How Long Coverage May Continue
If you or your eligible dependents lose coverage as a result of events described below, you have the following continuation rights:
-
If you divorce, legally separate, end a domestic partnership or die, your eligible dependents may elect to continue coverage for up to 36 months. If your spouse or domestic partner is age 55 or older at the time of the qualifying event, the 36-month limit does not apply — he or she may continue self-paid coverage until reaching age 65 or otherwise becoming entitled to or eligible for Medicare.
-
If your dependent child ceases to qualify as a dependent under the plan, he or she may continue coverage for up to 36 months.
-
If coverage is lost as a result of your becoming eligible for Medicare, your eligible dependents may continue coverage for up to a maximum of 36 months.
Continuation coverage ends on the last day of the monthly premium payment period if any one of the following occurs before the maximum available continuation period:
-
Payment for continuation coverage is not made to the Trust Office on a timely basis for the next monthly coverage period
-
You or your dependent becomes covered under any other group health plan after electing continuation coverage unless the other group health plan limits or excludes coverage for a pre-existing condition of the individual seeking continuation coverage
-
You or your dependent provides written notice that you wish to terminate your coverage
-
You or your dependent becomes entitled to Medicare benefits after electing continuation coverage.
In addition, continuation coverage will end if this plan is terminated or if the District begins contributing to another group health plan on behalf of the active employee classification in which you worked while employed by the District. However, coverage may still be available under a succeeding plan.
How Long Coverage May Continue — Disabled Individuals
If you or one of your dependents covered by the Trust is determined by the Social Security Administration (SSA) to be disabled either before a 24-month qualifying event or within the first 60 days of continuation coverage, the entire family of the disabled individual can receive an additional five months of continuation coverage for up to a maximum of 29 months. To obtain the additional months of coverage, you must notify the Trust Office in writing as follows:
-
Within 60 days of the later of:
-
Your qualifying event; or
-
Your receipt of your Social Security Disability Determination; and
-
Prior to the end of your initial 24-month period of continuation coverage.
If the disabled individual is subsequently found to not be disabled, you must notify the Trust Office within 30 days of that determination. The extension of continuation coverage available to a disabled individual will end the first of the month that begins more than 30 days from the date of the final determination that you are no longer disabled. (For example, if the determination is made June 15, coverage would end August 1.)
How Long Coverage May Continue — Second Qualifying Event
Eligible dependents who are entitled to continuation coverage as the result of your termination of employment or reduction of hours can extend their coverage up to a total of 36 months if a second qualifying event occurs during the initial 24 months of continuation coverage.
Possible second qualifying events during the initial 24 months of continuation coverage are:
-
Divorce or legal separation
-
A child's loss of dependent status under the plan
-
You becoming entitled to Medicare
-
Your death.
If an eligible dependent wants extended coverage as a result of a second qualifying event, he or she must notify the Trust Office in writing within 60 days of the second qualifying event. Failure to give such timely written notice of a second qualifying event will cause the individual's coverage to end as it normally would under the terms of the plan. In no event will continuation coverage extend beyond a total of 36 months from the original qualifying event.
How Long Coverage May Continue — Medicare Entitlement
If you have a 24-month qualifying event after becoming entitled to Medicare, your dependents may continue coverage until the later of 24 months from the date coverage would normally end or 36 months from the date you became entitled to Medicare.
USERRA Continuation Rights
If you lose coverage because you have entered military service for longer than 31 days and are covered by the Uniform Services Employment and Reemployment Rights Act (USERRA), you may elect to self-pay for coverage up to a maximum of 24 months. The maximum period of continuation coverage is the lesser of 24 months or the day after you fail to return to employment within the time frame provided by USERRA.
|
