Eligibility / COBRA
COBRA Continuation Coverage
Under COBRA, you and your covered dependents have the right to elect to continue your coverage under the Plan in lieu of minimum/difference payments if you (or your covered dependents) would otherwise lose coverage because of a qualifying event (refer to the chart below). Each qualified beneficiary has the independent right to elect COBRA coverage. A qualified beneficiary means each person (you, your spouse and your dependents) covered by the Plan on the day before a qualifying event, and any child born to you or placed for adoption with you while you are covered by COBRA. You may elect (but you may not waive) COBRA continuation on behalf of your spouse, as long as your spouse is a qualified beneficiary. Parents may elect COBRA continuation coverage on behalf of their dependent children, as long as the dependent children are qualified beneficiaries.
Continuation coverage under COBRA includes medical, prescription drug, dental and vision coverage that the qualified beneficiary would have been entitled to if the qualifying event had not occurred. It does not include weekly accident and sickness benefits, life insurance, or AD&D.
An active member who maintains coverage after a qualifying event by electing COBRA in lieu of minimum/difference payments may not elect minimum/difference payments to maintain active coverage at the termination of the COBRA coverage, unless and until the member reestablishes initial eligibility as provided in the Plan. Conversely, an active member who maintains coverage after a qualifying event by electing minimum/difference payments in lieu of COBRA may not elect COBRA to maintain active coverage at the termination of the period of minimum/difference payments, unless and until the member reestablishes initial eligibility as provided in the Plan, or unless a second qualifying event occurs before such termination.
Eligibility and Duration
The following chart shows the qualifying events and the periods of eligibility for COBRA continuation coverage:
|If you lose coverage for any one of these reasons||These people would be eligible for COBRA Continuation coverage||for up to this long|
|Your employment terminates for reasons other than gross misconduct||You and your eligible dependents||18 months*|
|You became ineligible due to reduced work hours||You and your eligible dependents||18 months*|
|You die||Your eligible dependents||36 months|
|You divorce or legally separate||Your eligible dependents||36 months|
|Your dependent children no longer qualify as dependents||Your eligible dependents||36 months|
|You become entitled to Medicare||Your eligible dependents||36 months|
*Subject to extension up to 29 months as described below.
Please note that entitlement to Medicare means you are eligible for and enrolled in Medicare. Also note that if you are entitled to Medicare at the time that your employment terminates or you become ineligible due to a reduction in hours and your Medicare entitlement began less than 18 months before the applicable qualifying event, your dependents will be eligible for up to 36 months of COBRA after the date of Medicare entitlement.
Extension of 18-month COBRA coverage period for disability. If you’re a qualified beneficiary who has COBRA continuation coverage because of termination of employment or reduction in hours, you and each enrolled member of your family can get an extra 11 months of COBRA coverage if you become disabled. (That is, you can get up to a total of 29 months of COBRA coverage.) To qualify for additional months of COBRA coverage, you must have a Notice of Award from the Social Security Administration that your disability began before the 61st day after your termination of employment or reduction in hours, and your disability must last at least until the end of the COBRA coverage period that would have been available without the extension.
To elect extended COBRA coverage, you must send a copy of the Social Security Administration’s determination to the Benefit Office, within 60 days of the date of the Social Security Administration’s determination notice (or the date of the qualifying event or the date coverage was or would be terminated as a result of the qualifying event, whichever is latest). In addition, your notification to the Benefit Office must occur within 18 months after your termination of employment or reduction in hours. If you do not notify the Benefit Office in writing within the 60-day (and 18-month) period, you will lose your right to elect extended COBRA continuation coverage.
Extension of 18-month COBRA coverage period for your spouse or dependent children due to a second qualifying event. If your spouse or dependent children have COBRA continuation coverage because of your termination of employment or reduction in hours, they can get up to an extra 18 months of COBRA coverage if they have a second qualifying event. (In other words, they can get up to a total of 36 months of COBRA coverage.) This extended COBRA coverage is available to your spouse and dependent children if the second qualifying event is your death, divorce, or legal separation. The extension is also available to a dependent child whose second qualifying event occurs when he or she stops being eligible under the Plan as a dependent child.
To elect extended COBRA coverage in all of these cases, you must notify the Benefit Office of the second qualifying event within 60 days after the second qualifying event (or the date that benefits would end under the Plan as a result of the first qualifying event, if later). If you do not notify ADP in writing within the 60-day period, you will lose your right to elect additional COBRA continuation coverage.
The Benefit Office will notify you or your dependents if you or your dependents become eligible for COBRA continuation coverage because of your death, termination of employment, reduction in hours of employment or Medicare entitlement. The notification must be made within 30 days after the qualifying event.
Under the law, you or your enrolled dependent is responsible for notifying the Benefit Office in writing of your divorce, legal separation or a child’s loss of dependent status. The notification must be made within 60 days after the qualifying event (or the date on which coverage would end because of the qualifying event, if later).
A disabled qualified beneficiary must notify the Benefit Office in writing of a disability determination by Social Security within 60 days after such determination (or the date of the qualifying event or the date coverage was or would be terminated as a result of the qualifying event, whichever is latest) and within the initial 18 months of COBRA coverage.
You or your dependent spouse can provide notice on behalf of yourself as well as other family members affected by the qualifying event. The written notice of the qualifying event should be sent to the Benefit Office, at 1419 Hampton Ave, St. Louis, MO 63139, and should include the following:
- Date written notice is submitted (month/day/year)
- Employee’s name
- Employee’s Social Security number/ID number
- Reason for loss of coverage
- Loss of coverage date (month/day/year)
- Spouse/dependent’s name
- Spouse’s Social Security number/ID number
- Spouse/dependent’s address
- Spouse/dependent’s telephone number
- Spouse/dependent’s gender
- Spouse/dependent’s date of birth (month/day/ year)
- Spouse/dependent’s relationship to employee
COBRA enrollment. Within 30 days after the Benefit Office is notified that a qualifying event has occurred, they will send you an election form and a notice of your right to elect COBRA. To receive COBRA continuation coverage, you must elect it by returning a completed COBRA election form to the Benefit Office within 60 days after the date of the notice of your right to elect COBRA (or within 60 days after the date you would lose coverage, if later).
If you make this election and pay the required premium within the required deadlines, COBRA coverage will become effective on the day after coverage under the Plan would otherwise end.
Instead of electing COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace or Medicaid. You may also be eligible for a “special enrollment period” in another group health plan for which you are otherwise eligible (such as a plan sponsored by your spouse’s employer) within 30 days after your group health coverage ends because of the qualifying events. You will also have the same special enrollment right at the end of your COBRA coverage if you take COBRA coverage for the maximum time available to you. Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.
Adding a Dependent
If a child is born to you (the employee) or placed for adoption with you while you are covered by COBRA, you can add the child to your coverage as a qualified beneficiary with independent COBRA rights. In addition, each qualified beneficiary covered by COBRA may add dependents in the same manner as an active employee, but such dependents are not qualified beneficiaries.
Cost of Coverage
As provided by law, you and/or your enrolled dependents must pay the full cost of coverage plus 2% for administrative expenses for the full 18- or 36-month period. For a disabled person who extends coverage for more than 18 months, the cost for months 19–29 is 150% of the Plan’s cost for the coverage. Since the cost to the Plan may change during the period of your continuation coverage, the amount charged to you may also change annually during this period.
Time for payment. You must send the initial payment for COBRA coverage to the Benefit Office within 45 days of the date you first notify the Benefit Office that you choose COBRA coverage. (A U.S. Post Office postmark will serve as proof of the date you sent your payment.) You must submit payment to cover the number of months from the date of regular coverage termination to the time of payment (or to the time you wish to have COBRA coverage end).
After your initial payment, all payments are due on the first of the month. You have a 30-day grace period from the due date to pay your premium. If you fail to pay by the end of the grace period, your coverage will end as of the last day of the last fully paid period. Once coverage ends, it cannot be reinstated. To avoid cancellation, you must send your payment on or before the last day of the grace period. (Again, a U.S. Post Office postmark will serve as proof.) Please note that if your check is returned unpaid from the bank for any reason, that may prevent your COBRA premiums from being paid on time and may result in cancellation of coverage.
When COBRA Continuation Coverage Ends
COBRA continuation coverage ends automatically on the last day of the month in which the earliest of the following dates falls:
- the date the maximum coverage period ends
- the last day of the period for which the person covered under COBRA made a required premium payment on time
- the date after the election of COBRA that the person covered under COBRA first becomes covered under another group medical plan
- the first of the month that begins more than 30 days after the date the person whose disability caused the extension of coverage to 29 months is no longer disabled (based on a final determination from the Social Security Administration)
- the date the Plan is terminated and Carpenters provides no other medical coverage.
If continuation coverage ends before the end of the maximum coverage period, the Benefit Office will send you a written notice as soon as practicable following their determination that continuation coverage will terminate. The notice will set out why continuation coverage will be terminated early, the date of termination, and your rights, if any, to alternative individual or group coverage.
COBRA continuation coverage cannot under any circumstances extend beyond 36 months from the date of the qualifying event that originally made you or a dependent eligible to elect COBRA.
Once COBRA continuation coverage ends for any reason, it cannot be reinstated. You must notify the Benefit Office if:
- you have a divorce or legal separation
- you, your spouse or an eligible enrolled dependent has a change of address
- you, your spouse or your dependent becomes entitled to Medicare
- your dependent child is no longer eligible
- you or a dependent ceases to be disabled, as determined by the Social Security Administration.
The COBRA Administrator for the Plan is:
Carpenters’ Health and Welfare Trust Fund of St. Louis (The Benefit Office)
1419 Hampton Avenue
St. Louis, MO 63139
All notices to the Benefit Office must be in writing and sent to this address. Any notice that you send by mail must be postmarked by the U.S. Post Office no later than the last day of the required notice period. The notice must state the name of the Plan under which you request COBRA continuation coverage, your name and address, the name and address of each qualifying beneficiary, the qualifying event and the date it happened. If the qualifying event is a divorce or legal separation, you must include a copy of the divorce decree or legal documentation of the legal separation. Other applicable documentation (such as birth certificates or adoption papers) may also be required.
Unavailability of coverage. If you or your enrolled dependent has notified the Benefit Office in writing of your divorce, legal separation or a child’s loss of dependent status, or a second qualifying event, but you or your enrolled dependent is not entitled to COBRA, the Benefit Office will send you a written notice stating the reason why you are not eligible for COBRA. This notice will be provided within the same time frame the Plan follows for election notices.
If You Have Questions
If you have any questions about your COBRA continuation coverage, contact the Benefit Office or the nearest office of the Employee Benefits Security Administration (EBSA), U.S. Department of Labor, listed in your telephone directory. Addresses and phone numbers of EBSA offices are available at www.dol.gov/ebsa. To protect your family’s rights to COBRA coverage, keep the Benefit Office informed of any changes of address for you and your family members.