COBRA Continuation Coverage
Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you or your dependents may continue health care coverage past the date coverage would normally end. Under certain circumstances, by making the required COBRA payments, you or your dependents may continue coverage under the:
- COBRA Core Plan, which includes Medical, Prescription Drug, and Death Benefits as described in this booklet; or
- COBRA Full Plan, which includes Medical, Prescription Drug, Dental, Vision, and Death Benefits as described in this booklet.
The COBRA Continuation Coverage will be identical to the coverage you had under the Plan on the day before your qualifying event. You will not be eligible to continue coverage for Weekly Income or Accidental Dismemberment Benefits.
You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA Continuation Coverage must pay for COBRA Continuation Coverage.
If you have a new child that meets the Plan’s definition of an eligible dependent (e.g., 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 that child to your coverage. You must give the Fund Office written notice of the birth, adoption, or placement of a child with you for adoption to have the child added to your coverage under the Plan.
Children born, adopted, or placed for adoption as described above, have the same COBRA rights as a spouse or dependents who were covered by the Plan before the event that triggered COBRA Continuation Coverage. Like all qualified beneficiaries with COBRA Continuation Coverage, these children’s continued coverage depends on timely and uninterrupted COBRA payments on their behalf.
For COBRA Continuation Coverage, you must notify the Fund Office within 60 days of a:
- Legal separation; or
- Child losing dependent status.
If you do not notify the Fund Office, you will lose your right to continue coverage under COBRA.
You do not have to show that you are insurable for COBRA Continuation Coverage. It is offered to you if you or your dependents lose coverage under the Plan because of a qualifying event. Qualifying events include:
- Termination of your covered employment (for causes other than gross misconduct);
- Reduction in your hours reported for covered employment;
- Your death;
- You become entitled to Medicare benefits (under Part A, Part B, or both);
- Legal separation or divorce of you and your spouse; or
- Your child’s loss of dependent status under the Plan.
Participant Agreement and Independent Self-Contributors
If you are receiving benefits under a Participation Agreement for Independent Self-Contributors, you are remitting benefits for yourself and possibly other non-bargaining unit employees who are performing collective bargaining work. You are not entitled to COBRA Continuation Coverage if you cease to remit contributions on your behalf. If you do not submit contributions on behalf of your employees covered under a collective bargaining agreement, your benefits will be suspended until such time that all contributions, penalties, interest, and any costs of collection are paid in full. The Trustees reserve the right to terminate a Participation Agreement for Independent Self-Contributors for failure to remit contributions required under that Participation Agreement as well as failure to remit contributions required under the terms of the related collective bargaining agreement.
Notifying the Fund Office
You or your beneficiary must inform the Fund Office of a legal separation, divorce, or child losing dependent status under the Plan within 60 days of the event. If you do not notify the Fund Office within 60 days of such an event, you lose your right to elect COBRA Continuation Coverage.
Your Employer may notify the Fund Office of your termination of employment, reduction in hours, death, or entitlement to Medicare coverage. However, because Employers contributing to multiemployer funds may not be aware of these events, the Fund Office will rely on its records for determining when eligibility is lost under these circumstances. To ensure that you do not suffer a gap in coverage, we urge you or your family to notify the Fund Office of any qualifying events as soon as they occur.
When the Fund Office is notified that one of these events has occurred, you and your dependents will be notified of your right to elect COBRA Continuation Coverage. Once you receive a COBRA notice, you have 60 days to respond to the Fund Office if you wish to elect COBRA Continuation Coverage; this is called the election period. Whether or not you elect coverage for yourself, your dependents have the opportunity to elect coverage independently from you.
The Plan currently offers two levels of COBRA Continuation Coverage, the COBRA Core Plan and the COBRA Full Plan. Once you elect a level of coverage, you may change your election to a different level of coverage only if the 60-day election period has not expired. Once the 60-day election period ends, you are no longer eligible to change coverage level.
Paying For COBRA Continuation Coverage
The Fund Office will notify you of the cost of your COBRA Continuation Coverage when it notifies you of your right to elect such coverage. The Trustees determine the cost for COBRA Continuation Coverage each year. It will not exceed 102% of the cost to provide this coverage. If you qualify for extended disability coverage under COBRA, the cost for the 19th through the 29th month is an amount determined by the Trustees, not to exceed 150% of the cost to provide coverage.
Premiums are comprehensive. This means that you pay the same amount of money each month for one person as for you and one or more dependents. You must remember to remit your premiums each month. Simply electing COBRA Continuation Coverage does not make you eligible.
Your first payment for COBRA Continuation Coverage must include payments for any months retroactive to the day coverage under the Plan terminated. This payment is due no later than 45 days after the date you or your dependent signed the election form and returned it to the 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 immediately. Once your COBRA Continuation Coverage is terminated, it cannot be reinstated.
No payments will be made on Claims presented to the Fund Office until a timely COBRA premium payment is received.
- Coverage Continues for 18 Months: You may elect to purchase COBRA Continuation Coverage for yourself and your dependents for up to 18 months if coverage ends due to your termination of covered employment (except for gross misconduct) or your reduction in hours.
- Coverage Continues for 29 Months (Extended Disability Coverage): Your coverage or your dependent’s coverage may continue for a total of 29 months (an additional 11 months) after your covered employment is terminated or you have a reduction in your hours if you or one of your dependents is totally disabled, as determined by the Social Security Administration. The determination must be made either:
- At the time of your termination from covered employment or reduction in hours; or
- Within the next 60 days after your termination from covered employment or reduction in hours.
You must notify the Fund Office of your determination of disability by the Social Security Administration before the end of the 18-month period of COBRA Continuation Coverage. In addition, if, at a later date, you become employed or are no longer considered totally disabled by the Social Security Administration, you must notify the Fund Office.
- Coverage Continues for 36 Months: Your dependents may elect to continue coverage for up to 36 months if coverage ends due to your:
- Your attainment of Medicare health care coverage entitlement during the first 18 months of COBRA Continuation Coverage;
- Legal separation or divorce; or
- Your dependent child no longer meets the definition of child and does not qualify for dependent coverage under the terms of the Plan.
When your COBRA Continuation Coverage ends, you will be provided with a Certificate of Creditable Coverage for your length of coverage under the Plan. This Certificate may help reduce or eliminate any pre-existing condition limitation under a new group medical plan.
Loss of Continued Coverage
The period of COBRA Continuation Coverage for you or your dependents may be cut short for any of the following reasons:
- You or your dependents do not make the required COBRA payments within 30 days of the due date;
- The Plan stops providing any group health benefits;
- After the qualifying event you or your dependents become covered under another group health care plan (provided such plan does not contain any exclusions or limitations with respect to any pre-existing conditions); or
- You or your eligible spouse becomes entitled to Medicare.