Reso 2010-1529 - Laserfiche WebLink

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I ) Your death; 2) Your divorce or legal separation; 3) You first become entitled to Medicare after your loss of coverage due to termination of employment or reduction in hours; or 4) Your Dependent child no longer qualifies as a Dependent under the Plan. t) A child who is born to (or placed for adoption) with a covered former employee during the continuation coverage period has the same continuation coverage rights as a Dependent child described above. 9.04.02 Notification. If a qualifying event other than divorce, legal separation, loss of Dependent status or entitlement to Medicare occurs, the Plan Administrator will be notified of the qualifying event by your employer and will send you an election form. To continue Plan coverage, you must return the election form within 60 days from the later of the date you receive the form, or the date your coverage ends due to a qualifying event. a) If divorce, legal separation, loss of Dependent status or entitlernent to Medicare under the Plan occurs, you or your covered Dependent must notify the Plan Administrator that a qualifying event has occurred. This notification must be received by the Plan Administrator within 60 days after the later of the date of such event, or the date you or your eligible Dependent would lose coverage on account of such event. Failure to promptly notify the Plan Administrator of these events will result in loss of the right to continue coverage for you and your Dependents. b) After receiving this notice, the Plan Administrator will send you an election form within 14 days. If you or your Dependents wish to elect continuation coverage, the election form must be returned to the Plan Administrator within 60 days from the later of the date you receive the form or the date your coverage ends due to the qualifying event. Cost. If you elect to continue coverage, you must pay the entire cost of coverage (the employer's contribution and the active employee portion of the contribution), plus a 2% administrative fee for the duration of COBRA continuation coverage. f) ) () ) 9.04.03 9.04.04 A V -01 00-2009 MP-5319 (10/09) a) If you or your Dependent is Social Security disabled (Social Security disability status rnust occur as defined by Title 11 or Title XVI of the Social Security Act), you may elect to continue coverage for the disabled person only or for some or all of COBRA eligible family members for up to 29 months if your employment is terminated or your hours are reduced. You must pay 102% of the cost of coverage for the first 18 months of COBRA continuation coverage and 150% of the cost of coverage for the 19th through the 29th months of coverage. The Social Security disability date must occur within the first 60 days of loss of coverage due to your termination of employment or reduction in hours. b) For COBRA coverage to remain in effect, payment must be received by the Plan Administrator by the fmt day of the month for which the premium is due. (Your first payrnent is due no later than 45 days after your election to continue coverage, and it must cover the period of time back to the first day of your COBRA continuation coverage). Duration. COBRA Continuation Coverage can be extended for: a) 18 months if coverage ended due to a reduction in your work hours or termination of your employment and you or one of your covered Dependents is not Social Security disabled within 60 days of the date you lose coverage due to termination of employment 18