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COBRA for Dental and Vision

Federal law requires most employers sponsoring group health plans to offer employees and their families the opportunity to elect a temporary extension of health coverage (called “continuation coverage”) in certain instances where coverage under the group health plans would otherwise end. The Trust maintains several health plans in two groups, dental and vision, that are subject to this notice: currently the vision plans are the EyeMed Vision Care and the Vision Service Plan; the dental plan is the UBT Dental Plan. For simplicity, each is referred to in this notice as the “Plan.”

You do not have to show that you are insurable to elect continuation coverage; however, you will have to pay all the premium for your continuation coverage. At the end of the maximum coverage period (described below), your coverage will end unless an individual conversion health plan is otherwise available.

This notice is intended to summarize, as best possible, your rights and obligations under the law. The Plan offers no greater COBRA rights than what the COBRA statute requires, and this notice should be construed accordingly. In areas where the notice is not clear, these points are interpreted by Federal agencies and the courts (and Congress often changes the law). Therefore, this summary is subject to change without notice as interpretations or changes of the law occur.

Both you (the employee) and your spouse should read this notice carefully and keep it with your records.

Qualifying Events

If you are a State of Ohio employee and an eligible member of a covered bargaining unit covered by the Plan, you have a right to elect continuation coverage if you lose coverage under the plan because of any one of the two following “qualifying events:”

  1. Termination (for reasons other than your gross misconduct) of your employment or
  2. Reduction in the hours of your employment.

If you are the spouse of an employee covered by the Plan, you have the right to elect continuation coverage if you lose coverage under the plan because of any one of the four following “qualifying events:”

  1. Death of your spouse
  2. termination of your spouse’s employment (for reasons other than gross misconduct) or reduction your spouse’s hours of employment with the State
  3. Divorce or legal separation from your spouse or
  4. Your spouse becomes entitled to Medicare benefits.

In the case of a dependent child of a State of Ohio employee and an eligible member of a covered bargaining unit covered by the Plan, he or she has the right to elect continuation coverage if group coverage under the Plan is lost because of any one of the five following “qualifying events:”

  1. Death of the employee parent
  2. A termination of employee parent’s employment (for reasons other than gross misconduct) or reduction your spouse’s hours of employment with the State
  3. Parent’s divorce or legal separation
  4. Employee parent becomes entitled to Medicare benefits or
  5. The dependent ceases to be a “dependent child” under the Plan.

Notices and Election

The Plan provides that your spouse’s coverage terminated (thus is lost) as of the last day of the month in which a divorce or legal separation occurs. A dependent child’s coverage terminates the last day of the month in which he or she ceases to be an eligible dependent under the Plan (for example, after attainment of a certain age). Under the COBRA statute, you (the employee) or a family member has the responsibility to notify the Plan Administrator upon a divorce, legal separation or a child losing dependent status. You or a family member must give notice no later than 60 days after the last day of the months of the divorce, legal separation or a child losing dependent status. If you or a family member fail to notify the Plan Administrator during the 60-day notice period, any family member who loses coverage will NOT be offered the option to elect continuation coverage. Further, if you or a family member fail to notify the Plan Administrator, and contrary to all Plan terms, any claims are paid for expenses incurred after the last day of the month of the divorce, legal separation or a child losing dependent status, then you and your family members will be required to reimburse the Plan for any claims so paid.

If the Plan Administrator is timely notified of a divorce, legal separation or a child losing dependent status that has caused a loss of coverage, the Plan Administrator will notify the affected family member of the right to elect continuation coverage. You (the employee) and/or your family member will also be notified of the right to elect continuation coverage automatically (i.e., without any action required by you or a family member) upon the following events that result in loss of coverage: the employee’s termination of employment (other than for gross misconduct), reduction in hours, death, or the employee becoming entitled to Medicare.

You (the employee) or your family member must elect continuation coverage within 60 days after Plan coverage ends, or, if later, 60 days after the Plan Administrator sends you or your family member notice of the right to elect continuation coverage. If you or your family member do not elect continuation coverage within this 60-day election period, you will lose your right to elect continuation coverage.

A covered employee or the spouse of the covered employee may elect continuation coverage for all family members. The covered employee, and his or her spouse and dependent children, however, each have an independent right to elect continuation coverage. Thus, a spouse or dependent child may elect continuation coverage even if the covered employee does not elect it.

Maximum Coverage Periods

36 Months. If you (spouse or dependent child) lose group health coverage because of the employee’s death, legal separation, or the employee’s becoming entitled to Medicare, or because you lose your status as a dependent under the Plan, the maximum coverage period (for spouse and dependent child) is three years from the date of the qualifying event.

18 Months.If you (employee, spouse or dependent child) lose group health coverage because of the employee’s termination of employment other than for gross misconduct) or reduction in hours, the maximum continuation coverage period (for the employee, spouse or dependent child) s 18 months from the date of termination or reduction in hours. There are three exceptions:

    • If an employee or family member is disabled at any time during the first 60 days of continuation coverage (running from the date or termination of employment or reduction in hours), the continuation coverage period for all qualified beneficiaries under the qualifying event is 29 months from the date of the date or termination of employment or reduction in hours. The Social Security Administration must formally determine under Title II (Old Age, Survivors and Disability Insurance) or Title XVI (Supplemental Security Income) of the Social Security Act that the disability exists and when it began. For the 29-month continuation coverage period to apply, notice of the determination of disability under the Social Security Act must be provided by the disabled individual to the Trust within the 18-month coverage period and within 60 days after the date of the determination.
    • If a second qualifying even occurs (for example, the employee dies or becomes divorced) within the 18-month or 29-month coverage period, the maximum coverage period becomes three years from the date of the initial termination or reduction in hours.
    • If the qualifying even occurs within 18 months after the employee becomes entitled to Medicare, the maximum coverage period (for the spouse and dependent child) ends three years from the date the employee became entitled to Medicare.

Newborn Children of, or Children Placed for Adoption with, the Covered Employee after the Qualifying Event

If, during the period of continuation coverage, a child is born to the covered employee, adopted by the covered employee or placed for adoption with the covered employee, the child is considered a qualified beneficiary. The covered employee or other guardian has the right to elect continuation coverage for the child, provided the child satisfies the otherwise applicable plan eligibility requirements (for example, age). The covered employee or family member must notify the Plan Administrator within 30 days of the birth, adoption or placement to enroll the child on COBRA. (The 30-day period is the Plan’s normal enrollment window for newborn children, adopted children or children placed for adoption.) If the covered employee or family member fails to so notify the Plan Administrator in a timely fashion, the covered employee will NOT be offered the option to elect COBRA coverage for the child.

Termination Before the End of the Maximum Coverage Period

Continuation coverage of the employee, spouse or dependent child will automatically terminate (even before the end of the maximum coverage period) when any one of the following five events occurs:

    • The Trust no longer provides group health coverage to any members
    • The premium for COBRA coverage is not timely paid
    • You (employee, spouse or dependent child) become covered under another group health plan (as an employee or otherwise) that has no exclusion or limitation with respect to any preexisting condition that you have. If the other plan has applicable exclusions or limitations, your COBRA coverage will terminate after the exclusion or limitation no longer applies (for example, after the 12-month preexisting condition waiting period expires). This rule applies only to the qualified beneficiary who becomes covered by another group health plan. (Note that under Federal Law (the Health Insurance Portability and Accountability Act of 1996/HIPAA), an exclusion or limitation of the other group health plan might not apply at all to the qualified beneficiary, depending on the length of his or her creditable health plan coverage prior to enrolling in the other group health plan.)
    • You (employee, spouse or dependent child) become entitled to Medicare benefits (applies only to the person who becomes entitled to Medicare)M/li>
    • If you (employee, spouse, or dependent child) became entitled to a 29-month maximum coverage period due to a disability of a qualified beneficiary, but then there is a final determination under Title II or XVI of the Social Security Act that the qualified beneficiary is no longer disabled (however, continuation coverage will not end until the month that begins more than 30 days after the determination).

Type of Coverage: Premium Payments

If COBRA coverage is elected, the Trust must provide coverage that is identical to the coverage provided under the Plan to similarly situated employees or family members. If the coverage for similarly situated employees or family members is modified, COBRA coverage will be modified the same way.

If you are covered by the Dental Plan and Vision Plan, you may elect COBRA coverage under one Plan or both Plans. If you are covered only by the Dental Plan, you may elect COBRA coverage under the Dental Plan. If you are covered only by the Vision Plan, you may elect COBRA coverage under the Vision Plan.

You (the employee) or a family member must pay the premium payments for the initial premium months” by the 45th day after electing continuation coverage. The initial premium months are the months that end on or before the 45th day after the date of the COBRA election. All other premiums are due on the 1st of the month for which the premium is paid, subject to a 30-day grace period.

The premiums are calculated each spring for the upcoming plan year (July 1 to June 30). Here are the current COBRA rates:

Single Family
DENTAL
DT7 Delta $29.53 $73.86
VISION
VCT VSP $7.57 $18.93
VCC EyeMed $6.62 $16.55

Other Information

If you (the employee) or a family member have any questions about this notice or COBRA, please contact the Trust. Also, please contact the Plan Administrator if you wish to receive the most recent plan documentation.

If your marital status changes, or a dependent ceases to be a dependent eligible for coverage under the Plan terms, or your or your spouse’s address changes, you must notify both the Trust and the State (via your Payroll/Personnel officer).

Plan Administrator: Union Benefits Trust is the Plan Administrator. All notices and other communications regarding the Plan and regarding COBRA should be directed to the following individual who is acting on behalf of the Plan Administrator: Call Customer Service Coordinator at 614-508-2255, or 800-228-5088. Mailing address is 390 Worthington Road, Suite B, Westerville, Ohio 43082-8332.