Continuation of Coverage Options
The rules governing continuation coverage are complex.
If you experience a major life event such as termination of employment, injury or illness that may impact your eligibility, contact the Administrative Office and they can help you determine the best way to continue your coverage in the Health & Welfare Plan.
If you or your dependent’s eligibility for Plan coverage ends due to termination of employment, reduction in work hours, termination of your employer’s contributions to the Fund, entry into military service, you become Totally Disabled, divorced, or in the event of your death, you or your dependents may be able to continue coverage for a period of time under one or more options available under the Plan or federal law.
Termination of employment; or layoff or reduction in hours
Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), “qualified beneficiaries” may extend health benefits (medical, dental, vision) on a self-pay basis under certain circumstances called “qualifying events” – including termination of employment or reduction in hours. See the COBRA Continuation Coverage section below for more details.
Lost time due to illness or injury
If you are unable to work as the result of an Illness or Injury, you and your dependents’ coverage will continue during the period of disability up to a maximum of 6 months. In order to obtain this continuation coverage, you must have the period of Illness or Injury certified by your Physician.
- If you have hour bank eligibility, the time lost during the 6-month Illness or Injury disability extension period will not be counted as unemployed time for the purposes of reinstatement of eligibility.
- If you are a monthly employee, any months of coverage that are added due to employer contributions while disabled will be canceled if not used within 36 months after the month in which the coverage was gained.
During military service
If you leave employment with a contributing employer for military service:
- If you have an hour bank, you may elect to either run-out your hour bank; or freeze your hour bank until you return from military service. If you elect to run-out your hour bank, when your hour bank has less than one month of eligibility you may then elect to extend coverage by making self-payments for USERRA continuation coverage.
- If you do not have an hour bank, you still have the option of electing to self-pay for either USERRA continuation coverage or COBRA Continuation Coverage. The length of USERRA continuation coverage may be different from that of COBRA Continuation Coverage.
You must contact the Administrative Office prior to the date your military service begins and notify the Administrative Office once your military service ends.
During family and medical leave of absence (FMLA)
As a general matter, the Fund does not determine whether you are eligible for FMLA leave. If you believe you may be eligible for FMLA leave, you should contact your employer immediately. Your employer must provide documentation to the Administrative Office confirming eligibility for FMLA leave and make arrangements to pay the required contributions to continue coverage.
In the event of your death
- For Monthly Employees: If you should die while eligible under a monthly plan, coverage for your dependents will terminate on the last day of the calendar month for which you earned a month of coverage under the appropriate collective bargaining agreement or special agreement.
- For Employees with Hour Bank Eligibility: If you should die while eligible under an hourly plan, coverage will continue to your dependents for as long as your hour bank has sufficient hours to continue coverage. Coverage will terminate on the last day of the calendar month in which you have fewer than 130 hours remaining in your hour bank.
- For Both Monthly and Hourly Employees: Your dependents may be eligible for additional continuation coverage in the Plan for up to 36 months on a self-pay basis (see COBRA Continuation Coverage section). As an alternative to COBRA Continuation Coverage, if an employee dies before retiring, his/her surviving spouse will be eligible for retiree coverage if at the time of death:
- the employee would have qualified for retiree coverage;
- the employee was age 58 or older; and
- the surviving spouse and employee were married for at least 3 years.
COBRA Continuation Coverage
COBRA, short for the Consolidated Omnibus Budget Reconciliation Act is a federal law that requires group health plans (including the Alaska Electrical Health & Welfare Fund) to give qualified beneficiaries (participants and their dependents) the opportunity to continue their health benefits (medical, dental, vision) when there is a “qualifying event” that would result in the loss of coverage under the Plan.
Under COBRA, a qualified beneficiary means:
- Any individual who, on the day before a qualifying event, is covered under the Plan, either as an employee or as a dependent of an employee or Retiree.
- A child who is born to, adopted by, or placed for adoption with an employee (as opposed to another family member) during COBRA, provided the child is enrolled by submitting an enrollment form and a copy of the birth certificate or adoption papers to the Administrative Office within 30 days of birth, adoption, or placement for adoption, and the appropriate self-payments are made. The child will have the same COBRA rights as a dependent who was covered by the Plan before the qualifying event that resulted in the loss of coverage.
18-Month Qualifying Events: You and your dependents may elect COBRA for a maximum of 18 months following the date coverage would otherwise end due to one of the following qualifying events:
- Your termination of employment; or
- Your layoff or reduction in hours of employment.
An extension to 29 months is available if you are determined to have been disabled by the Social Security Administration at any time during the first 60 days in which you had COBRA coverage.
36-Month Qualifying Events: A dependent may elect COBRA for a maximum of 36 months following the date coverage would otherwise end due to one of the following qualifying events: A dependent may elect COBRA for a maximum of 36 months following the date coverage would otherwise end due to one of the following qualifying events:
- Death of the employee;
- Divorce between the employee and spouse; or
- The dependent child ceases to meet the Plan’s definition of “dependent.”
Election of COBRA
When the Administrative Office is notified of a qualifying event, an election form is mailed to the qualified beneficiaries. The election form must be completed and returned to the Administrative Office within 60 days of the later of the termination of coverage, or the date the application was sent. If the election form is not sent to the Administrative Office by this date, the qualified beneficiaries will lose the right to elect COBRA.
Each qualified beneficiary has an independent right to elect COBRA. An employee or spouse may elect COBRA on behalf of other qualified beneficiaries in the family. A parent or legal guardian may elect COBRA on behalf of a child under age 18.
Cost and Payment
There is a cost for COBRA. Information regarding the cost will be sent with the election forms.
COBRA eligibility will not commence, nor will claims be processed for expenses incurred following the date of the qualifying event, until the appropriate COBRA payments have been made. COBRA terminates if a monthly payment is made later than 30 days from the beginning of the month to be covered. If the initial payment, or any subsequent payment is not made in a timely fashion, COBRA terminates. All payments must be sent to the Administrative Office.