University Governance, Ethics, Integrity, and Legal Compliance
COBRA - Compliance with Consolidated Omnibus Budget Reconciliation Act
This notice 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 active or retiree medical, dental/vision, and/or health care flexible spending account benefit to which you are enrolled, with eligibility determined by each individual plan document), you will have the opportunity for a temporary extension of Group Health Plan coverage (called "Continuation Coverage") if your coverage terminates for one of the reasons specified below (commonly known as a "Qualifying Event"). Syracuse University, or its designee, will notify you of your right to continue your coverage, once notice has been received that a Qualifying Event triggering that right has occurred. For important information regarding notification procedures, please read Section V.
I. Eligibility for Continuation Coverage
A "Qualified Beneficiary" is a person who has a right to enroll in Continuation Coverage following a Qualifying Event. Qualified Beneficiary may refer to the covered employee, or retiree, or the covered employee's/retiree's spouse, domestic partner, or dependent child (collectively "Family Members") who has continuation rights with respect to a Qualifying Event. In general, all individuals must have health coverage on the day before a Qualifying Event in order to be a Qualified Beneficiary. As an exception, an eligible dependent child who is born or placed for adoption with a covered employee/retiree during a period of Continuation Coverage immediately becomes a Qualified Beneficiary. The COBRA period for such a child is measured from the same date as for other Family Members arising from the Qualifying Event, not from the date the child became enrolled in Continuation Coverage. The term "placed for adoption" includes an adoption without a preceding placement.
II. Qualifying Events
Qualifying Event means an event that gives rise to Continuation Coverage, depending upon whether the Qualified Beneficiary is the covered employee, covered retiree, or a Family Member.
III. Continuation Coverage Term Limits
In general, Continuation Coverage is available for up to 18 months due to employment termination or reduction of hours of work. However, certain Qualifying Events, or a second Qualifying Event during the initial period of coverage, may permit a Qualified Beneficiary to receive a maximum of 36 months of coverage as identified in A., B., and C. as follows:
IV. Premium Payments
If you elect to continue your coverage, you will be required to pay the applicable 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 coverage (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 full cost of the coverage to the Group Health Plan, which includes an administration fee.
Premiums must be paid 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. Payment is considered made on the date it is postmarked to the applicable Group Health Plan.
V. Notification Procedures
The University will notify the designated COBRA Administrator of the Qualifying Event within 30 days following the date coverage ends when the Qualifying Event is:
In order to protect your family's rights, you should keep the University informed of any changes in your address and the addresses of family members. You should also keep a copy, for your records, of any notices you send to the University.
VI. Termination of Continuation Coverage
Continuation Coverage may be terminated for the following reasons:
The University reserves the right to terminate for cause the coverage of a Qualified Beneficiary on the same basis that the Group Health Plan terminates for cause the coverage of similarly situated non-continuation beneficiaries (for example, for the submission of a fraudulent claim).
In the case of an individual who is not a Qualified Beneficiary and who is receiving coverage under the Group Health Plan solely because of the individual's relationship to a Qualified Beneficiary, if the Group Health Plan's obligation to make Continuation Coverage available to the Qualified Beneficiary ceases, the Group Health Plan is not obligated to make coverage available to the individual who is not a Qualified Beneficiary.
VII. Other Coverage Options
In addition to Continuation Coverage, there may be other coverage options available when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a special enrollment opportunity for another group health plan for which you are eligible (such as a spouse's plan), even if the plan generally does not accept late enrollees, if you request enrollment within 30 days.
VIII. Note to Employees Losing Medical Plan Coverage by Reason of Retirement
Upon retirement from employment with the University, you and your Qualifying Dependents will be provided with the option to elect Continuation Coverage. You may also be eligible to enroll in the Syracuse University Retiree Medical Plan. If you elect Continuation Coverage of your active medical benefits upon retirement, you lose your eligibility to enroll in the Retiree Medical Plan. If you enroll in the Retiree Medical Plan, you will not be provided with an opportunity to enroll in Continuation Coverage when those benefits terminate, except as identified in Section II, C. Your Qualified Beneficiaries may have a limited right, at their own expense, to elect Continuation Coverage if the requirements in Section II, B (3) or (4), or C are satisfied. If you have any questions regarding your coverage options at retirement, please contact the Office of Human Resources.
The information above summarizes your rights and obligations under the continuation coverage provisions of COBRA, as amended and reflected in the final and proposed regulations published by the U.S. Department of the Treasury. This information is intended to reflect the law and does not grant or take away any rights under the law. Complete information about COBRA and the applicable Group Health Plan, including but not limited to, the applicable premium payments and summary plan descriptions, may be obtained by contacting the Syracuse University Office of Human Resources by phone: 315.443.4042, or email: firstname.lastname@example.org, or the University's designated COBRA Administrator.
For further information regarding your rights under COBRA, you may also contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefits Security Administrations ("EBSA"). Visit the U.S. Department of Labor's EBSA website or call their toll-free number at 1.866.444.3272. For more information about health insurance options available through a Health Insurance Marketplace, visit healthcare.gov.
X. Right to Amend or Terminate
As is the case with all of its employee benefits, the University reserves the right to amend or terminate these benefits at any time and from time to time, and retains the discretion to construe any ambiguity or uncertainty that might arise with respect to this notice.
Created: November 2005
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