Continuation coverage applies to participants and/or dependents that lose coverage due to a variety of circumstances. The program you consider may depend on one or more reasons including premium costs, coinsurance limits and deductibles, available physician and hospital networks in your area, and the length of time you anticipate continuation coverage may be necessary.
A law known as the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 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. The member may choose Medical (including Prescription Drug) coverage only, or Medical (including Prescription Drug) with Dental and Vision coverage.
The advantages of choosing to pay COBRA in lieu of other programs that are available outside the Plan is that you have the option to choose full coverage that includes both dental and vision coverage. In addition, COBRA coverage you receive before you retire under an IBEW qualified retirement plan and while you are registered on Local 6' out of work list will be counted towards your entitlement to retiree coverage.
If you lose coverage after leaving covered employment, you and your family will be notified of your COBRA rights when your hour bank eligibility runs out.
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.
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.
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 $18.40) 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%.
|Maximum Coverage Period
|Termination of Covered Employee's Covered Employment (other than for gross misconduct) or reduction in hours of employment resulting in a loss of coverage
|Employee and Dependents
|18 months after loss of coverage
|Death of Participant
|36 months after loss of coverage
|Divorce of Participant
|36 months after loss of coverage
|Dependent ceases to qualify as Dependent
|36 months after loss of coverage
Monthly COBRA Rates
(Medical, Dental and Vision)
|Self Funded PPO Plan
|Blue Shield HMO
For more information view the Summary of Continuation Coverage Rights Under COBRA and State Law (pdf).
If you are unable to perform the duties of your regular occupation and your disability has continued for a period of 30 days, you may qualify for No-Cost Disability Coverage and Reduced-Cost COBRA provided you meet requirements as explained below.
If you become disabled while covered as an Active Employee and you provide a Physician's Statement confirming that you are unable to perform your regular occupation as a result, your coverage will, upon reduction of your Hour Bank below 120 hours, be continued at no cost to you, up to a maximum of six months or, if earlier, either at the end of the month in which you cease to be disabled or after you have been covered for the number of months as you were covered as an Active Employee during the 12-month period preceding the run out of your Hour Bank coverage. If you have less than 7 months of coverage as an Active Employee during the 12-month period preceding the run out of your Hour Bank coverage, Reduced-Cost COBRA Coverage described below will not be available. You may, however, continue coverage at the standard COBRA Monthly Coverage Payment amount.
After your no-cost disability coverage has ended, you may continue to be covered by the Plan by electing COBRA Coverage. If you continue to be disabled as you begin COBRA Coverage and you have more than 6 months of coverage as an Active Employee during the 12-month period preceding the run out of your Hour Bank coverage, your COBRA Monthly Coverage Payment will be reduced to the amount approved by the Board of Trustees (currently $145.00 per month) for up to the first six months of COBRA Coverage. Reduced-cost COBRA Coverage will end earlier if you cease to be disabled, or once the number of your combined months of no-cost disability coverage and reduced cost disability coverage equals the number of months you were covered as an Active Employee during the 12-month period immediately before your no-cost disability coverage began. Once reduced-cost COBRA Coverage ends, you may continue COBRA Coverage at the standard COBRA Monthly Coverage Payment amount for the remainder of your 18-month Maximum COBRA Coverage period.
Certain participants may be eligible for Family medical Leave in accordance with Federal law. An employer must provide an eligible employee with up to 12 weeks of unpaid leave each year for any of the following reasons:
Employees are eligible for leave if they have worked for their employer at least 12 months, at least 1,250 hours over the past 12 months, and work at a location where the company employs 50 or more employees within 75 miles. If an employee is provided group health insurance, the employee is entitled to the continuation of the group health insurance coverage during FMLA leave on the same terms as if he or she had continued to work.
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.
California insurance law requires the Kaiser HMO and the Blue Shield HMO to offer an extension of the maximum continuation coverage period for HMO enrollees whose 18-month COBRA maximum coverage period is expiring. Under this state law, the combined federal COBRA and state extension coverage cannot exceed 36 month. You should contact the HMO in which you are participating to inquire about Cal-COBRA. Visit California's Department of Managed Care website at http://www.dmhc.ca.gov/HealthPlansCoverage.aspx for information regarding additional HMO continuation coverage options.
Coverage options may be available to you under an individual policy through the Health Insurance Marketplace. These options may be less expensive than COBRA, and you may be eligible for premium tax credits and cost-sharing reductions that reduce your overall out-of-pocket cost. Contact California's Health Insurance Marketplace at www.coveredca.com or call 1-800-318-2596 to obtain information regarding coverage available through the Marketplace.
In general, however, if you elect COBRA, you will not be able to drop COBRA coverage and enroll through the Health Insurance Marketplace except during the Marketplace's annual open enrollment period unless one of the special enrollment rules applies. To learn more visit: http://www.coveredca.com/FAQs/cobra/.