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GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS
** CONTINUATION COVERAGE RIGHTS UNDER COBRA**
You are receiving this notice because you have recently become covered under Indiana State University's group health plan.
This notice contains important information about your right to COBRA continuation coverage, which is a temporary extension
of coverage under the Plan. This notice generally explains COBRA continuation coverage, when it may become available to you
and your family, and what you need to do to protect the right to receive it.
The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of
1985 (COBRA). COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage.
It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their
group health coverage. For additional information about your rights and obligations under the Plan and under federal law, you
should review the Plan's Summary Plan Description or contact the Plan Administrator.
WHAT IS COBRA CONTINUATION COVERAGE?
COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known
as a "qualifying event." Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation
coverage must be offered to each person who is a "qualified beneficiary." You, your spouse, and your dependent children could
become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified
beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.
If you are an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because either one of the
following qualifying events happens:
- Your hours of employment are reduced; or
- Your employment ends for any reason other than your gross misconduct.
If you are the spouse of an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because any
of the following qualifying events happens:
- Your spouse dies;
- Your spouse's hours of employment are reduced;
- Your spouse's employment ends for any reason other than his or her gross misconduct;
- Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or
- You become divorced or legally separated from your spouse.
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because any of the following
qualifying events happens:
- The parent-employee dies;
- The parent-employee's hours of employment are reduced;
- The parent-employee's employment ends for any reason other than his or her gross misconduct;
- The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
- The parents become divorced or legally separated; or
- The child stops being eligible for coverage under the plan as a "dependent child."
WHEN IS COBRA COVERAGE AVAILABLE?
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that
a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the
employee, or the employee's becoming entitled to Medicare benefits (under Part A, Part B, or both), the employer must notify the Plan
Administrator of the qualifying event.
YOU MUST GIVE NOTICE OF SOME QUALIFYING EVENTS
For the other qualifying events (divorce or legal separation of the employee and spouse or a dependent child's losing eligibility for
coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide
this notice to:
Staff Benefits Administration
Indiana State University
300 Rankin Hall
Terre Haute, IN 47809
HOW IS COBRA COVERAGE PROVIDED?
Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of
the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered
employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf
of their children.
COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, the employee's
becoming entitled to Medicare benefits (under Part A, Part B, or both), your divorce or legal separation, or a dependent child's losing
eligibility as a dependent child, COBRA continuation coverage lasts for up to a total of 36 months. When the qualifying event is the end of
employment or reduction of the employee's hours of employment, and the employee became entitled to Medicare benefits less than 18 months
before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the
date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his
employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare
entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). Otherwise, when the qualifying
event is the end of employment or reduction of the employee's hours of employment, COBRA continuation coverage generally lasts for only up to
a total of 18 months. There are two ways in which this 18-month period of COBRA continuation coverage can be extended.
DISABILITY EXTENSION OF 18-MONTH PERIOD OF CONTINUATION COVERAGE
If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled and you notify the
Plan Administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation
coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation
coverage and must last at least until the end of the 18-month period of continuation coverage.
SECOND QUALIFYING EVENT EXTENSION OF 18-MONTH PERIOD OF CONTINUATION COVERAGE
If your family experiences another qualifying event while receiving 18 months continuation coverage, the spouse and dependent children in your
family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event
is properly given to the Plan. This extension may be available to the spouse and any dependent children receiving continuation coverage if the
employee or former employee dies, becomes entitled to Medicare benefits (under Part A, Part B, or both), or gets divorced or legally separated,
or if the dependent child stops being eligible under the Plan as a dependent child, but only if the event would have caused the spouse or
dependent child to lose coverage under the Plan had the first qualifying event not occurred.
IF YOU HAVE QUESTIONS
Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For
more information about your rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws
affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefits Security
Administration (EBSA) in your area or visit the EBSA website at www.dol.gov/ebsa. (Addresses and phone
numbers of Regional and District EBSA
Offices are available on EBSA's website.)
KEEP YOUR PLAN INFORMED OF ADDRESS CHANGES
In order to protect your family's rights, you should keep the Plan Administrator informed of any changes in the addresses of family members. You
should also keep a copy, for your records, of any notices you send to the Plan Administrator.
PLAN CONTACT INFORMATION
Indiana State University
300 Rankin Hall
Terre Haute, IN 47809