Employer Responsibilities for Providing Health Coverage
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.
As the employer, you are obligated to follow all laws pertaining to continuation coverage. We assume the administrative role for you, provided you promptly notify us of any qualifying event or change in any employee’s status that impacts the legal continuation rights of an employee or dependent.
To ensure the Trust can properly perform the necessary administrative duties within the proper time frames, you, as the employer, are responsible for notifying us within 30 days of:
- A covered employee’s death.
- A covered employee’s termination of employment or reduction in hours (including approved leaves of absences).
- A covered employee’s entitlement to Medicare benefits.
Covered employees or their family members must notify us within 60 days of:
- A divorce or annulment.
- A child ceasing to be eligible as a dependent under the group plan’s rules.
Please note that while you’re not legally required to inform the Trust of these events, you should notify us as soon as you are aware of them. Doing so will allow us to promptly contact the individuals involved and inform them of their continuation coverage rights. Do not assume your employee has notified us.