HomeMy WebLinkAboutGeneral notice of continuation coverage rightsRevised May 2014 - 1 -
GENERAL NOTICE OF CONTINUATION COVERAGE RIGHTS
Introduction
You are receiving this notice because you have recently become covered under the City of Iowa City's
health and/or dental and/or EAP plan (the Plan). This notice contains important information about your
right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This
notice generally explains COBRA continuation coverage, when it may become available to you and
your family, and what you need to do to protect the right to receive it. When you become eligible for
COBRA, you may also become eligible for other coverage options that may cost less than COBRA
continuation coverage.
The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus
Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you
when you would otherwise lose your group health coverage. It can also become available to other
members of your family who are covered under the Plan when they would otherwise lose their group
health coverage. For additional information about your rights and obligations under the Plan and under
federal law, you should review the Plan's Summary Plan Description or contact the Plan Administrator.
You may have other options available to you when you lose group health coverage. For example, you
may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in
coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and
lower out‐of‐pocket costs. Additionally, you may qualify for a 30‐day special enrollment period for
another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally
doesn’t accept late enrollees.
What is COBRA Continuation Coverage?
COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end
because of a life event known as a "qualifying event." Specific qualifying events are listed later in this
notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a
"qualified beneficiary." 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 are an employee, you will become a qualified beneficiary if you lose your coverage under the Plan
because either one of the following qualifying events happens:
Your hours of employment are reduced, or
Your employment ends for any reason other than your gross misconduct.
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If you are the spouse of an employee, you will become a qualified beneficiary if you will lose your
coverage under the Plan because any of the following qualifying events happens:
Your spouse dies;
Your spouse's hours of employment are reduced;
Your spouse's employment ends for any reason other than his or her gross misconduct;
Your spouse becomes entitled to Medicare benefits (Part A, Part B, or both); or
You become divorced or legally separated from your spouse.
Your dependent children will become qualified beneficiaries if they will lose coverage under the Plan
because any of the following qualifying events happens:
The parent‐employee dies;
The parent‐employee's hours of employment are reduced;
The parent‐employee's employment ends for any reason other than his or her gross misconduct;
The parent‐employee becomes entitled to Medicare benefits (Part A, Part B, or both);
The parents become divorced or legally separated; or
The child stops being eligible for coverage under the plan as a "dependent child."
Sometimes, filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying
event. If a proceeding in bankruptcy is filed with respect to the City of Iowa City, and that bankruptcy
results in the loss of coverage of any retired employee covered under the Plan, the retired employee will
become a qualified beneficiary. The retired employee’s spouse, surviving spouse, and dependent
children will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under
the Plan.
When is COBRA Coverage Available?
The plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan
Administrator has been notified that a qualifying event has occurred. When the qualifying event is the
end of employment or reduction of hours of employment, death of the employee, commencement of a
proceeding in bankruptcy with respect to the employer, or the employee's becoming entitled to
Medicare benefits (under Part A, Part B, or both), the employer must notify the Plan Administrator of
the qualifying event.
You Must Give Notice of Some Qualifying Events
For the other qualifying events (divorce or legal separation of the employee and spouse or a dependent
child's losing eligibility for coverage as a dependent child), you must notify Human Resources. The Plan
requires you to notify Human Resources within 60 days after the qualifying event occurs or the date that
coverage ends due to the event, whichever is later. You must provide this notice to: Human Resources,
City of Iowa City, 410 E Washington St., Iowa City, IA 52240, (319) 356‐5025 or (319) 356‐5028.
How is COBRA Coverage Provided?
Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation
coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an
independent right to elect COBRA continuation coverage. Covered employees may elect COBRA
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continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage
on behalf of their children.
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18
months due to employment termination or reduction of hours of work. Certain qualifying events, or a
second qualifying event during the initial period of coverage, may permit a beneficiary to receive a
maximum of 36 months of coverage.
These are the ways in which this 18 month period of COBRA continuation coverage can be extended:
Disability extension of 18‐month period of continuation coverage
If you or anyone in your family covered under the Plan is determined by the Social Security
Administration to be disabled and you notify the Plan Administrator in a timely fashion, you and your
entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage,
for a total maximum of 29 months. The disability would have to have started at some time before the
60th day of COBRA continuation coverage and must last at least until the end of the 18‐month period of
continuation coverage. Human Resources must be notified of Social Security Disability determination
within 60 days starting from the latest of (1) the date on which Social Security Administration issues the
disability determination; (2) the date on which the qualifying event occurs; (3) the date on which the
qualified beneficiary loses (or would lose) coverage under the plan as a result of the qualifying event; or
(4) the date on which the qualified beneficiary is informed, through the furnishing of the Summary Plan
Document or COBRA general notice, of the responsibility to notify the plan and the procedures for doing
so. The affected individual must also notify Human Resources within 30 days of any final determination
that the individual is no longer disabled.
Second qualifying event extension of 18‐month period of continuation coverage
If your family experiences another qualifying event while receiving 18 months of COBRA continuation
coverage, the spouse and dependent children in your family can get up to 18 additional months of
COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is
properly given to the Plan. This extension may be available to the spouse and any dependent children
receiving continuation coverage if the employee or former employee dies, becomes entitled to
Medicare benefits (under Part A, Part B, or both), or gets divorced or legally separated, or if the
dependent child stops being eligible under the Plan as a dependent child, but only if the event would
have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying
event not occurred.
Are there other coverage options besides COBRA Continuation Coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you
and your family through the Health Insurance Marketplace, Medicaid, or other group health plan
coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some
of these options may cost less than COBRA continuation coverage. You can learn more about many of
these options at www.healthcare.gov.
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If You Have Questions
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the
contact or contacts identified below. For more information about your rights under COBRA , the Patient
Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest
Regional or District Office of the U.S. Department of Labor's Employee Benefits Security Administration
(EBSA) in your area or visit the EBSA website at www.dol.gov/ebsa. (Addresses and phone numbers of
Regional and District EBSA Offices are available through EBSA's website.) For more information about
the Marketplace, visit www.healthcare.gov.
Keep Your Plan Informed of Address Changes
In order to protect your family's rights, you should keep Human Resources informed of any changes in
the addresses of family members. You should also keep a copy, for your records, of any notices you
send to Human Resources.
Plan Contact Information
The Plan Administrator is Karen Jennings, Human Resources Administrator, 410 E Washington St, Iowa
City IA 52240, (319) 356‐5025. COBRA continuation coverage for the Plan is administered by Human
Resources staff. Human Resources staff may be contacted at 410 E. Washington St. Iowa City, IA 52240
or by calling (319) 356‐5020 or (319) 356‐5028.