Iowa Cobra Insurance

iowa

Continuation Coverage Rights Under Cobra

 

Introduction

 

You are receiving this notice because you have recently become covered under the State’s group health 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 your right to receive it.

 

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.

 

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. (For more information see the American Recovery and Reinvestment Act of 2009 (ARRA) below)

 

If you are the spouse of an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because any of the following qualifying events happen:

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 and elects Medicare benefits to be primary while still working (under 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 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 and elects Medicare benefits to be primary while still working (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.”

 

American Recovery and Reinvestment Act of 2009 (ARRA)

 

The American Recovery and Reinvestment Act of 2009 (ARRA) was signed by President Obama on February 17, 2009. A portion of this new legislation makes changes in COBRA continuation rights for persons who are involuntarily terminated from employment.

Employees who are involuntarily terminated from employment between September 1, 2008 and December 31, 2009 may be eligible for a reduced COBRA premium for up to nine months. If eligible, the former employee will be considered an Assistance Eligible Employee (AEI) and will be required to pay just 35% of the total premium for COBRA continuation coverage and the State will pay the other 65%. After the nine month subsidy, the former employee may continue COBRA coverage for the rest of the 18 month time period by paying the full premium.

An AEI MUST:

Have left employment due to an involuntary termination (dismissed or laid off); AND

NOT be eligible for coverage under any other group health or dental plan; AND

NOT be eligible for Medicare.

 

In addition an AEI who elects to continue COBRA coverage must notify the plan in writing if they become eligible for other group health coverage of Medicare. Failure to do so may result in a tax penalty for the AEI.

 

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, or the employee’s becoming entitled to and elects Medicare benefits to be primary while still working (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 the Plan Administrator within 60 days the qualifying event occurs. You must provide this notice to your department’s personnel assistant.

 

How is COBRA Coverage Provided?

 

Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA 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. When the qualifying event is the death of the employee, the employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both), your divorce or legal separation, or a dependent child’s losing eligibility as a dependent child, COBRA continuation coverage lasts for up to a total of 36 months. When the qualifying event is the end of employment or reduction of the employee’s hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement.

Otherwise, when the qualifying event is the end of employment or reduction of the employee’s hours of employment, COBRA continuation coverage generally lasts for only up to a total of 18 months. There are two ways in which this 18-month period of COBRA continuation coverage can be extended.

 

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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 (Department of Administrative Services-HRE) 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.

 

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.

 

If You Have Questions

 

Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to your department’s personnel assistant. For more information about your rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), 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.

 

Keep Your Plan Informed of Address Changes

 

In order to protect your family’s rights, you should keep your personnel assistant 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 your personnel assistant.

 

 

Name of Entity/Sender: State of Iowa, Department of Administrative Services

Contact–Position/Office: Rose Baughman

Address: Hoover State Office Building, Level A

1305 E. Walnut St., Des Moines, IA 50319-0150

Phone Number: 515-281-8989

 

If you leave state employment, the federal Consolidated Omnibus Budget Reconciliation Act (COBRA) provides for continuation of health benefits coverage after your coverage with the state ends. However, certain events must occur for any persons covered under your contract to be eligible.

COBRA Qualifying Events

Maximum Eligibility Period Beyond Termination

Employee Termination/ Resignation The employee and covered   dependents have 18 months of COBRA eligibility. If the employee meets the   Social Security Administration’s definition of disabled at any time during   the first 60 days of COBRA coverage, the employee and covered dependents have   29 months of COBRA eligibility.
Death or Divorce of Employee The covered dependents have 36   months of COBRA eligibility.
Employee Reduces Work Hours; No   Longer Eligible for Coverage The employee and covered   dependents have 18 months of COBRA eligibility.
Employee’s Dependent No Longer   Eligible (Over age 26, full-time student over age 26 and marries or   graduates) The covered dependent has 36   months of COBRA eligibility.
Employee on Active Military Duty The employee and covered   dependents have 24 months of COBRA eligibility.

The State’s share of the premium payment for health and dental benefits will cease at the end of the month in which the qualifying events occurs, and you will be responsible for full payment of the premium.

COBRA coverage begins the first of the month following the qualifying event. The COBRA election period is 60 days after the later of:

  • the date      coverage would otherwise end, or
  • the date      of the COBRA Notification/Election Form.

If your employment ends, DAS will mail a COBRA Notification/ Election Form to you within two weeks following your last paycheck. The notification includes monthly benefit costs and election instructions. In the event of the death of an active employee, the family will receive notice of their COBRA rights. If an employee divorces, reduces hours, or has a dependent that is no longer eligible for coverage, the employee must notify his or her Personnel Assistant within 60 days following the event so that the personnel assistant can send the COBRA information.

NOTE: COBRA rights will not be extended to a Domestic Partner or his/her children, if the relationship terminates, if the employee terminates from state employment, or if the domestic partner’s children have an event that makes them ineligible for employee’s plan.

For More Information:

For questions regarding your particular plan please contact your personnel assistant