SSMC Employee Health Benefit Plan
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In cases where a second qualifying event occurs after COBRA continuation starts, the law states "
...
a
qualified beneficiary may have more than one qualifying event, but the length of coverage cannot exceed
36 months." For example, if an Employee's eligibility ends due to reduction in work hours and he or she
elects to continue family coverage, and then dies while COBRA coverage is in effect, his or her death is a
second qualifying event. Because the death of an Employee is a qualifying event for a 36-month
continuation period, his or her Dependent beneficiaries may elect to continue COBRA coverage up to 36
months from the date of the first qualifying event, the date the Employee lost eligibility due to reduction in
hours. In no event will COBRA continuations exceed 36 months for any beneficiaries.
4. COBRA Election. Qualified beneficiaries will have at least 60 days to elect COBRA continuation. The
election period is measured from the later of the date that coverage was lost or the date that the COBRA
election notice is provided. COBRA coverage is retroactive if elected and paid for. If a qualified
beneficiary waives COBRA continuation during the election period, the waiver may be revoked before the
end of the election period. The Plan need only provide COBRA continuation from the date the waiver was
revoked.
5. COBRA Participation Payments. To temporarily continue coverage, COBRA qualified beneficiaries
may be required to pay the entire costs of coverage for individual or family coverage plus administrative
costs. By law, the payment cannot exceed 102% (or 150% for the 11-month Social Security disability
extension) of the premium equivalent costs for the selected Plan coverage.
The beneficiary must pay his or her initial COBRA Participation Payment within 45 days after COBRA
election is made. If this initial payment is received after the 45-day period COBRA continuation will not
be available. Payment will not be made for any expenses Incurred after Plan coverage ended. Subsequent
premium payments may generally be made on a monthly or quarterly basis. If the amount of the payment is
made in error, but is not significantly less than the amount due, the qualified beneficiary will be notified of
the deficiency and granted 30 days to pay the difference.
If premium payments are not received 30 days from the date due, your continued coverage will cease as of
the last day of the month for which a prior timely payment was received. Benefits will not be available for
Covered Expenses unless timely COBRA Participation Payments have been made for the periods such
expenses were Incurred.
6. When Continued Coverage Ends. Once COBRA continuation is ended, an individual cannot be
reinstated for COBRA continuation even if they have not exhausted the maximum period of COBRA
continuation. Continued coverage ends for qualified beneficiaries on the earliest of any of the following:
a. The last day at the end of the applicable maximum continuation period;
b. The date
SSMC
no longer sponsors or provides group health coverage for any of its Employees;
c. The due date when the COBRA Participation Payment is not paid or is not paid on a timely basis;
d. The date that coverage becomes effective under another group plan (or if the beneficiary becomes
entitled to Medicare Parts A or B or Medicare Part C) after COBRA was elected. This does not apply
if pre-existing provisions of the other plan affects coverage for a beneficiary. The coverage would then
end on the date the other plan covers the pre-existing condition;
e. The date a beneficiary is no longer disabled during the 11-month Social Security disability extension;
f. The date the Employee is reinstated for coverage under this Plan; or.
g. Coverage may be stopped immediately if you or your Dependent knowingly submits a claim or allows
a claim for benefits to be submitted with false information, or conceals any facts, that could affect the
outcome of a claim determination.
COBRA Beneficiaries are required to notify the SSMC Human Resources Department
when Medicare
entitlement or another group health coverage become effective or when eligibility for Social Security
disability ends during a period of COBRA continuation.
