Your children are eligible to continue coverage under COBRA when they no longer satisfy the Plan’s definition of dependent because of age.
COBRA Coverage continues for a limited period of time, depending on your Qualifying Event.
The Fund Office will notify you of the cost of the coverage at the time that you receive your notice of entitlement to COBRA coverage, and of any monthly COBRA premium amount changes.
Generally payments are due on the first of the month preceding the coverage month. Waiting until the end of the 30-day grace period to make your payment will delay reinstatement of your benefits.
The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) allows you and your eligible dependents to continue health care coverage at your own expense, under certain circumstances, when health care coverage would otherwise end. Your COBRA rights are subject to change. Coverage will be provided only as required by law. If the law changes your rights will change accordingly.
Certain “Qualifying Events,” may cause your Plan coverage to terminate. If these circumstances apply to you, you and your dependents may have an opportunity to continue coverage for a limited time through the Plan’s self-pay program, if you are an active employee, or through COBRA. The following are “Qualifying Events” under the Plan:
|Qualifying Event||Who May Purchase |
|For How Long|
|Employee loses eligibility due to termination or a reduction in hours of employment (including retirement)||Employee, spouse and/or dependent children ||18 months|
|Termination or reduction in hours while you or your Dependent is disabled (The disability must be determined by the Social Security Administration.)||Employee, spouse and/or dependent children||29 months (18 months plus an additional 11)
|Employee becomes entitled to Medicare and voluntarily drops coverage||Spouse and/or dependent children||36 months
|Employee dies||Spouse and/or dependent children||36 months|
|Employee is divorced or is legally separated from spouse||Spouse and/or dependent children||36 months|
|Child is no longer considered an eligible Dependent under this Plan’s definition||Dependent child||36 months|
Medical coverage (including hospitalization and surgery);Under COBRA, you and/or your covered dependents may continue ONLY the same coverage in which you and/or your dependents were enrolled immediately before the COBRA Qualifying Event. The coverage includes:
- Prescription drug coverage;
- Employee assistance program benefits;
- Dental coverage;
- Vision coverage; and
- Hearing coverage.
You are not eligible to continue:
- Accidental dismemberment and loss of sight benefits;
- Weekly accident and sickness benefits;
- Supplemental occupational accident benefits; or
- Death benefits.
COBRA for Yourself
COBRA coverage is available to you if coverage would otherwise end because:
- Your regularly scheduled hours are reduced so that you are no longer eligible to participate in the Plan;
- Your employment ends for any reason other than gross misconduct; or
- You are an Active Non-Bargaining Unit Employee and your employer no longer participates in the Plan because he or she no longer has employees covered under the collective bargaining agreement with the union.
COBRA for Your Dependents
COBRA coverage is available to your eligible dependents if dependent coverage would otherwise end because:
- Your regularly scheduled hours are reduced so that you are no longer eligible to participate in the Plan;
- Your employment ends for any reason other than gross misconduct;
- You die, are divorced or legally separated, or become entitled to Medicare; or
- Your dependent ceases to be eligible for coverage under the terms of the Plan.
Even if the participant rejects COBRA continuation coverage, each eligible dependent has the independent right to elect or reject COBRA continuation coverage. An election on behalf of a minor dependent child can be made by the child’s parent or legal guardian.
You must notify the Fund Office in writing within 60 days of certain Qualifying Events, such as divorce, legal separation, or a child losing dependent eligibility due to age, in order for you and/or your dependents to be eligible for COBRA. If notice is not received by the end of that 60-day period, the affected spouse or dependent will not be entitled to elect COBRA continuation coverage.
In case of your death, termination of employment, reduction in hours or entitlement to Medicare, your Employer must notify the Fund Office within 30 days of the event.
Notice of a Qualifying Event should be sent to:
10003 Derekwood Lane
Lanham, MD 20706
The Notice must include the following information: name and address of affected participant and/or beneficiary, date of occurrence of the qualifying event, and the nature of the qualifying event. In addition, you should enclose evidence of the occurrence of the qualifying event (for example: a copy of the divorce decree, separation agreement or death certificate).
Financial Responsibility for Failure to Give Notice
If a participant or dependent does not give written notice within 60 days of the date of the qualifying event, or a Participating Employer within thirty days of the qualifying event, and as a result, the Plan pays a claim for a person whose coverage terminated due to a qualifying event, then that person or the Participating Employer, as applicable, must reimburse the Plan for any claims that should not have been paid. If the person fails to reimburse the Plan, then all amounts due may be deducted from other benefits payable on behalf of that individual or on behalf of the Participant, if the person was his or her dependent.
How to Elect COBRA Continuation Coverage
Once the Fund Office receives notice of your or your dependent’s Qualifying Event, it will send you and/or your covered dependents notice of the date your or your dependent’s coverage ends and the information and forms you and/or your dependent will need to elect COBRA Continuation Coverage.
If you and/or any of your covered dependents do not elect COBRA continuation coverage within the later of the date coverage would otherwise end or 60 days after receiving notice from the Fund office of your and/or your dependents’ right to elect COBRA coverage, you and/or they will not have any group health coverage from this Plan after coverage ends. The only way for you to regain eligibility under the Plan is by meeting the initial eligibility requirements as set forth in this SPD.
Cost of COBRA Coverage
Individuals who continue coverage under COBRA pay, on an after-tax basis, 102% of the Plan’s cost of providing the benefits, except in cases of extended COBRA coverage due to disability where you can pay up to 150% of the Plan’s cost for the 11-month extension. The amount you, your covered spouse, and/or your covered dependent child(ren) must pay for COBRA coverage is due monthly (first of the month with a maximum grace period of 30 days).
The cost of COBRA Continuation Coverage may be subject to future increases during the period it remains in effect. However, generally your premiums will remain in effect for at least a 12-month period before an increase.
You have up to 45 days from the date you elect COBRA to pay all initial amounts due. If you elect COBRA coverage within the election period but after the date your coverage ends, you will have to pay the initial required COBRA premiums retroactively to cover the elapsed period. The full monthly amount must be paid before coverage starts. If this payment is not made when due, COBRA Continuation Coverage will not take effect. After that, payments are due on the first day of the coverage month with a 30-day grace period. For example, if you are paying for January coverage, your payment is due on January 1, but you have until January 31 to make the payment.
If full payment of the amount due is not made by the end of the applicable grace period, your COBRA coverage will terminate and cannot be reinstated.
Duration of COBRA Coverage
Your COBRA coverage can continue for up to 18, 29, or 36 months depending on the COBRA Qualifying Event. The COBRA Continuation Coverage period begins on the date of loss of coverage (rather than on the date of the Qualifying Event).
COBRA health coverage can continue for up to 18 months if you would otherwise lose health coverage because of:
- Your reduction in hours; or
- Your change from active to inactive work status due to your:
- Discharge (except for discharge for gross misconduct);
- Leave of absence, except for leave under the Family and Medical Leave Act (FMLA); or
COBRA coverage can continue for up to a total of 29 months if you or an eligible dependent becomes permanently disabled (as determined by the Social Security Administration), within the first 60 days of COBRA coverage. You or your dependent must notify the Fund Office of the determination no later than 60 days after it was received and before the end of the initial 18-month COBRA period in order to be eligible for this extended coverage. It is important that you apply for Social Security disability benefits as soon as you become disabled because it can take time to receive an award determination from the Social Security Administration. Remember to notify the Fund office immediately upon receipt of the Social Security Administration’s determination if you want to take advantage of the COBRA disability extension.
This extended period of COBRA coverage will end at the earlier of:
- The first day of the month that begins more than 30 days after the Social Security Administration has determined that you and/or your dependent(s) are no longer disabled;
- The end of 29 months from the date of the COBRA Qualifying Event; or
- The date the disabled individual becomes entitled to Medicare.
Your dependents may extend their coverage to 36 months from the date of the first Qualifying Event, if, during an 18-month or 29-month period of COBRA Continuation Coverage, a second Qualifying Event occurs due to:
- Your divorce or separation;
- Your death; or
- Your dependent ceasing to be a dependent child under the Plan.
Your dependents must notify the Fund Office in writing and in accordance with the notification procedures described in this Section in order to extend their period of COBRA Continuation Coverage upon the occurrence of a second qualifying event.
For example, assume Jack loses his job (the first COBRA Qualifying Event), and enrolls himself and his covered eligible dependents in COBRA coverage. Three months after his COBRA coverage begins, his child turns 26 years old and is no longer eligible for Plan coverage. This is a second Qualifying Event. Although Jack’s coverage is limited to 18 months, Jack’s child can continue COBRA coverage for 33 months, for a total of 36 months of COBRA coverage.
This extended period of COBRA Continuation Coverage is not available to anyone who became your spouse after the termination of your employment or reduction in your hours. However, the extended period of COBRA is available to any child(ren) born to, adopted by or placed for adoption with you (the active employee) during the 18-month period of COBRA Continuation Coverage.
In no case are you entitled to COBRA Continuation Coverage for more than a total of 18 months if your employment is terminated or you have a reduction in hours (unless you are entitled to an additional COBRA Continuation Coverage period on account of disability). As a result, if you experience a reduction in hours followed by termination of employment, the termination of employment is not treated as a second Qualifying Event and COBRA may not be extended beyond 18 months from the initial Qualifying Event.
Cost of COBRA Coverage in Cases of Disability
If the 18-month period of COBRA Continuation Coverage is extended because of disability, the Plan may charge employees and their families up to 150% of the cost of coverage for the COBRA family unit that includes the disabled person for the 11-month period following the 18th month of COBRA Continuation Coverage.
Acquiring a New Dependent(s) while Covered by COBRA
If you acquire a new dependent through marriage, birth or placement for adoption while you are enrolled in COBRA Continuation Coverage, you may add that dependent to your coverage for the balance of your COBRA coverage period at an additional cost.
For example, if you have five months of COBRA left and you get married, you can enroll your new spouse for five months of COBRA coverage. To enroll your new dependent for COBRA coverage, you must notify the Fund Office within 31 days. There may be a change in your COBRA premium amount in order to cover the new dependent.
If COBRA coverage ceases for you before the end of the maximum 18, 29, or 36 month COBRA coverage period, COBRA coverage also will end for your newly added spouse. However, COBRA coverage can continue for your newly added newborn child, adopted child or child placed with you for adoption until the end of the maximum COBRA coverage period if the required premiums are paid on time.
Loss of Other Group Health Plan Coverage or Other Health Insurance Coverage
If, while you are enrolled in COBRA Continuation Coverage, your spouse or dependent loses coverage under another group health plan, you may enroll the spouse or dependent for coverage for the balance of the applicable COBRA period. The spouse or dependent must have been eligible for, but not enrolled in, coverage under the terms of the Plan, and when enrollment was previously offered under the Plan and declined, the spouse or dependent must have been covered under another group health plan or had other health insurance coverage.
After your spouse or dependent loses coverage under another health plan you must enroll the spouse or dependent within 31 days. Adding a spouse or dependent child may increase the amount you must pay for COBRA Continuation Coverage. The loss of coverage must be due to:
- Exhaustion of COBRA Continuation Coverage under another plan;
- Termination as a result of loss of eligibility for the coverage; or
- Termination as a result of employer contributions toward the other coverage being terminated.
Loss of eligibility does not include a loss due to failure of the individual or participant to pay premiums on a timely basis or termination of coverage for cause.
When COBRA Coverage Ends
COBRA coverage will be terminated upon the occurrence of any of the following events:
- The first day of the time period for which you don’t timely pay the required COBRA premiums;
- The date all health care coverage offered by the Electrical Welfare Trust Fund terminates;
- The date on which the Fund is terminated;
- The date on which you or your eligible dependent(s) first become covered by another group health plan;
- The date on which you or your eligible dependent(s) first become entitled to Medicare (usually age 65);
- If you fail to follow the Fund’s policies and procedures and take actions that would result in termination of coverage for an active employee for cause (for example, if you submit false claims to the Fund);
- When the employer that employed you prior to the Qualifying Event has stopped contributing to the Plan and either: (i) establishes one or more group health plans covering a class of the employer’s employees formerly covered under this Plan; or (ii) starts contributing to another multiemployer plan that is a group health plan;
- The applicable COBRA period (18, 29, or 36 months) ends.
Confirmation of Coverage to Health Care Providers
Under certain circumstances, federal rules require the Fund to inform your health care providers (through UHC) as to whether you have elected and/or paid for COBRA Continuation Coverage. This rule is applicable under the following two circumstances:
- If a health care provider requests confirmation of coverage during the COBRA election period, and you, your spouse or your dependent child(ren) have not yet elected COBRA continuation coverage, UHC and/or the Fund will give a complete response to the health care provider about you and your dependents’ COBRA continuation rights during the election period; and
- If, after you have elected COBRA continuation coverage, a health care provider requests confirmation of coverage for a period for which the Fund Office has not yet received payment, UHC and/or the Fund will give a complete response to the health care provider about you and your dependents’ COBRA continuation rights during that period.
Coverage under the Plan is cancelled for you and your dependents as of the first day of a period of coverage (i.e., the applicable month) if the Fund does not receive the payment due. However, the Fund retroactively reinstates your coverage once the COBRA payment is made if paid during the 30-day grace period. If you and/or your dependents have not paid the applicable COBRA payment including during the applicable 30-day grace period, during this time UHC will inform the health care provider that you do not currently have coverage, but that you and your dependents would have coverage retroactively to the first day of the applicable coverage period if payment is made before the expiration of the grace period. Charges for services that are obtained during this grace period will not be paid by the Plan if payment is not received before the expiration of the grace period.
Interaction of COBRA, the Affordable Care Act and Medicare – Other Options
If you lose group health coverage under the Plan and become eligible for COBRA Coverage, you may also become eligible for other coverage options that may cost less than COBRA Coverage. For example, you and/or your family may be eligible to buy an individual plan through the Health Insurance Marketplace (the “exchange”), Medicaid, Medicare, the Children’s Health Insurance Program (“CHIP”) or other group health plan coverage (such as a spouse’s plan) through a 30-day “special enrollment period”, even if the other plan generally does not accept late enrollees. If you enroll in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. You can learn more about many of these options and about your rights under the Affordable Care Act at www.healthcare.gov.
In general, if you don’t enroll in Medicare Part A or B when you are first eligible because you are still employed, after the Medicare initial enrollment period, you have an 8-month special enrollment period to sign up for Medicare Part A or B, beginning on the earlier of:
- The month after your employment ends; or
- The month after group health plan coverage based on current employment ends.
If you don’t enroll in Medicare and elect COBRA continuation coverage instead, you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later enroll in Medicare Part A or B before the COBRA continuation coverage ends, the Plan may terminate your continuation coverage. However, if Medicare Part A or B is effective on or before the date of the COBRA election, COBRA coverage may not be discontinued on account of Medicare entitlement, even if you enroll in the other part of Medicare after the date of the election of COBRA coverage.
If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation coverage will pay second. For more information visit https://www.medicare.gov/medicare-and-you.
Medicare and Second Qualifying Events
If you become entitled to Medicare and you later have a termination of employment or reduction in hours, your eligible dependents would be entitled to COBRA Continuation Coverage either for: (a) a period for 18 months (29 months if the 11-month Social Security Disability extension applies) from your termination of employment or reduction in hours; or (b) 36 months from the date you became entitled to Medicare, whichever is longer.
If You Have Questions
Questions concerning your Plan or your COBRA Coverage rights should be addressed to the Plan at the address and telephone number listed at the beginning of this booklet. For more information about your rights under ERISA, COBRA, the Affordable Care Act, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, visit the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) website at www.dol.gov/ebsa or call their toll-free number at 1-866-444-3272. Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website. For more information about health insurance options available through the Health Insurance Marketplace, and to locate a representative in your area to whom you can talk about the different options, visit www.HealthCare.gov.
Keep Your Plan Informed of Address Changes
In order to protect your and your family’s rights, you should keep the Fund Office informed of any changes in your address and the addresses of family members. You also should keep a copy, for your records, of any notices you send to the Fund Office.