Explained coverage and qualifying events
After your employees enroll in our health and dental plans, we will send them information explaining their continuation rights and options. An individual is entitled to continuation coverage if he or she is a qualified beneficiary who experiences a qualifying event.
A qualified beneficiary can be an employee, spouse, or dependent(s) who is covered under the employer’s group plan on the day before a qualifying event takes place. The only exception to this rule is a child who is born to, or placed for adoption with, a qualified beneficiary who was previously the covered employee during the COBRA continuation period also becomes a qualified beneficiary.
Note: If your policy covers domestic partners, the Trust extends continuation coverage to domestic partners and their biological or legally adopted children who were covered under the group plan on the day before a qualifying event took place.
A qualifying event is any of the following which causes a qualified beneficiary to lose his or her coverage under the employer’s group plan:
- Death of the covered employee.
- Termination of the covered employee’s employment.
- Reduction in the covered employee’s hours.
- Divorce or annulment of the covered employee’s marriage.
- Covered employee’s eligibility for Medicare benefits.
- Loss of a dependent child’s eligibility for coverage under the plan.
Our insurance responsibilities
After the Trust receives notification, we will:
- Notify all qualified beneficiaries within 14 days that they have the right to purchase continuation coverage.
- Provide an explanation of rights and responsibilities, as well as all necessary election forms to the qualified beneficiaries.