Home

Medical Benefits - Continuing Coverage (COBRA)

You and/or your covered dependents may be eligible to continue your health coverage through the Alaska Electrical Health & Welfare Fund on a self-payment basis for up to eighteen, twenty-nine, or thirty-six months, depending upon the event resulting in the loss of coverage.  The self-pay provisions of the Plan are intended to comply with the Consolidated Omnibus Reconciliation Act (COBRA).  Self-pay coverage may terminate under certain conditions.

Continuing coverage for the participant by self-pay

As the participant, you may elect to continue your health coverage under one of the self-pay plans offered by the Alaska Electrical Health & Welfare Fund. You may elect to continue your current medical/dental/vision coverage, your current medical only coverage, or catastrophic medical only coverage. You cannot select a self-pay plan with greater health coverage than the plan you were covered under and you may not cover dependents that were not covered immediately prior to losing active coverage. COBRA coverage may be continued for up to eighteen months for a participant if active eligibility was lost due to

• Termination of employment (except for gross misconduct); or
• Reduction in hours worked; or
• Your retirement.

Coverage may be extended up to twenty-nine months if you were totally disabled within the first sixty days of COBRA continuation coverage.

Top

Continuing Coverage for Dependents by Self-Pay

Your covered dependents may elect to continue health coverage under one of the self-pay plans for up to eighteen (18) months if coverage is lost due to:

• Termination of the participant’s employment (except for gross misconduct) and the participant does not elect to self-pay; or

• A reduction in the participant’s hours worked and the participant does not elect to self-pay;  or

• The participant’s retirement and the participant does not enroll or qualify for retiree coverage and does not elect to self-pay.

The eighteen month period may be extended to twenty-nine months if a covered individual is considered totally disabled for social security disability purposes on the date eligibility ends.

Your covered dependents may elect to continue health coverage under one of the self-pay plans for up to thirty-six (36) months if coverage is lost due to:

• Death of the participant and you do not qualify for survivor coverage; or

• Divorce or legal separation; or

• A dependent child no longer meets the definition of an eligible dependent under the plan.

In the event you or your covered dependent’s coverage ceases due to termination of employment, reduction in hours, retirement, or your death, the Trust Office will send a COBRA Election Notice indicating that your coverage may be terminating.  If your dependents lose coverage due to divorce, legal separation, or no longer meet the definition of a dependent under the plan, the Trust Office must be notified within 60 days of the event.

Top

Payment for Continuing  Coverage

You and your dependents will have 60 days from the date you are notified of your eligibility for continuation of coverage or the date coverage ceases, whichever is later, to elect continued coverage.  You will then have 45 days from the date of your election to pay for your continued coverage, retroactive to the date your coverage would have otherwise ended.

After the initial payment, the payments for self-pay continuation coverage (COBRA) are due on the first day of the month for which coverage is requested.  For example, your payment for January coverage is due on January 1^st.  If you make your monthly payment on before its due date, your coverage under the Plan will continue without any break.  The Plan will not send you monthly notices of payment due.

Although monthly payments are due on the first of the month, you will be given a grace period of 30 days or the end of the month, whichever is later, to make each monthly payment.  Your continuation coverage will be provided for each month as long as payment for that month is made before the end of the grace period for that month.  However, if you make your monthly payment after the first of the month but during its grace period, your coverage under the Plan will be suspended as of the due date (the 1^st) and when the payment is received your coverage will be retroactively reinstated (going back to the 1^st).  This means that any claim you submit while your coverage is suspended will be denied and will have to be resubmitted once your coverage is reinstated.  In addition, you may be responsible for any hospital retro-certification fees and/or for the difference between the Plan’s cost and retail cost for prescription drugs.

If you fail to make your monthly payment before the end of the grace period for that payment, you will lose all rights to continuation coverage under the Plan.  That is, your payment will not be accepted and your COBRA coverage will terminate if your payment is postmarked after 30 days or end of the month, whichever is later. 

Top

Termination of Self-Pay Coverage

Self-pay coverage for you and/or your dependents will cease on the date any of the following occurs:

• The Alaska Health & Welfare Fund ceases to provide any group health coverage;
• Self-pay coverage costs (premiums) are due and unpaid;
• An individual becomes covered under another group health plan that does not contain any exclusion or limitation with respect to any pre-existing condition you may have or becomes entitled to Medicare benefits;
• An individual re-establishes eligibility under this Plan;
• An individual becomes covered under an individual conversion policy;
• The end of eighteen, twenty-nine, or thirty-six months of self-pay coverage; or
• You extend coverage beyond eighteen months due to disability and a final determination has been made that the individual is no longer disabled.

Top