect at the time of the Qualifying Event under a federal law known as "COBRA". Dependents for COBRA purposes shall not include Registered Domestic Partners. The following are Qualifying Events: 1. The Employee's loss of eligibility under the Plan due to insufficient hours, termination of employment (other than for gross misconduct) or retirement; 2. The Employee's legal separation and/or dissolution of marriage; 3. Death of the Employee; 4. The loss of status as a dependent child; 5. The Employee’s eligibility for Medicare.
If less than the minimum work hours were reported for a month on your behalf, and your hour bank is insufficient to cover the minimum required hours needed for coverage, or if you terminate employment (other than for gross misconduct) or retire, you and your Dependents are entitled to 18 months of coverage under the Plan from the date of the Qualifying Event, as well as an additional 18 months under Cal-COBRA. Each of the other above listed items (Items 2 through 5) entitles your Dependents to 36 months of coverage from the date of the Qualifying Event. If a second Qualifying Event occurs within an 18-month continuation coverage period, your Dependents may extend their period of COBRA coverage up to a total of 36 months from the date of the first Qualifying Event.
The COBRA coverage is available only at your own expense. If you or your eligible Dependents elect to continue coverage, you will be charged the full cost of the coverage plus an administrative charge. You may elect to continue medical and prescription drug coverage only (Core coverage); or medical, prescription, and dental coverage (Core Plus coverage), provided you were eligible for these coverages before the qualifying event. Life insurance and Accidental Death and Dismemberment benefits may not be continued under COBRA; however your Life Insurance may be converted to an individual policy as described in the Life Insurance section of the SPD.
If you or your Dependent are determined by Social Security to have been totally disabled at the time you terminated employment, retired or had less than the minimum work hours reported for the month, coverage may be extended for the disabled person beyond the original 18 months up to 29 months. To qualify for these additional 11 months, the disabled person must report the Social Security determination to the Trust Fund Office before the original 18-month period expires and within 60 days after the date of the determination. Further, the Trust Fund Office must be notified within 30 days of a final Social Security determination that the qualified beneficiary is no longer totally disabled. The premium for the additional 11 months can be approximately 50% higher than the initial 18-month COBRA premium.
Under COBRA, you or your family members have the responsibility to inform the Trust Fund Office within 60 days of one of these events: a divorce; or a child losing Dependent status under the Plan. The Trust Fund Office will notify you of your rights to choose continuation coverage within 14 days of receiving your notice. COBRA rights will be forfeited if the Trust Fund Office is not notified within 60 days of the Qualifying Event. Your Employer has the responsibility to notify the Trust Fund Office within 30 days of the date coverage would otherwise be lost for one of the following reasons: your death; termination of employment, retirement or a month for which your Employer reports less than the minimum required work hours to the Fund on your behalf. However, you or your Dependents should also advise the Trust Fund Office of these events as well. The Trust Fund Office has 14 days to notify you of your rights to continue coverage. The Trust Fund Office will send you a notice when your hour bank is less than the minimum required work hours for you in a month. This notice will tell you when your eligibility will run out and ask you to complete and return the form if you want to self-pay COBRA continuation coverage beyond the termination of your eligibility. It is very important that you return this form to the Trust Fund Office within 60 days, even if you think you will be returning to work and will not need COBRA coverage. You must sign the form and return it to the Fund within 60 days or you will not be eligible for COBRA continuation coverage. You do not have to show that you are insurable to choose COBRA coverage. COBRA rights will be forfeited if you or your eligible Dependents do not file the COBRA election forms within this 60-day period. Your first payment for continuation coverage must include payments for any months retroactive to the day you and/or your dependents’ coverage under the Plan terminated. This payment is due no later than 45 days after the date you or your dependents returned the election form to the Trust Fund Office. Subsequent payments are due on the first business day of each month for which coverage is provided, with a grace period of 30 days. If payment is not received by the due date, all benefits will terminate retroactively to the first day of the month. Once your continuation coverage is terminated, it cannot be reinstated. If you do not choose continuation coverage, your health insurance coverage will end. However, your spouse and/or your eligible Dependent children may elect the continuation coverage independent of your rejection. Your initial continuation coverage will be the same as coverage provided to similarly situated Employees under the Plan on the day prior to the Qualifying Event, although it may be modified if coverage changes for other participants or family members.
COBRA Continuation Coverage will terminate on the first day of the month following the occurrence of any one of the events listed below: 1. Failure to remit the required premium payments in full and on time (within 45 days following the submission of the initial COBRA election form and which payment must include the cost of coverage retroactive to the first day your coverage would have otherwise terminated, or within 30 days following the due date established by the Trust Fund Office for subsequent periodic payments); 2. You or your Dependents receive coverage, as an Employee or as a Dependent, under any other group medical plan; 3. You or your Dependents become entitled to Medicare benefits; 4. Your employer no longer provides group health coverage to any of its Employees; or 5. You or your Dependents have continued coverage for additional months due to a disability and there has been a final determination by Social Security that you or your Dependents are no longer totally disabled. 6. You have used of the maximum coverage period applicable under COBRA. NOTE: At the end of the 18 or 29-month COBRA continuation coverage period, you and your eligible Dependents may be eligible for CalCOBRA and enrollment in any individual health conversion plan that may be offered by the Kaiser HMO medical plan. If you have changed marital status, or you or your spouse have changed addresses, please contact the Trust Fund Office. Please let the Trust Fund Office know of any Qualifying Event even if your Employer is otherwise required to give notice to the Trust Fund Office. *If your eligibility ends due to your termination of employment or reduction in hours and within 60 days of the Qualifying Event, you or one of your dependents is totally disabled (as determined by Social Security), coverage may continue for an additional 11 months, for a total of 29 months. If a second qualifying event occurs within the first 18-month period, COBRA coverage may be extended for up to a maximum of 36 months from the date of the first Qualifying Event. Additionally, if you receive less than the maximum of 36 months of COBRA coverage, you may be eligible for Cal-COBRA.  You will receive notification from Kaiser if you are eligible for Cal-COBRA coverage.  If you believe you are eligible for Cal-COBRA and you have not received any notification from Kaiser, you should contact Kaiser directly.  Please note, that the Fund is not responsible for and does not provide Cal-COBRA coverage.
 
Uniformed Services Employment and Reemployment Act of 1994 (USERRA) was enacted by Congress to provide protections to individuals who are members of the “Uniformed Services.” This includes the Armed Forces, the Army National Guard and the Air National Guard, when engaged in active duty for training, inactive duty training, or fulltime National Guard duty, the commissioned corps of the Public Health Services, and any other category of persons designated by the President in time of war or national emergency.
1. If you are on a military leave of absence from your employment and the period of military leave is for more than thirty (30) days, USERRA permits you to continue coverage for yourself and your dependents at your own expense at a cost of 102% for up to 24 months, so long as you give your employer advance notice (with certain exceptions) of the leave, and so long as your total leave, when added to any prior periods of leave, does not exceed five (5) years. In addition, dependents may be eligible for coverage under TRICARE. 2. The maximum period of continuation coverage for health car under USERRA is the lesser of (a.) twenty-four (24) months after you leave work due to military leave or; (b.) the day after the date you fail to timely apply or return to a position of employment with a participating provider. 3. If you continue coverage under USERRA, you will be required to submit any required self-payment to the contract administrator. If you do not elect to continue coverage during your military leave, upon your return to work, your coverage will be reinstated at the same benefit level immediately preceding your service before your leave if you are eligible for re-employment under the criteria established under USERRA. 4. Upon release from active service, your coverage will be reinstated on the day you return to work as if you had not taken leave, provided you are eligible for re-employment under the terms of USERRA and provided you return to work within: a. Ninety (90) days from the date of your discharge if the period of service was thirty-one (31) days or more; or b. At the beginning of the first full regularly scheduled working period on the first calendar day following your discharge (plus travel time and an additional eight (8) hours) if the period of service was less than thirty-one (31) days. If you are hospitalized or convalescing from an injury caused by active duty, the above time limits are extended for up to two (2) years. A copy of your separation papers must be submitted to the contract administrator to establish your period of service. 5. If you do not return to work at the end of your military leave, you may be entitled to purchase COBRA continuation coverage as provided in the preceding COBRA portion of this SPD. Coverage will not be offered for any illness or injury determined by the Secretary of Veterans Affairs to have been incurred in, or aggravated during, performance of service in the Uniformed Services. The Uniformed Services and the Department of Veterans Affairs will provide care for service connected injuries or illness. Continuation coverage under COBRA or USERRA shall run concurrently.

 

 

 

 

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