SSMC Employee Health Benefit Plan
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H. Continuing Coverage under COBRA
The Consolidated Omnibus Budget Reconciliation Act of 1996, a federal law otherwise known as COBRA,
provides that most employers who sponsor group health plans must offer employees and their Dependents the
opportunity to temporarily continue their group health coverage at group rates in specific instances where this
coverage would otherwise end. This notice summarizes this law and its current rules concerning your rights
and obligations under COBRA continuation. For questions concerning your specific circumstances and rights
under this Plan, contact the SSMC Human Resources Department. You, your Spouse, and your Dependents
should take the time to read this provision carefully.
Participants must send written notification to the SSMC Human Resources Department
within 60 days after the
qualifying event. SSMC will send COBRA election forms to qualified beneficiaries within 14 days of after notification
such. Details concerning election options, Participation Payments and time restrictions for COBRA enrollment will be
sent with the election forms. At the time of COBRA election, Employees and/or Dependents will be offered coverage
identical to that available to similarly situated plan participants who are not receiving COBRA coverage under the Plan.
(Generally, the same coverage they are enrolled in at the time of the qualifying event). All notices of changes in
benefits and/or premiums occurring during the COBRA continuation will be sent directly to the participating qualified
beneficiaries. Qualified beneficiaries are also allowed to change from their current level of benefits during any open
enrollment period in the same manner as other Plan participants who are not receiving COBRA coverage under the Plan.
1. Qualifying Events.
a. As an Employee Covered under the SSMC Employee Health Benefits Plan, you and/or your
Dependents may qualify for temporary extension of existing Plan coverage when coverage is lost due
to the following COBRA qualifying events:
1) A reduction of your work hours that make you ineligible for group health coverage;
2) Termination of eligible employment with SSMC. (For reasons other than gross misconduct); or
3) Resignation of your employment with SSMC.
b. If you are the Spouse of a Covered Employee, you could qualify for continuation of Plan coverage
under COBRA when you lose eligibility under the Plan due to any of the following reasons:
1) Death of your spouse (eligible employee of SSMC);
2) Termination of your spouse's employment with
SSMC.
(For reasons other than gross misconduct);
3) Spouse's resignation from employment with SSMC.
4) Reduction of a spouse's work hours. (So that he/she is no longer eligible for Plan coverage)
5) Divorce or legal separation from your Spouse; or
6) Becomes eligible for Medicare.
c. Dependent children of Covered Employees may continue their Plan coverage when Plan eligibility is
lost due to any of the following reasons:
1) Death of a parent who was a Covered Employee;
2) Termination of a parent's employment with SSMC
(For reasons other than gross misconduct);
3) Parent's resignation from employment with SSMC;
4) Reduction in parent's work hours. (So that parent is no longer eligible for Plan coverage);
5) Parent becomes eligible for Medicare;
6) Loss of the child's Dependent status (i.e., marriage, limiting age, no longer full-time student); or
7) Parents' divorce or legal separation.
Qualified beneficiaries also include an Employee's child(ren) born, adopted, or placed for adoption (who
are under age 18) acquired during a period of COBRA continuation elected by that Employee. To be
covered under COBRA continuation, the Employee must enroll the child under family coverage within 30
days after the date of birth, adoption or placement for adoption.
