An 18-month period of COBRA
may be extended to 36 months for the affected qualified beneficiary (spouse or
child), if one of the 36-month period qualifying events occurs during the first
18 months of COBRA. In no event will COBRA extend beyond 36 months from the date
coverage was first lost due to the initial qualifying event. This extension
applies only if the qualified beneficiary notifies the plan administrator in
writing within 60 days of the second qualifying event. The notice must identify
the qualifying event that occurred. In the absence of such notice, COBRA will
terminate.
If you have an 18-month
qualifying event after becoming entitled to Medicare, your dependents may
continue COBRA until the later of:
- 18
months from the date coverage would normally end due to the termination of
employment or reduction in hours; or
- 36
months from the date you become entitled to
Medicare.
Notice
Requirements
The plan offers COBRA only
after it has been notified of a qualifying event. A qualified beneficiary is
responsible for notifying the plan administrator of a qualifying event that is a
divorce, legal separation, or child losing dependent status.
The
qualified beneficiary must provide this notice to the plan administrator in
writing within 60 days of the later of the date of the qualifying event; the
date coverage would be terminated as a result of the qualifying event; or the
date this booklet or other notice is provided of the procedure for electing
COBRA.
The notice must identify the
individual who has experienced a qualifying event, the employee’s name,
and the qualifying event which occurred. If the plan administrator is not
notified during the 60-day period, the qualified beneficiary will lose the right
to elect COBRA.
If a child is born to,
adopted by, or placed for adoption with you during a period of COBRA, you must
notify the plan administrator in writing within 30 days of the birth, adoption
or placement for adoption, and provide a copy of the child’s birth
certificate or adoption papers. If the plan administrator is not notified, the
child will lose the right to receive COBRA.
In
order to qualify for a Social Security disability extension, the qualified
beneficiary must notify the plan administrator in writing within 60 days after
the latest of: the date of the Social Security determination; the date on which
the qualifying event occurs; the date coverage would be terminated as a result
of the qualifying event; or the date this booklet or other notice is provided
describing the procedures for electing COBRA. In any case, the notice of the
Social Security determination must be provided before expiration of the initial
18 months of COBRA. A copy of the Social Security determination must be included
with the written notice. Thereafter, if there is a final determination by Social
Security that the individual is no longer disabled, the qualified beneficiary
must notify the plan administrator in writing within 30 days of the
determination.
A qualified beneficiary who
first becomes, after the date of the election of COBRA, covered under any other
group health plan, must notify the plan administrator in writing of the other
coverage.
The plan administrator will
notify qualified beneficiaries of loss of coverage due to termination of
employment, reduction in work hours, or the employee’s death. However, you
are encouraged to inform the plan administrator of any qualifying event to best
ensure prompt handling of your COBRA rights.
Election
of COBRA
When the plan administrator
is notified of a qualifying event, an election form is mailed to the qualified
beneficiaries. The election form must be completed and returned to the plan
administrator within 60 days of the later of the termination of coverage, or the
date the application was sent. If the election form is not sent to the plan
administrator by this date, the qualified beneficiaries will lose the right to
elect COBRA.
Each qualified beneficiary
has an independent right to elect COBRA. An employee or spouse may elect COBRA
on behalf of other qualified beneficiaries in the family. A parent or legal
guardian may elect COBRA on behalf of a minor child.
Type
of Benefits
Under COBRA, a qualified
beneficiary may continue medical, prescription drug, dental, and vision
coverage, provided the qualified beneficiary was eligible for such benefits
immediately prior to the qualifying event. Life insurance, accidental death and
dismemberment benefits, and time loss benefits are not available under
COBRA.
Cost
and Payment
There is a cost for COBRA.
Information regarding the cost will be sent with the election forms. The first
payment is due 45 days from the date the election form is sent to the plan
administrator. The first payment must cover all months since the date coverage
would have otherwise terminated. Thereafter, payments must be made monthly to
continue COBRA. All payments must be sent to the plan
administrator.
COBRA eligibility will not
commence, nor will claims be processed for expenses incurred following the date
of the qualifying event, until the appropriate COBRA payments have been made.
COBRA terminates if a monthly payment is made later than 30 days from the
beginning of the month to be covered. If the initial payment, or any subsequent
payment is not made in a timely fashion, COBRA terminates.
Termination
of COBRA
COBRA ends on the first of
the dates indicated below:
- The
last day of the month the maximum coverage period for the qualifying event has
ended (18, 29, or 36 months).
- The
last date for which the self-payment was paid, or when the qualified beneficiary
does not make the next payment in full when due. Payments must be made within 30
days of the due date.
- The
date the qualified beneficiary first becomes, after the date of election of
COBRA, covered under any other group
health plan which does not contain any exclusion or limitation that actually
applies to any preexisting condition of the qualified beneficiary.
- The
date the qualified beneficiary becomes entitled to Medicare after the date of
election of COBRA.
- The
last day of the month that begins more than 30 days from the final determination
that the qualified beneficiary is no longer disabled as determined by Social Security.
This applies only to the 19th through 29th month of disability extended
COBRA.
- The
date the Trust no longer provides group health coverage or the date the
employee’s employer no longer participates in the plan, unless the
employer or its successor does not offer another health plan for any
classification of its employees which formerly participated in the
Trust.
COBRA
is provided subject to eligibility. The plan reserves the right to terminate
COBRA retroactively if the qualified beneficiary is determined to be ineligible
for coverage.
Notices
Notices and self-payments
that are required for COBRA must be sent in writing to the plan administrator at
the following address:
Enrollment
Department
Carpenters Health and
Security Trust of
Western
Washington
PO Box
1929
Seattle, WA
98111-1929
If you have any questions
about continuation coverage, please contact the plan administrator.
Election
of Alternative Coverage In Lieu of COBRA
An individual who is eligible
may elect one of the following alternative coverage options in lieu of COBRA
Continuation Coverage:
- Extension
of Benefits. If you or a dependent are
totally disabled when coverage under the Employed Plan terminates, the disabled
individual can apply for an Extension of Benefits. An Extension of Benefits
provides continued coverage for the disabled individual but only for treatment
of the condition that caused the disability. An Extension of Benefits continues
for a period not to exceed 12 months but ends earlier if the disabled individual
is no longer considered totally disabled. If you elect an Extension of Benefits
in lieu of COBRA Continuation Coverage, you may not elect COBRA when the
Extension of Benefits terminates. Please contact the Trust Office for an
Extension of Benefits Application.
- Self-Contribution
Coverage. You may elect COBRA Continuation
Coverage when Self-Contribution Coverage terminates. Total coverage under
Self-Contribution Coverage and COBRA may not exceed 18 months, or 36 months in
the case of a qualified beneficiary (spouse or dependent child) who has a second
qualifying event.
- Carpenters
Health and Security Plan – For Retired
Carpenters. If you elect COBRA
Continuation Coverage in lieu of the Retired Plan, you may later enroll in the
Retired Plan, but only if you first exhaust the maximum coverage period under
COBRA, and you complete a
Notice To Decline
Coverage Agreement at the time you elect COBRA.
- Self-Contribution
Coverage Following Entry Into the Uniformed Services
(USERRA). If you elect Self-Contribution
Coverage upon entry into the uniformed services, COBRA Continuation Coverage may
be elected following termination of Self-Contribution Coverage. Total coverage
under Self-Contribution Coverage and COBRA may not exceed 24 months, or 36
months in the case of a qualified beneficiary (spouse or dependent child) who
has a second qualifying event.
- Family
Medical Leave Act (FMLA). COBRA
Continuation Coverage may be elected following termination of leave under
FMLA.
- Conversion
Coverage. There is no conversion option
for the medical, prescription drug, dental, or vision coverage provided by the
plan.
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 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. (Addresses and phone numbers of Regional and
District EBSA Offices are available through EBSA’s website.)
Keep
Your Plan Informed of Address Changes
In order to protect your
family’s rights, you should keep the plan administrator 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 the plan administrator.
Plan
Contact Information
Enrollment
Department
Carpenters Health and
Security Trust of
Western
Washington
PO Box
1929
Seattle, WA
98111-1929
(206) 441-6514 Seattle
Area
(800) 552-0635
Nationwide
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