Health and Welfare Plan BenefitTabs™
Continuation coverage applies to participants who lose coverage due to a variety of circumstances. The choice of programs available, the cost, and the length of time that coverage depend on the reason you (or your dependents) have lost coverage as an Active Member.
The "Direct Self-Pay" option has been eliminated from the Plan as a stand-alone option for continuation coverage. Instead, the trustees have incorporated this benefit into the changes made to your COBRA rights, which will allow you to maintain continuous coverage by making direct payments to the plan through COBRA (see COBRA Continuation Coverage below).
Temporary Disability Coverage
If you become disabled while an Active Member coverage is in force, you may be eligible to qualify for this continued coverage provided that you meet the following criteria:
- you are unable to perform the duties of your regular occupation covered under the bargaining agreement, and
- your disability continues for a period of 30 days, and
- you submit an application within 90 days of the date you become disabled.
The maximum period of coverage under this provision is 12 months but may be less depending on the number of months you are eligible within the twelve months immediately preceding the date our hourbank runs out. If you become disabled while hour bank coverage is in force, it is possible that you may combine COBRA and 6 months of temporary disability coverage for a maximum of 24 months.
If you recover from your disability within the 12 month maximum, in order that you have time to regain your covered status as an Active Member, temporary disability coverage may be extended for up to 3 months following the month of recovery, provided you are registered for immediate employment, and coverage does not extend beyond 12 months.
Effective 8/1/11: the monthly copayment is $145 per month for both new applicants and currently eligible participants.
Family Medical Leave
Certain participants may be eligible for Family Medical Leave in accordance with Federal law. This continuation coverage can be triggered by birth, adoption, or having to care for a seriously ill member of your immediate family.
If you are an Active Member and are called to active duty, you may qualify for continuation coverage for a limited period of time under the Uniformed Services Employment and Reemployment Rights Act of 1994 ("USERRA") similar to the COBRA coverage described below. You may also elect to freeze your hour bank until you have completed your tour of active duty. See the SPD for complete details, or read the USERRA Notice.
- COBRA Continuation Coverage
COBRA in General
A law known as COBRA allows a participant and/or family to self-pay for continued coverage under a set of defined "Qualifying Events". Participants must apply and make monthly self-payments in strict compliance with the rules in order to be covered under the COBRA provision. Medical, prescription, dental, and vision benefits only can be continued under COBRA.
Election and Payment Rules
You or your dependents must notify the Plan if coverage is terminated because of a death, divorce, or a child's losing dependent status within 60 days of the event. Once a qualifying event has occurred and the Plan is notified, you will be sent a COBRA information package. You have 60 days from the date this package is sent to notify the Plan that you want to elect COBRA coverage. You must remit your first monthly payment (and payment for each month since the qualifying event) within 45 days of electing COBRA. After initial election and payment, your payment is due on the 1st day of the month of coverage. There is a 30 day grace period. Failure to meet the deadlines for notification, election, or payment will result in forfeiture of all rights to continued coverage under COBRA.
Qualifying Events and Maximum Continuation Period
COBRA Maximum Payments
COBRA Payments have been changed such that they cannot exceed the lesser of (1) the applicable premium and administrative charges, plus 2% or (2) the hourly employer Plan contribution rate (currently $12.15) multiplied by the number of hours required for one month of Plan coverage (currently 120). If COBRA coverage goes beyond 18 months because of total disability, payment must equal the applicable premium and administrative charges, plus 50%.
Monthly COBRA Rates
8/1/2012 thru 7/31/2013
8/1/2012 thru 7/31/2013
(Medical, Dental and Vision)
PPO Plan$1,218.19$1,458.00 Kaiser$1,043.18$1,192.99 Blue Shield$1,218.19$1,458.00
For more information on COBRA subsidy click here.