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Health & Welfare Medical
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.
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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.
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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 1st. 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
1st) and when the payment is received your coverage
will be retroactively reinstated (going back to the 1st).
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.
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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.
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