Reso 2010-1529 - Laserfiche WebLink

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f) ) 8.04 q ) Continuation Coverage under COBRA. Under certain provisions of COBRA, the Subscriber or his Dependents may elect continued coverage under the Plan if coverage is lost due to a qualifying event. 8.04.01 Eligibility. You or your covered Dependents will become eligible for continuation coverage under COBRA after any of the following qualifying events result in the loss of Plan coverage: a) Loss of benefits due to a reduction in your hours of employment; b) Termination of your employment, inclnding retirement but excluding termination for gross misconduct; c) Termination of employment following leave under the Family and Medical Leave Act of 1993 (FMLA), in which case the qualifying event will occur on the earlier of the date you indicated you were not retuming to work or the last day of the FMLA leave; d) You or a Dependent first become entitled to Medicare or covered under another group health plan prior to your loss of coverage due to termination of employment or reduction in hours. 8.04.02 8.04.03 e) In addition, your Dependents will become eligible for COBRA continuation coverage after any of the following qualifying events occur to cause a loss of Plan coverage: 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 Dcpendent under the Plan. l) A child who is bom 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. 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 fonn. 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 entitlement 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 reccived 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 retumed 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. 18 A V-CHOlCE-2009 MP-5320 (10/09)