Scope

Policy Statement

This policy summarizes your rights and obligations with regard to continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (commonly known as "COBRA").

In the event that you are no longer covered under a Syracuse University Group Health Plan (Group Health Plan refers to the individual medical, dental, prescription drug and/or medical reimbursement plan to which you are enrolled, with eligibility determined by each individual plan), you will have the opportunity for a temporary extension of Group Health Plan coverage (called "Continuation Coverage") at active employee rates, if your coverage terminates for one of the reasons specified below. The University will notify you of your right to continue your coverage, once notice has been received that an event triggering that right has occurred.

Eligibility

If you are an employee covered by a Group Health Plan, you have the right to choose Continuation Coverage if your Group Health Plan coverage terminates:

1. because of a reduction in your hours of employment; or
2. because your employment has terminated (for reasons other than gross misconduct on your part).

If you are the spouse of an employee and are covered by a Group Health Plan, you have the right to choose Continuation Coverage if your Group Health Plan coverage terminates due to one of the following events:

1. the death of your spouse;
2. the termination of your spouse's employment (for reasons other than gross misconduct) or reduction in your spouse's hours of employment;
3. a divorce or legal separation from your spouse; or 4. the entitlement of your spouse to Medicare.

If you are the dependent child (a dependent child includes a newborn child, an adopted child, and a child placed with the covered employee for adoption during the COBRA coverage period) of an employee and are covered by a Group Health Plan, you have the right to choose Continuation Coverage if your Group Health Plan coverage terminates due to one of the following events:

1. the death of a parent employed by Syracuse University;
2. the termination of a parent's employment (for reasons other than gross misconduct) or reduction in a parent's hours of employment with the University;
3. the divorce or legal separation of your parents;
4. the entitlement of a parent employed by the University to Medicare; or
5. your ineligibility for coverage as a "dependent child" under a Group Health Plan.

It is your responsibility to notify the University within 60 days of the event of a divorce, legal separation, or a child losing dependent status under a Group Health Plan.

Term Limits

Your benefit coverage may be continued for 36 months in the event of death, divorce or legal separation, entitlement to Medicare, or ineligibility for dependent coverage.

Your coverage may be continued for 18 months in the event of termination or reduction in hours of employment. The 18-month coverage period may be extended to 29 months for covered family members, if:

1. any covered family member (employee, spouse, or dependent child) is determined under Title II or Title XVI of the Social Security Act to have been disabled on or within 60 days of the date of termination or reduction in hours of the covered employee's employment; and
2. you or another qualified beneficiary notifies the University within 60 days after the determination and before the end of the 18-month coverage period. Any coverage extended after the initial 18 months because of a disability determination may be charged to you at 150% of the active employee rate (even if your coverage is ultimately continued for a total of 36 months, pursuant to the paragraph below), so long as the disabled person is covered during the extension. If it is later determined that the covered family member whose disability resulted in the extended coverage is no longer totally disabled, you or another qualified beneficiary must notify the University within 30 days of the determination.

If you are a covered spouse or dependent child and you continue your coverage upon a termination or reduction in hours of employment, your Continuation Coverage may be extended to 36 months if another event (death, divorce or legal separation, Medicare entitlement, or ineligibility for dependent coverage) occurs during the initial 18-month period. If one of these events occurs, you should notify the University right away.Continuation Coverage will not last beyond 36 months from the date of the first event that made you eligible to continue your coverage. However, special rules may apply if Medicare entitlement is involved.

Termination of Continuation Coverage

Continuation Coverage may be cut short for the following reasons:

1. the University no longer provides Group Health Plan coverage to any of its employees;
2. you fail to make timely payment of any premium due;
3. after you elect Continuation Coverage, you become covered under another group health benefits plan that either: (i) does not contain any exclusion or limitation; or (ii) contains an exclusion or limitation that does not apply to you or has been satisfied in accordance with federal law;
4. after you elect Continuation Coverage, you become entitled to Medicare; or
5. your Continuation Coverage has been extended for up to 29 months due to a covered family member's disability, and there has been a final determination that the family member is no longer totally disabled.

If you decide to continue your coverage, you must submit a written election form to the University within 60 days of the later of: (i) the date on which your coverage terminates due to one of the events specified above; or (ii) the date you are given additional notice of your right to continue coverage under a Group Health Plan. If you do not return the election form within that 60-day period, it will be assumed that you do not wish to continue your Group Health Plan coverage.

Premium Payments

If you elect to continue your coverage, you will be required to pay the premium for your benefits. Except with respect to Continuation Coverage extended for up to 29 months for a disabled person and any other covered family members whose coverage is extended with the disabled person's (or up to 36 months in the event that a second qualifying event occurs with respect to a qualified beneficiary whose coverage is extended due to disability), your premium payment will not exceed 102% of the active employee rate for your benefits; this includes an administration fee.

If you wish, you may pay the premium on a monthly basis. You will be required to pay the first premium payment in advance, along with any retroactive premium payments owed from the date of termination of your coverage, within 45 days after you submit your written election form.

At the end of your COBRA Continuation Coverage period, you may enroll in an individual conversion health benefits contract, if a conversion benefit is provided under the applicable Group Health Plan.

Additional information about the continuation coverage option or applicable premium payments may be obtained from the Office of Human Resources upon termination of coverage. All notices submitted should be addressed to the Office of Human Resources at Syracuse University.

Policy Administration

• Human Resources

Date: November 2005