4421 - FEDERAL GROUP HEALTH CONTINUATION (COBRA)

Qualifying Event

1. A covered employee shall be offered the opportunity to continue the District’s group health coverage if the employee loses coverage under the Plan upon either of the following "qualifying events": 
    
   1. voluntary or involuntary termination of employment for reasons other than "gross misconduct"
      
      Gross misconduct may be intentional, wanton, willful, deliberate, reckless or in deliberate indifference to the District’s interests.  It is misconduct beyond mere minor breaches of employee standards, but conduct which would be considered gross in nature.
   2. reduction in the number of hours of employment
2. The spouse of a covered employee may continue the District’s group health coverage if the spouse loses coverage under the Plan because of any of the following "qualifying events":
    
   1. termination of the covered employee’s employment for any  reason than "gross misconduct" 
   2. reduction in the hours worked by the covered employee
   3. divorce or legal separation with the covered employeeAlso, if the employee reduces or eliminates group health coverage in anticipation of divorce or legal separation, then divorce or legal separation may be considered to be a qualifying event even though the spouse’s coverage was reduced or eliminated prior to the divorce or legal separation.
   4. death of the covered employeeThe spouse of a covered employee may continue the District’s group health coverage if the spouse loses coverage under the Plan because of any of the following "qualifying events": 
3. Dependent children may continue the group health coverage if the dependent child loses coverage under the Plan because of any of the following "qualifying events":
    
   1. termination of covered employee’s employment for any reason other than "gross misconduct"
   2. reduction in the hours worked by the covered employee
   3. loss of "dependent child" status under the Plan rulesUnder the Patient Protection and Affordable Care Act, the Plan must offer coverage for an adult child until the child attains age twenty-six (26).
   4. divorce or legal separation of the covered employee
   5. death of the covered employee 

Notification by Qualified Beneficiaries

Qualified beneficiaries are required to notify the Plan Administrator of the following qualifying events in order to be eligible for COBRA continuation coverage:  (a) divorce or legal separation of the employee and spouse; and (b) loss of eligibility for coverage of a dependent child.  The qualified beneficiary is required to notify the Plan Administrator in writing of these events within sixty (60) days of the later of: (a) the date of the qualifying event; or (b) the date on which the qualified beneficiary loses (or would lose) coverage under the terms of the Plan as a result of the qualifying event.  Failure to comply with these rules will result in forfeiture of any COBRA continuation coverage. 

COBRA Election

Qualified beneficiaries are required to elect COBRA continuation coverage within the sixty (60) day election period set forth in the Plan’s COBRA election notice.  Qualified beneficiaries have the right to elect to continue coverage that is identical to the coverage provided under the Plan.  If a COBRA beneficiary does not elect COBRA continuation coverage within the sixty (60) day election period, then the COBRA beneficiary will forfeit his/her right to elect COBRA.

• a qualified beneficiary becomes entitled to Medicare benefits; 
• during a disability extension period, the disabled qualified beneficiary is determined by the Social Security Administration to be no longer disabled. 

A qualified beneficiary is required to notify the District in writing if the qualified beneficiary becomes eligible for Medicare or becomes covered under another group health plan.  In addition, if a disabled qualified beneficiary is determined by the Social Security Administration to no longer be disabled, the qualified beneficiary must notify the District of the fact within thirty (30) days after the Social Security Administration’s determination.

© Neola 2016