COBRA Administered by WEX Health
COBRA Continuation Coverage
When COBRA Coverage Is Available
Your Requirement To Give SDSU Research Foundation Notice
How Long does COBRA Last?
Disability Extension of 18-month period of continuation coverage
Second Qualifying Event Extension
California CAL-COBRA Extension Under AB 1401
How to Elect Continued Coverage
Cost of Continued Coverage
When Continued Coverage Stops
Modification of Benefits
The Trade Act of 2002
Other Coverage Options
If You Have Questions
Keep your Plan Informed of Address Changes
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 the 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 and to other members of your family who are covered under the Plan when you would otherwise lose your group health coverage. This notice only gives a summary of your COBRA continuation coverage rights. For more information about your rights and obligations under the Plan and under federal law, you should either review the Plan's Summary Plan Description or get a copy of the Plan Document from the Plan Administrator.
The Plan Administrator is SDSU Research Foundation, 5250 Campanile Drive, San Diego, CA 921821945, 6195944139, www.foundation.sdsu.edu.
COBRA continuation coverage for the Plan is administered by WEX Health, P.O. Box 2926,Fargo, ND 58108-2926, 866–451–3399, www.wexinc.com.
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. A qualified beneficiary is someone who will lose coverage under the Plan because of a qualifying event. Depending on the type of qualifying event, employees, spouses or domestic partners of employees, and dependent children of employees or a domestic partner may be qualified beneficiaries. 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 will lose your coverage under the Plan because 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, or
- Your unpaid FMLAeligible leave of absence ends
If you are the spouse or domestic partner of an employee, you will become a qualified beneficiary if you will lose your coverage under the Plan because any of the following qualifying events happens:
- Your spouse or domestic partner dies
- Your spouse's or domestic partner's hours of employment are reduced;
- Your spouse's or domestic partner's employment ends for any reason other than his or her gross misconduct;
- Your spouse or domestic partner becomes enrolled in Medicare (Part A, Part B, or both); or
- You become divorced or legally separated from your spouse. Also, if your spouse (the employee) reduces or eliminates your group health coverage in anticipation of divorce or legal separation, and a divorce or legal separation later occurs, then the marital status change may be considered a qualifying event for you, even though your coverage was reduced or eliminated before the divorce.
- Your domestic partnership ends.
Your or your domestic partner's dependent children will become qualified beneficiaries if they will lose coverage under the Plan because any of the following qualifying events happens:
- The parentemployee dies;
- The parentemployee's hours of employment are reduced;
- The parentemployee's employment ends for any reason other than his or her gross misconduct;
- The parentemployee becomes enrolled in Medicare (Part A, Part B, or both);
- The parents become divorced, legally separated, or the domestic partnership ends; or
- The child stops being eligible for coverage under the plan as a dependent child.
Children born to or adopted by a qualified beneficiary during a period of COBRA coverage are also considered qualified beneficiaries.
Sometimes, filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event. If a proceeding in bankruptcy is filed with respect to SDSU Research Foundation, and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan, the retired employee is a qualified beneficiary with respect to the bankruptcy. The retired employee's spouse, surviving spouse, or domestic partner will also be a qualified beneficiary if bankruptcy results in the loss of their coverage under the Plan.
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, commencement of a proceeding in bankruptcy with respect to the employer, or enrollment of the employee in Medicare (Part A, Part B, or both), you will not need to notify SDSU Research Foundation of the qualifying event.
For the other qualifying events (divorce or legal separation of the employee and spouse, or end of domestic partnership, or a dependent child's losing eligibility for coverage as a dependent child), you must notify SDSU Research Foundation. The Plan requires you to notify SDSU Research Foundation within 60 days after the qualifying event occurs. You must send this notice to SDSU Research Foundation, Human Resources. Failure to provide this notice within the 60 days means that you may not be offered COBRA continuation coverage.
Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouse, or domestic partner, and parents may elect COBRA continuation coverage on behalf of their children. For each qualified beneficiary who elects COBRA continuation coverage, COBRA continuation coverage will begin on the date that Plan coverage would otherwise have been lost.
COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, enrollment of the employee in Medicare (Part A, Part B, or both), your divorce or legal separation or the end of the domestic partnership, or a dependent child losing eligibility as a dependent child, COBRA continuation coverage lasts for up to 36 months.
When the qualifying event is the end of employment or reduction of the employee's hours of employment, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). 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, however, in which this 18month period of COBRA continuation coverage can be extended.
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 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 18month period of continuation coverage. You must notify the COBRA Plan Administrator in writing of the Social Security Administration's determination within 60 days of the date of the determination and before the end of the 18month period of COBRA continuation coverage. Failure to provide this notice within the 60 days means that you may not be offered the COBRA disability extension.
If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, the spouse or domestic partner, and dependent children in your family can get 18 additional months of COBRA continuation coverage, up to a maximum of 36 months, if notice of the second qualifying event is properly given to the Plan. This extension maybe available to the spouse or domestic partner, and dependent children if the employee or former employee dies, becomes entitled to Medicare (Part A, Part B, or both), or gets divorced, legally separated, or the domestic partnership ends. The extension is also available to a dependent child when that child stops being eligible under the Plan as a dependent child. These extensions are only available if the event would have caused the spouse, domestic partner, or dependent child(ren) to lose coverage under the plan had the first qualifying event not occurred. In all of these cases, you must make sure that the Plan Administrator is notified of the second qualifying event within 60 days of the second qualifying event and before the end of the 18month period of COBRA continuation coverage. This notice must be sent to the COBRA Plan Administrator. Failure to provide this notice within the 60 days means that you may not be offered the COBRA extension.
California law may require health insurers to offer specified individuals who begin receiving continuation coverage on or after January 1, 2003, and who have exhausted their continuation coverage under federal continuation coverage an opportunity to extend the term of their coverage to 36 months. Contact your health plan insurer for more information on this extension.
When coverage terminates and you are eligible for COBRA, you will receive notification of your options from WEX Health. You must complete and return the COBRA Election Form within 60 days of your Qualifying Event date or the date the Election Notice is provided to you, whichever is later, in order to keep your coverage. If you and/or a covered dependent (or dependents) elect to continue coverage, you must pay the monthly premium required for the elected coverage retroactive to the date your active coverage ended. Payment of your retroactive amounts must be postmarked within 45 days of your COBRA election. For each Qualified Beneficiary who elects COBRA coverage, COBRA continuation coverage will begin on the date that Plan coverage would otherwise have been lost. Your coverage will become active upon receipt of payment.
You may reduce your coverage level or drop your coverage at any time. However, you may add dependents only when you have a qualified change in status (birth or adoption of a child; marriage; gain or loss of coverage by eligible dependent). You must also provide any address change, as this may affect the coverage available to you. You must notify the COBRA Plan Administrator in writing of the change in status or address within 31 days of the change. Failure to provide this notice within the 31 days means that you may be prevented from making changes in your coverage.
In considering whether to elect continuation coverage, you should take into account that a failure to continue your group health coverage will affect your future rights under federal law. First, you can lose the right to avoid having preexisting condition exclusions applied to you by other group health plans if you have more than a 63day gap in health coverage, and election of continuation coverage may help you not have such a gap. Second, you will lose the guaranteed right to purchase individual health insurance policies that do not impose such preexisting condition exclusions if you do not get continuation coverage for the maximum time available to you. Finally, you should take into account that you have special enrollment rights under federal law. You have the right to request special enrollment in another group health plan for which you are otherwise eligible (such as a plan sponsored by your spouse's employer) within 30 days after your group health plan ends because of the qualifying event listed above. You will also have the same special enrollment right at the end of continuation coverage if you get continuation coverage for the maximum time available to you.
Under the Plan, Qualified Beneficiaries who elect COBRA continuation coverage must pay for that coverage. COBRA participants pay both the employer and employee portions of the cost of coverage. The cost for COBRA coverage during the 18month or 36month period may not exceed 102% of the entire cost of the coverage for a similarly situated plan participant who is not receiving continuation coverage. If a Qualified Beneficiary is eligible for the disability extension, during the additional 11 months of continuation coverage the cost for that coverage may be approximately 150% of the active employee rates. The current monthly costs for coverage will be given to you when you have a Qualifying Event. Those costs are subject to change. Please note the following:
- In most situations, when you or a family member loses SDSURF paid group coverage, a COBRA election notice will automatically be sent to you.
- The monthly cost for the first 18 months is 102% of the applicable monthly premium.
- If you become eligible for COBRA you may be eligible for an extension of health only coverage beyond the initial 18 months. The monthly cost during the extension is 110% of the applicable monthly premium.
- Within 60 days of your COBRA coverage, if you are disabled as determined by the Social Security Administration, you may qualify for an extension of coverage beyond the initial 18 months. The monthly cost for months 19 through 29 is up to 150% of the applicable monthly premium.
- Monthly rates are subject to change every January 1.
- If you are enrolled in Kaiser or Cigna HMO and move outside the service area but within the U.S., you will be enrolled in Aetna's OAP (PPO) plan, and the PPO rates will apply to you.
- If you move outside of the U.S., COBRA coverage will not be available to you. Contact HR at email@example.com for alternate coverage options.
- For more information on COBRA, contact Human Resources at firstname.lastname@example.org.
The continued coverage will stop for any person either at the end of the applicable period, or earlier when:
- the cost of continued coverage is not paid within the 30day grace period; or
- that person becomes entitled to Medicare (Part A, Part B, or both); or
- that person becomes covered under another group health plan, unless that other plan contains an exclusion or limitation with respect to any preexisting condition affecting you or a covered dependent (in this case, coverage will cease when the preexisting condition exclusion period has been satisfied); or
- a disabled person is no longer disabled during the 11month extension period, or
- the Plan terminates for all employees, or
- SDSU Research Foundation or the COBRA Plan Administrator becomes aware that a qualified beneficiary submitted a false claim.
If any of these occurs, you must notify WEX Health immediately at 8664513399.
Failure to pay your monthly premiums within the grace period of 30 days will result in loss of coverage. Payment must be postmarked within the month in which it is due. Checks returned for insufficient funds or checks that otherwise cannot be cashed do not constitute payment. Once coverage is lost, it cannot be reinstated.
COBRA continuation coverage will be the same health coverage you and/or your dependents would have been entitled to if your employment (or his/her dependent status) had not changed. SDSU Research Foundation reserves the right to eliminate or modify benefits offered under its health plan. If a health plan is replaced, COBRA continuation coverage will continue under any succeeding arrangement.
The Trade Act of 2002 created a new tax credit for certain individuals who become eligible for trade adjustment assistance (eligible individuals). This was updated on October 21, 2011 by the Trade Adjustment Assistance Extension Act of 2011. Under the new tax provisions, eligible individuals can either take a tax credit or get advance payment of 72.5% of premiums paid for qualified health insurance, including continuation coverage. You must contact the Plan Administrator promptly after qualifying for assistance under the Trade Act or you may lose these special COBRA rights. More information about the Trade Act can be found by visiting www.doleta.gov/tradeact/ or www.irs.gov/HCTC, or by contacting the Plan Administrator.
Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.
If you have questions about your COBRA continuation coverage, you should contact WEX Health, P.O. Box 2926, Fargo, ND 58108-2926, 8664513399. 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 or call their toll-free number at 866-444-3272. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA's website.)
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.
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