[PPT] - COBRA Cindy K o e ne ma nn-Wa rre n, E sq . L ynn, L ynn, Bla c PowerPoint Presentation

SLIDE 1

COBRA

Cindy K

e ne ma nn-Wa rre n, E

sq . L ynn, L ynn, Bla c kma n & Ma nitsky, P.C. VSHRP Me e ting – June 15, 2017, upda te d Ja nua ry18, 2018

SLIDE 2

DI SCL AI ME RS/ CAVE AT S

T his pre se nta tio n do e s no t c o nstitute le g a l a dvic e . T he la ws a nd le g a l re q uire me nts c o nc e rning the se ma tte rs a re c o mple x a nd spe c ific issue s sho uld b e a ddre sse d a nd a na lyze d o n a c a se -b y-c a se b a sis in dire c t c o nsulta tio n with sc ho o l distric t le g a l c o unse l.

2

SLIDE 3

DI SCL AI ME RS/ CAVE AT S

T his is no t a c o mpre he nsive tra ining o n COBRA. T he fo c us is o n imple me nta tio n o f COBRA in a sc ho o l se tting . T he re a re o the r rule s tha t ma y a pply in o the r e mplo ye r se tting s. T ho se a re no t c o ve re d he re .

3

SLIDE 4

WHAT I S COBRA?

Co nso lida te d Omnib us Budg e t Re c o nc ilia tio n Ac t
Re q uire s g ro up he a lth pla ns to o ffe r c o ntinua tio n

c o ve ra g e to c o ve re d e mplo ye e s, fo rme r e mplo ye e s, spo use s, fo rme r spo use s a nd de pe nde nt c hildre n

Applie s to pla ns spo nso re d b y sta te a nd lo c a l

g o ve rnme nts

I

f c o ntinua tio n o f c o ve ra g e is e le c te d, sa me rig hts a nd pla ns a s simila rly situa te d individua ls no t re c e iving c o ntinua tio n o f c o ve ra g e – inc lude s o pe n e nro llme nt, b irth o f a c hild, e tc .

L
ss o f c o ve ra g e ma y trig g e r spe c ia l e nro llme nt rig hts.

4

SLIDE 5

WHAT I S A HE AL T H PL AN UNDE R COBRA?

De finitio n o f He a lth Pla n:
Any a rra ng e me nt tha t a n e mplo ye r e sta b lishe s o r ma inta ins to

pro vide e mplo ye e s o r the ir fa milie s with me dic a l c a re , whe the r it is pro vide d thro ug h insura nc e , b y a he a lth ma inte na nc e

rg a niza tio n, o ut o f the e mplo ye r’ s a sse ts, o r thro ug h a ny o the r

me a ns. T his inc lude s a He a lth Re imb urse me nt Arra ng e me nt (HRA).

Me dic a l c a re inc lude s:
Inpa tie nt a nd o utpa tie nt ho spita l c a re
Physic ia n c a re
Surg e ry a nd o the r ma jo r me d ic a l b e ne fits
Pre sc riptio n d rug s
De nta l a nd visio n c a re
Do e s no t inc lude :
L

ife insura nc e

Disa b ility Insura nc e

5

SLIDE 6

QUAL I F I E D BE NE F I CI ARI E S

Qua lifie d Be ne fic ia ry is:

An individua l who wa s c o ve re d b y a g ro up he a lth pla n
n the da y b e fo re a q ua lifying e ve nt o c c urre d

AND

Who is a n e mplo ye e , the e mplo ye e ’ s spo use o r fo rme r

spo use , o r the e mplo ye e ’ s de pe nde nt c hild.

6

SLIDE 7

QUAL I F YI NG E VE NT S

A Qua lifying E ve nt is the e ve nt tha t c a use s a n individua l to lo se g ro up he a lth c o ve ra g e Qua lifying E ve nts fo r E mplo ye e s:

T

e rmina tio n o f e mplo yme nt fo r a ny re a so n o the r tha n g ro ss misc o nduc t OR

Re duc tio n in the c o ve re d e mplo ye e ’ s ho urs o f

e mplo yme nt

7

SLIDE 8

QUAL I F YI NG E VE NT S

A Qua lifying E ve nts fo r Spo use o r De pe nde nt Child:

T

e rmina tio n o f c o ve re d e mplo ye e ’ s e mplo yme nt fo r a ny re a so n o the r tha n g ro ss misc o nduc t

Re duc tio n in the c o ve re d e mplo ye e ’ s ho urs o f

e mplo yme nt

Co ve re d e mplo ye e b e c o me s e ntitle d to Me dic a re
Divo rc e o r le g a l se pa ra tio n o f the spo use fro m the

c o ve re d e mplo ye e

De a th o f the c o ve re d e mplo ye e
L
ss o f de pe nde nt c hild sta tus unde r pla n rule s (Ag e 26)

8

SLIDE 9

NOT I CE S AND PROCE DURE S

BDD (Be ne fit De sc riptio n Do c ume nt)/ COC (Ce rtific a te o f

Co ve ra g e ) a nd No tic e s must inc lude info rma tio n a b o ut:

Na me o f pla n
Addre ss/ te le pho ne c o nta c t info rma tio n fo r Pla n

Administra to r

No tific a tio n re q uire me nts (who , wha t, ho w, whe n)
I

mpo rta nc e o f pro viding c urre nt a ddre sse s fo r a ll q ua lifie d b e ne fic ia rie s

Othe r info rma tio n spe c ific to the type o f no tic e (o utline d

la te r in pre se nta tio n) Yo u a re the Pla n! Unle ss yo u use a T PA fo r COBRA, the n yo u a re b o th the Pla n!

9

SLIDE 10

COBRA NOT I CE RE QUI RE ME NT S

Be ne fit De sc riptio n Do c ume nt (BDD/ COC)
Othe r No tic e s:
COBRA Ge ne ra l No tic e
COBRA Qua lifying E

ve nt No tic e

CORBA E

le c tio n No tic e

COBRA No tic e o f E

a rly T e rmina tio n o f Co ntinua tio n Co ve ra g e

COBRA No tic e o f Una va ila b ility o f Co ntinua tio n o f

Co ve ra g e (I ne lig ib ility)

10

SLIDE 11

COBRA GE NE RAL NOT I CE

COBRA Ge ne ra l No tic e
Ha s to b e pro vide d within first 90 da ys o f c o ve ra g e to the

e mploye e and spouse c o ve re d unde r the pla n

Ca n b e inc lude d with the BDD/ COC
Use o f the Mo de l Ge ne ra l No tic e is c o nside re d g o o d fa ith

c o mplia nc e with g e ne ra l no tic e c o nte nt re q uire me nts

Ge ne ra l No tic e o f COBRA Rig hts must c o nta in:
A g e ne ra l de sc riptio n o f the c o ntinua tio n c o ve ra g e pro vide d

unde r the pla n

An e xpla na tio n o f wha t q ua lifie d b e ne fic ia rie s must do to

no tify the pla n o f q ua lifying e ve nts o r disa b ilitie s

A sta te me nt tha t the g e ne ra l no tic e do e s no t fully de sc rib e

COBRA o r the pla n a nd mo re info rma tio n is a va ila b le fro m the pla n a dministra to r a nd the BDD/ COC

And no tic e c o nte nts o utline d o n prio r slide

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SLIDE 12

COBRA QUAL I F YI NG E VE NT / E L E CT I ON NOT I CE

COBRA Qua lifying E

ve nt No tic e

T

he e mplo ye r must no tify the pla n if the q ua lifying e ve nt is:

T

e rmina tio n o r re duc tio n in ho urs o f e mplo yme nt o f c o ve re d e mplo ye e

De a th o f the c o ve re d e mplo ye e
Co ve re d e mplo ye e ’ s b e c o ming e ntitle d to Me dic a re
Must no tify the pla n within 30 da ys a fte r the e ve nt o c c urs
T

his trig g e rs the E le c tio n No tic e Re q uire me nts

12

SLIDE 13

COBRA QUAL I F YI NG E VE NT / E L E CT I ON NOT I CE

COBRA Qua lifying E

ve nt No tic e

T

he c o ve re d e mplo ye e o r q ua lifie d b e ne fic ia rie s must no tify the pla n if the q ua lifying e ve nt is:

Divo rc e
L

e g a l Se pa ra tio n

Child’ s lo ss o f de pe nde nt sta tus unde r the pla n
T

his trig g e rs the E le c tio n No tic e Re q uire me nts

13

SLIDE 14

COBRA E L E CT I ON NOT I CE

CORBA E

le c tio n No tic e

Afte r re c e iving no tic e o f q ua lifying e ve nt, the pla n must

pro vide a n e le c tio n no tic e , whic h de sc rib e s rig hts to c o ntinua tio n o f c o ve ra g e a nd ho w to ma ke a n e le c tio n

Must b e pro vide d within 14 da ys o f no tic e o f the q ua lifying

e ve nt

Use o f the mo de l no tic e will b e c o nside re d g o o d fa ith

c o mplia nc e with the e le c tio n no tic e c o nte nt re q uire me nts

f COBRA, if c o mple te ly pro pe rly

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SLIDE 15

COBRA E L E CT I ON NOT I CE

CORBA E

le c tio n No tic e No tic e must inc lude :

No tic e c o nte nts liste d pre vio usly
Id e ntific a tio n o f q ua lifying e ve nt
Id e ntific a tio n o f the q ua lifie d b e ne fic ia rie s b y na me o r sta tus
An e xpla na tio n o f the q ua lifie d b e ne fic ia rie s rig hts to e le c t

c o ntinua tio n c o ve ra g e

T

he d a te c o ve ra g e will te rmina te / te rmina te d if no t c o ntinua tio n c o ve ra g e is no t e le c te d

Ho w to e le c t c o ntinua tio n c o ve ra g e
Wha t will ha ppe n if c o ntinua tio n c o ve ra g e is no t e le c te d o r is

wa ive d

Wha t c o ntinua tio n c o ve ra g e is a va ila b le , fo r ho w lo ng a nd ho w it

c a n b e e xte nd e d fo r d isa b ility o r se c o nd q ua lifying e ve nts

Ho w c o ntinua tio n mig ht te rmina te e a rly
Pre mium pa yme nt re q uire me nts, inc lud ing d ue d a te s a nd g ra c e

pe rio d s

Sta te me nt tha t the e le c tio n no tic e d o e s no t fully d e sc rib e COBRA
r the pla n a nd mo re info rma tio n is a va ila b le fro m pla n

a d ministra to r a nd the BDD/ COC

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SLIDE 16

E L E CT I ON PROCE DURE S

At a minimum must g ive a t le a st 60 da ys to e le c t

c o ntinua tio n c o ve ra g e

60 da ys fro m the la te r o f:
Da te the q ua lifying e ve nt o c c urs
Da te o n whic h the q ua lifie d b e ne fic ia ry lo se s/ wo uld lo se

c o ve ra g e a s a re sult o f the q ua lifying e ve nt

Da te o n whic h the q ua lifie d b e ne fic ia ry is info rme d o f no tic e

re spo nsib ilitie s a nd pro c e dure s (Ge ne ra l No tic e / BDD/ COC)

I

f o ne pe rso n g ive s no tic e , the no tic e c o ve rs a ll q ua lifie d b e ne fic ia rie s a ffe c te d b y the e ve nt

E

a c h q ua lifie d b e ne fic ia ry ha s a n inde pe nde nt rig ht to e le c t c o ntinua tio n c o ve ra g e

E

ve n if wa ive d, c a n c ha ng e mind until e nd o f e le c tio n pe rio d; Co ve ra g e c a n b e g in o n da te wa ive r wa s re vo ke d

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SLIDE 17

DURAT I ON OF COVE RAGE

17

Qua lifying E ve nt Qua lifie d Be ne fic ia rie s Ma ximum Pe riod of Continua tion Cove ra g e

T e rmina tio n o r re duc tio n in ho urs E mplo ye e , Spo use , De pe nde nt Child 18 mo nths E mplo ye e e nro llme nt in Me dic a re Spo use , De pe nde nt Child 36 mo nths Divo rc e o r le g a l se pa ra tio n Spo use , De pe nde nt Child 36 mo nths De a th o f e mplo ye e Spo use , De pe nde nt Child 36 mo nths L

ss o f “de pe nde nt

c hild” sta tus unde r the pla n De pe nde nt c hild 36 mo nths

SLIDE 18

E XT E NSI ON OF 18 MONT HS PE RI OD OF CONT I NUAT I ON COVE RAGE

Disa b ility
I

f o ne q ua lifie d b e ne fic ia ry in a fa mily is disa b le d a nd me e ts c e rta in re q uire me nts, a ll q ua lifie d b e ne fic ia rie s in tha t fa mily a re e ntitle d to a n 11 mo nth e xte nsio n o f the ma ximum pe rio d

T
ta l o f 29 mo nths (18 mo nths + 11 mo nths)
Re q uire me nts
SSA de te rmine s disa b ility b e fo re 60th da y o f c o ntinua tio n

c o ve ra g e AND

Disa b ility c o ntinue s during the re st o f the 18 mo nths pe rio d
f c o ntinua tio n c o ve ra g e

18

SLIDE 19

E XT E NSI ON OF 18 MONT HS PE RI OD OF CONT I NUAT I ON COVE RAGE

Se c o nd Qua lifying E

ve nt

18 mo nth e xte nsio n ma y b e a va ila b le if q ua lifie d

b e ne fic ia ry/ b e ne fic ia rie s e xpe rie nc e s a se c o nd q ua lifying e ve nt

T
ta l 36 mo nths (18 mo nths + 18 mo nths)
Se c o nd q ua lifying e ve nts:
De a th o f c o ve re d e mplo ye e
Divo rc e o r le g a l se pa ra tio n o f the c o ve re d e mplo ye e a nd

spo use

Me dic a re e ntitle me nt
L
ss o f de pe nde nt c hild sta tus unde r the pla n

19

SLIDE 20

E XT E NSI ON OF 18 MONT HS PE RI OD OF CONT I NUAT I ON COVE RAGE

Ca n o nly b e a se c o nd q ua lifying e ve nt if it wo uld ha ve

c a use d the q ua lifie d b e ne fic ia ry to lo se c o ve ra g e unde r the pla n in the a b se nc e o f the first q ua lifying e ve nt E xa mple :

Jo hn Smith lo se s his jo b a nd is e ntitle d to COBRA with his

wife Ja ne Smith fo r 18 mo nths o n the b e g inning o f Ja nua ry. F

ur mo nths into COBRA, Jo hn a nd Ja ne Smith

ha ve a divo rc e fina lize d o n April 1st. Jo hn Smith's a c c o unt will c o ntinue fo r a no the r 14 mo nths. Ja ne Smith will b e re mo ve d fro m Jo hn Smith's a c c o unt a nd pla c e d

n he r o wn a c c o unt e ffe c tive April 1st. He r COBRA will

e xpire in 32 mo nths.

20

SLIDE 21

PAYI NG F OR CONT I NUAT I ON COVE RAGE

Ma ximum a mo unt c ha rg e d c a nno t e xc e e d 102% o f c o st o f pla n

(100% o f pre miums plus 2% a dmin fe e )

11 mo nth disa b ility a llo ws fo r diffe re nt c a lc ula tio n
Ca n inc re a se c o st if pre miums a re inc re a se d (12 mo nths)
Mo st a llo w mo nthly pa yme nt; c a n a llo w we e kly o r q ua rte rly
E

le c tio n No tic e must o utline c o st o f pre miums, pa yme nt due da te (s), a nd c o nse q ue nc e s fo r pa yme nt a nd no npa yme nt

Must a llo w up to 45 da ys a fte r e le c tio n to ma ke pre mium

pa yme nts; if no t pa id a fte r 45 da ys c a n te rmina te c o ve ra g e

Minimum o f a 30 da y g ra c e pe rio d to ma ke pa yme nts
Ha ve to a llo w 30 da ys to c o rre c t insig nific a ntly inc o rre c t

pa yme nts ($50 o r 10%)

Co ve ra g e b e g ins the da te a fte r c o ve ra g e wa s lo st due to

q ua lifying e ve nt (pre miums due fro m tha t po int fo rwa rd)

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SLIDE 22

E ARL Y T E RMI NAT I ON

Ca n te rmina te b e fo re e nd o f ma ximum pe rio d o f

c o ve ra g e fo r fo llo wing re a so ns:

Pr

e miums not paid in full on a time ly basis

E

mplo ye r c e a se s to ma inta in a ny g ro up he a lth pla n

Qua lifie d b e ne fic ia ry b e g ins c o ve ra g e unde r a no the r

g ro up he a lth pla n a fte r e le c ting c o ntinua tio n c o ve ra g e

Qua lifie d b e ne fic ia ry b e c o me s e ntitle d to Me dic a re

b e ne fits a fte r e le c ting c o ntinua tio n c o ve ra g e

Qua lifie d b e ne fic ia ry e ng a g e s in c o nduc t tha t wo uld

justify the pla n te rmina ting c o ve ra g e o f a simila rly situa tio n pa rtic ipa nt o r b e ne fic ia ry no t re c e iving c o ntinua tio n o f c o ve ra g e (suc h a s fra ud)

Ha ve to pro vide no tic e o f E

a rly T e rmina tio n

22

SLIDE 23

SAMPL E COBRA NOT I CE OF E ARL Y T E RMI NAT I ON (PRE MI UM PAYME NT S ONL Y)

Re : COBRA Pre mium Pa yme nt
Da te : [to d a y’ s d a te ]
De a r [COBRA b e ne fic ia ry na me ],
Ac c o rd ing to o ur re c o rd s, yo u e le c te d COBRA c o ntinua tio n c o ve ra g e b e g inning [d a te ]. As sta te d o n

the e le c tio n fo rm yo u sub mitte d (c o py e nc lo se d ), yo u a re re q uire d to ma ke pe rio d ic pa yme nts in full fo r e a c h COBRA c o ve ra g e pe rio d . Altho ug h the se pe rio d ic pa yme nts a re d ue o n the first d a y o f the mo nth fo r tha t mo nth’ s c o ve ra g e , yo u ha ve a g ra c e pe rio d o f 30 d a ys a fte r the d a y o f the c o ve ra g e pe rio d to ma ke the pa yme nt. Yo ur c o ntinua tio n c o ve ra g e is pro vid e d fo r e a c h c o ve ra g e pe rio d a s lo ng a s pa yme nt is ma d e b e fo re the e nd o f the g ra c e pe rio d . If yo u fa il to ma ke a pe rio d ic pa yme nt b e fo re the e nd o f the g ra c e pe rio d fo r tha t c o ve ra g e pe rio d , yo u will lo se a ll rig hts to c o ntinua tio n c o ve ra g e und e r the pla n.

As o f this d a te , we ha ve no t re c e ive d yo ur COBRA pre mium pa yme nt fo r the mo nth o f [mo nth]. As

the g ra c e pe rio d o f 30 d a ys ha s e xpire d , ple a se a c c e pt this le tte r a s no tic e tha t yo ur COBRA c o ntinua tio n c o ve ra g e is te rmina te d a s o f [la st c o ve ra g e d a te fo r la st mo nth fo r whic h pa yme nt wa s re c e ive d ].

If yo u ha ve q ue stio ns, ple a se c a ll me a t [te le pho ne numb e r].
Sinc e re ly yo urs,
[Na me , T

itle ]

E

nc lo sure s

23

SLIDE 24

SAMPL E COBRA NOT I CE OF E ARL Y T E RMI NAT I ON (SE L E CT RE ASON)

[NOT

E : T his no tic e must be c usto mize d ac c o r ding to yo ur sc ho o l’s plan par tic ular s and the e mplo ye e s spe c ific situatio n. T he no tic e must e xplain the r e aso n c o ve r age has te r minate d, pr

vide the date o f te r

minatio n and de sc r ibe any r ights the qualifie d be ne fic iar y may have to e le c t alte r native gr

up o r

individual c o ve r age , suc h as a c o nve r sio n r ight (29 C.F .R. 2590.606-4(d)). T he time fo r pr

viding this no tic e is as so o n as

r e aso nably pr ac tic able fo llo wing the plan administr ato r s de te r minatio n that c o ntinuatio n c o ve r age will te r minate (69 F e d. Re g. 30090).Se e NOT E T O E MPL OYE R at the e nd o f this no tic e fo r additio nal info r matio n.]

[Da te o f No tic e ]
[E

mplo ye e , Spo use a nd Co ve re d De pe nde nts L a st kno wn ma iling a ddre ss]

T

his no tic e pe rta ins to yo ur COBRA c o ntinua tio n c o ve ra g e unde r [Na me o f the pla n(s) unde r whic h COBRA c o ve ra g e will te rmina te ]. I t is impo rta nt tha t a ll c o ve re d individua ls re a d this no tic e . Ple a se a dvise [Na me o f COBRA a dministra to r] imme dia te ly if the re is a c o ve re d de pe nde nt no t living a t the a b o ve a ddre ss.

Co ve ra g e unde r the pla n(s) na me d a b o ve c e a se d o r will c e a se o n [la st da y o f

c o ve ra g e ] fo r the fo llo wing individua ls:

[inse rt na me (s) o f q ua lifie d b e ne fic ia ry(ie s) who a re lo sing c o ve ra g e ]
COBRA c o ntinua tio n c o ve ra g e te rmina te d o r will te rmina te fo r the fo llo wing re a so n:

24

SLIDE 25

SAMPL E COBRA NOT I CE OF E ARL Y T E RMI NAT I ON (SE L E CT RE ASON CONT

I NUE D)

_____ A re q uire d pre mium wa s no t pa id in full o n time .
_____ A q ua lifie d b e ne fic ia ry b e c a me c o ve re d , a fte r e le c ting c o ntinua tio n c o ve ra g e , und e r a no the r

g ro up he a lth pla n tha t d o e s no t impo se a ny pre e xisting c o nd itio n e xc lusio n fo r a pre e xisting c o nd itio n

f the q ua lifie d b e ne fic ia ry.
_____ A c o ve re d e mplo ye e b e c a me e ntitle d to Me d ic a re b e ne fits (und e r Pa rt A, Pa rt B o r b o th) a fte r

e le c ting c o ntinua tio n c o ve ra g e .

_____ T

he e mplo ye r c e a se d to pro vid e a ny g ro up he a lth pla n fo r its e mplo ye e s.

_____ F
r c a use (i.e ., fra ud ): _______________________________________
[De sc rib e a ny rig hts the q ua lifie d b e ne fic ia ry ma y ha ve to e le c t a lte rna tive g ro up o r ind ivid ua l

c o ve ra g e , suc h a s a c o nve rsio n rig ht.]

If yo u b e lie ve tha t yo ur COBRA c o ve ra g e sho uld no t ha ve b e e n te rmina te d , yo u c a n re q ue st us to

re c o nsid e r o ur d e te rmina tio n b y filing a n a ppe a l a s fo llo ws:

1. Se nd a writte n a ppe a l to [Na me a nd Ad d re ss] within 30 d a ys o f yo ur re c e ipt o f this no tic e .
2. E

xpla in why yo u b e lie ve yo ur COBRA c o ntinua tio n c o ve ra g e wa s impro pe rly te rmina te d a nd inc lud e a ll info rma tio n yo u wish to b e re vie we d . Be sure to inc lude yo ur na me , c urre nt a d d re ss a nd the na me s o f a ny c o ve re d d e pe nd e nts yo u wish to inc lud e in yo ur a ppe a l.

If yo u ha ve a ny q ue stio ns re g a rd ing the info rma tio n in this no tic e , yo u sho uld c o nta c t:
[Na me o f COBRA a d ministra to r, T

e le pho ne Numb e r a nd Ad d re ss].

Sinc e re ly,

25

SLIDE 26

NOT I CE OF I NE L I GI BI L I T Y

COBRA No tic e o f Una va ila b ility o f Co ntinua tio n o f

Co ve ra g e

I

ne lig ib le o r De nia l o f Co ve ra g e

26

SLIDE 27

SAMPL E NOT I CE OF UNAVAI L ABI L I T Y OF CONT I NUAT I ON COVE RAGE

NOT

E : T his no tic e must be c usto mize d ac c o r ding to yo ur sc ho o l’s plan par tic ular s and the e mplo ye e s spe c ific situatio n. T he no tic e must e xplain why an individual is no t e ntitle d to c o ntinuatio n o f c o ve r age (29 C.F .R. 2590.606-4(c )). T he plan administr ato r must pr

vide the no tic e within 14 days afte r

r e c e iving a no tic e o f qualifying e ve nt fr

m a par

tic ipant, be ne fic iar y o r

the r

individual (29 C.F .R. 2590.606- 4(b)(2)).

[Da te o f No tic e ]
[E

mplo ye e , Spo use a nd Co ve re d De pe nd e nts L a st kno wn ma iling a d d re ss]

De a r [Na me ],
It is impo rta nt tha t a ll c o ve re d ind ivid ua ls re a d this no tic e . Ple a se a d vise [Na me o f COBRA

a d ministra to r] imme d ia te ly if the re is a c o ve re d d e pe nd e nt no t living a t the a b o ve a d d re ss.

E

ffe c tive o n [d a te c o ve ra g e c e a se s] yo u a re no lo ng e r c o ve re d b y the e mplo ye r-spo nso re d [Co ve ra g e / Pla n Na me ] pla n. T

his me ans c laims for se r vic e on or afte r this date will not be paid.

Yo ur lo ss o f c o ve ra g e is a re sult o f [e ve nt] o n [e ve nt d a te ]. Und e r COBRA, so me e ve nts a nd

sub se q ue nt lo ss o f c o ve ra g e e ntitle yo u to c o ntinue yo ur c o ve ra g e und e r this pla n. Ho we ve r, g ive n the c irc umsta nc e s yo u d e sc rib e d a nd a ny d o c ume nta tio n yo u ma y ha ve pro vid e d , [Co mpa ny Na me ] ha s d e te rmine d tha t COBRA is una va ila b le to yo u a nd yo ur c o ve re d d e pe nd e nts b e c a use :

[inse rt d e sc riptio n o f re a so n fo r una va ila b ility o f COBRA c o ve ra g e ]
If yo u ha ve q ue stio ns o r wish to a ppe a l this d e c isio n, ple a se c o nta c t [COBRA a d ministra to rs na me

a nd c o nta c t info rma tio n] fo r a ssista nc e .

Sinc e re ly,
[Na me ]

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SLIDE 28

SUMMARY OF T I ME L I NE S

Notic e or

the r

Re quir e me nt T ime line

BDD/ COC At hire , o pe n e nro llme nt o r upo n re q ue st Ge ne ra l No tic e 1st 90 da ys o f c o ve ra g e Qua lifying E ve nt E R: 30 da ys to te ll T PA E E : As de fine d b y the Pla n E le c tio n No tic e T PA: 14 da ys fro m no tic e E R: 44 da ys to ta l (no tic e o f e ve nt & se nding e le c tio n no tic e ) E le c tio n o f Co ve ra g e 60 da ys to e le c t; 45 da ys fo r 1st pa yme nt; 30 da ys g ra c e pe rio d 2nd Qua lifying E ve nt As so o n a s pra c tic a b le E a rly T e rmina tio n No tic e As so o n a s pra c tic a b le I ne lig ib ility No tic e 14 da ys

28

SLIDE 29

SUMMARY OF ST E PS

Ste p Whe n

I ssue BDD/ COC At hire , o pe n e nro llme nt o r upo n re q ue st I ssue Ge ne ra l No tic e 1st 90 da ys o f c o ve ra g e T

E

mplo ye e AND q ua lifie d b e ne fic ia rie s (spo use / de pe nde nts) No tic e o f Qua lifying E ve nt Pre pa re a nd I ssue E le c tio n No tic e T e rmina te o r Cha ng e E nro llme nt due to Qua lifying E ve nt Yo u c a n a lwa ys a dd b a c k o n a fte r COBRA e le c tio n is kno wn Do NOT a ntic ipa te wha t the y ma y o r ma y no t do ! Pro c e ss the E le c tio n F

rm

Re -e nro ll; (F

r a n e x-spo use e nro ll in sing le ;

e mplo ye r do e s no t pa y a po rtio n o f the pre miums. E mplo ye e e x-spo use c a nno t pa y pre miums thro ug h pre ta x de duc tio n T ra c k Pa yme nts 45 da ys fro m e le c tio n; 30 da y g ra c e pe rio d No tify o f Ope n E nro llme nt Sa me o ppo rtunity a s a c tive e mplo ye e s T e rmina te fro m pla n E nd o f COBRA Pe rio d o r E a rly T e rmina tio n

29

SLIDE 30

SUGGE ST E D NOT I CE ME T HODS & MAI NT AI N GOOD F AI T H ST AT US

Ma il to E

mplo ye e a nd F a mily

Use 1st c la ss ma il a nd ke e p a lo g o f le tte rs se nt OR
Ob ta in a Ce rtific a te o f Ma iling
Do no t use re turn re c e ipts – pro o f no t re c e ive d
T

he q ua lify fo r g o o d fa ith use o f DOL fo rms, yo u must inc lude a nd pe rso na lize the no tic e fo r yo ur distric t’ s use

Alwa ys re me mb e r to pe rso na lize sa mple s to ma tc h

yo ur sc ho o l’ s pro c e dure s

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SLIDE 31

RE CORD K E E PI NG RE QUI RE ME NT S

COBRA re g ula tio ns do no t spe c ify a ma nda to ry re c o rd-

ke e ping pe rio d fo r COBRA-re la te d no tic e s a nd c o rre spo nde nc e with e mplo ye e s.

Re c o mme nda tio n is to ke e p me dic a l re c o rds a t le a st

six ye a rs

Re c o rds wo uld inc lude :
Writte n no tic e to e mplo ye e a nd the ir de pe nde nts o f the ir
ptio n to c o ntinue g ro up he a lth pla n c o ve ra g e fo llo wing

q ua lifying e ve nts

With issue s a ro und c o ntinuing c o ve ra g e yo u will wa nt to

b e a b le to do c ume nt no tic e wa s se nt

Wha t a b o ut re c o rds o f pa yme nts?

31

SLIDE 32

RE SOURCE S

VE

HI Re so urc e s:

http:/ / ve hi.o rg / b e ne fits/ na vig a ting -2018-he a lth-

pla ns/ e mplo ye r-na vig a tio n/ c o b ra /

No tifying Ne w E

mplo ye e s Ab o ut the E xc ha ng e

http:/ / ve hi.o rg / b e ne fits/ na vig a ting -2018-he a lth-

pla ns/ e mplo ye r-na vig a tio n/ a dditio na l-re so urc e s/

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