This notice summarizes your rights and obligations with regard to continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (commonly known as “COBRA”).
In the event that you are no longer covered under a Syracuse University Group Health Plan (Group Health Plan refers to the individual active or retiree medical, dental/vision, and/or health care flexible spending account benefit to which you are enrolled, with eligibility determined by each individual plan document), you will have the opportunity for a temporary extension of Group Health Plan coverage (called “Continuation Coverage”) if your coverage terminates for one of the reasons specified below (commonly known as a “Qualifying Event”). Syracuse University, or its designee, will notify you of your right to continue your coverage, once notice has been received that a Qualifying Event triggering that right has occurred. For important information regarding notification procedures, please read Section V.
I. Eligibility for Continuation Coverage
A “Qualified Beneficiary” is a person who has a right to enroll in Continuation Coverage following a Qualifying Event. Qualified Beneficiary may refer to the covered employee, or retiree, or the covered employee’s/retiree’s spouse, domestic partner, or dependent child (collectively “Family Members”) who has continuation rights with respect to a Qualifying Event. In general, all individuals must have health coverage on the day before a Qualifying Event in order to be a Qualified Beneficiary. As an exception, an eligible dependent child who is born or placed for adoption with a covered employee/retiree during a period of Continuation Coverage immediately becomes a Qualified Beneficiary. The COBRA period for such a child is measured from the same date as for other Family Members arising from the Qualifying Event, not from the date the child became enrolled in Continuation Coverage. The term “placed for adoption” includes an adoption without a preceding placement.
II. Qualifying Events
Qualifying Event means an event that gives rise to Continuation Coverage, depending upon whether the Qualified Beneficiary is the covered employee, covered retiree, or a Family Member.
- If you are an employee covered by a Group Health Plan, you have the right to elect Continuation Coverage if your Group Health Plan coverage terminates due to one of the following Qualifying Events:
- a reduction in your hours of employment; or
- your employment has terminated (for reasons other than gross misconduct on your part). Termination of employment or reduction of hours is not a qualifying event with respect to coverage under the Syracuse University Retiree Medical Benefits Plan or the Syracuse University Retiree Prescription Drug Plan.
- If you are the Family Member of an employee/retiree and are covered by a Group Health Plan, you have the right to elect Continuation Coverage if your Group Health Plan coverage terminates due to one of the following Qualifying Events:
- death of the covered employee/retiree;
- termination (for reasons other than gross misconduct), or reduction of hours of the covered employee’s employment. Termination of employment or reduction of hours is not a qualifying event with respect to coverage under the Syracuse University Retiree Medical Benefits Plan or the Syracuse University Retiree Prescription Drug Plan;
- divorce or legal separation of a covered employee/retiree from the employee’s/retiree’s spouse;
- the employee’s/retiree’s action to file a termination of domestic partnership with the Office of Human Resources; or
- a dependent child’s ceasing to satisfy the requirements for a dependent child under a Group Health Plan.
- In addition, sometimes filing a bankruptcy proceeding under Title 11 of the United States Code can be a Qualifying Event. If a bankruptcy proceeding is filed with respect to Syracuse University, and that bankruptcy results in the loss of coverage of any retired employee covered under a Group Health Plan, the retired employee will become a Qualified Beneficiary. The retired employee’s covered Family Member will also become a Qualified Beneficiary if bankruptcy results in the loss of their coverage under a Group Health Plan.
III. Continuation Coverage Term Limits
In general, Continuation Coverage is available for up to 18 months due to employment termination or reduction of hours of work. However, certain Qualifying Events, or a second Qualifying Event during the initial period of coverage, may permit a Qualified Beneficiary to receive a maximum of 36 months of coverage as identified in A., B., and C. as follows:
- Your benefit coverage may be continued for up to 36 months in the event of death, divorce or legal separation, dissolution of domestic partnership, or loss of dependent eligibility.
- The 18-month coverage period may be extended to 29 months for Qualifying Beneficiaries, if:
- any Qualifying Beneficiary is determined under Title II or Title XVI of the Social Security Act to have been disabled on or within 60 days of the date of termination or reduction in hours of the covered employee’s employment; and
- you or another Qualified Beneficiary notifies the University within 60 days after the determination and before the end of the 18-month coverage periodAny coverage extended after the initial 18 months because of a disability determination may be charged to you at 150% of the applicable premium (even if your coverage is ultimately continued for a total of 36 months, pursuant to the paragraph below), so long as the disabled person is covered during the extension. If it is later determined that the Qualifying Beneficiary whose disability resulted in the extended coverage is no longer totally disabled, you or another Qualified Beneficiary must notify the University within 30 days of the determination.
- If you are a covered Family Member and you continue your coverage upon a termination or reduction in hours of employment, your Continuation Coverage may be extended to 36 months if another event (death, divorce or legal separation, dissolution of domestic partnership, or ineligibility for dependent coverage) occurs during the initial 18-month period. If one of these events occurs, you should notify the University right away. Continuation Coverage will not last beyond 36 months from the date of the first event that made you eligible to continue your coverage.
IV. Premium Payments
If you elect to continue your coverage, you will be required to pay the applicable premium for your benefits. Except with respect to Continuation Coverage extended for up to 29 months for a disabled person and any other covered Family Members whose coverage is extended with the disabled person’s coverage (or up to 36 months in the event that a second Qualifying Event occurs with respect to a Qualified Beneficiary whose coverage is extended due to disability), your premium payment will not exceed 102% of the full cost of the coverage to the Group Health Plan, which includes an administration fee.
Premiums must be paid on a monthly basis. You will be required to pay the first premium payment in advance, along with any retroactive premium payments owed from the date of termination of your coverage, within 45 days after you submit your written election form. Payment is considered made on the date it is postmarked to the applicable Group Health Plan.
V. Notification Procedures
The University will notify the designated COBRA Administrator of the Qualifying Event within 30 days following the date coverage ends when the Qualifying Event is:
- the end of employment or reduction of hours employment;
- death of the employee/retiree; or
- commencement of a proceeding in bankruptcy with respect to the University.For other Qualifying Events (divorce, legal separation, dissolution of domestic partnership, or a dependent child’s losing eligibility for coverage as a dependent child), you or someone on your behalf must notify the University or its designee in writing within 60 days after the Qualifying Event occurs, using the procedures specified below. If these procedures are not followed or if the notice is not provided in writing to the University or its designee during the 60-day notice period, any spouse/domestic partner or dependent child who loses coverage will not be offered the option to elect Continuation Coverage.NOTICE PROCEDURES:Any notice that you provide must be in writing. Oral notice, including notice by telephone, is not acceptable. You must mail, email, fax or hand-deliver your notice to the department listed below, at the following address:
Office of Human Resources, Suite 101
640 Skytop Road
Syracuse, New York 13244
If mailed, your notice must be postmarked no later than the last day of the required notice period. Any notice you provide must state:
- the name of the plan or plans under which you lost or are losing coverage;
- the name and address of the employee covered under the plan;
- the name(s) and address(es) of the Qualified Beneficiary(ies); and
- the Qualifying Event and the date it happened.
If the Qualifying Event is a divorce or legal separation, your notice must include a copy of the divorce decree or the legal separation agreement.
Please be aware that there are other notice requirements in other contexts (for example, to qualify for a disability extension).
In order to protect your family’s rights, you should keep the University informed of any changes in your address and the addresses of family members. You should also keep a copy, for your records, of any notices you send to the University.
VI. Termination of Continuation Coverage
Continuation Coverage may be terminated for the following reasons:
- you reach the applicable maximum coverage period;
- the University no longer provides Group Health Plan coverage to any of its employees/retirees;
- you fail to make timely payment of any premium due;
- your Continuation Coverage has been extended for up to 29 months due to a Qualifying Beneficiary’s disability, and there has been a final determination that the Qualifying Beneficiary is no longer totally disabled;
- after you enroll in Continuation Coverage, you become entitled to Medicare; or
- after you elect Continuation Coverage, you become covered under another group health benefits plan that either: (i) does not contain any exclusion or limitation; or (ii) contains an exclusion or limitation that does not apply to you or has been satisfied in accordance with federal law.
The University reserves the right to terminate for cause the coverage of a Qualified Beneficiary on the same basis that the Group Health Plan terminates for cause the coverage of similarly situated non-continuation beneficiaries (for example, for the submission of a fraudulent claim).
In the case of an individual who is not a Qualified Beneficiary and who is receiving coverage under the Group Health Plan solely because of the individual’s relationship to a Qualified Beneficiary, if the Group Health Plan’s obligation to make Continuation Coverage available to the Qualified Beneficiary ceases, the Group Health Plan is not obligated to make coverage available to the individual who is not a Qualified Beneficiary.
VII. Other Coverage Options
In addition to Continuation Coverage, there may be other coverage options available when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a special enrollment opportunity for another group health plan for which you are eligible (such as a spouse’s plan), even if the plan generally does not accept late enrollees, if you request enrollment within 30 days.
VIII. Note to Employees Losing Medical Plan Coverage by Reason of Retirement
Upon retirement from employment with the University, you and your Qualifying Dependents will be provided with the option to elect Continuation Coverage. You may also be eligible to enroll in the Syracuse University Retiree Medical Plan. If you elect Continuation Coverage of your active medical benefits upon retirement, you lose your eligibility to enroll in the Retiree Medical Plan. If you enroll in the Retiree Medical Plan, you will not be provided with an opportunity to enroll in Continuation Coverage when those benefits terminate, except as identified in Section II, C. Your Qualified Beneficiaries may have a limited right, at their own expense, to elect Continuation Coverage if the requirements in Section II, B (3) or (4), or C are satisfied. If you have any questions regarding your coverage options at retirement, please contact the Office of Human Resources.
The information above summarizes your rights and obligations under the continuation coverage provisions of COBRA, as amended and reflected in the final and proposed regulations published by the U.S. Department of the Treasury. This information is intended to reflect the law and does not grant or take away any rights under the law. Complete information about COBRA and the applicable Group Health Plan, including but not limited to, the applicable premium payments and summary plan descriptions, may be obtained by contacting the Syracuse University Office of Human Resources by phone: 315.443.4042, or email: email@example.com, or the University’s designated COBRA Administrator.
For further information regarding your rights under COBRA, you may also contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administrations (“EBSA”). Visit the U.S. Department of Labor’s EBSA website or call their toll-free number at 1.866.444.3272. For more information about health insurance options available through a Health Insurance Marketplace, visit healthcare.gov.
X. Right to Amend or Terminate
As is the case with all of its employee benefits, the University reserves the right to amend or terminate these benefits at any time and from time to time, and retains the discretion to construe any ambiguity or uncertainty that might arise with respect to this notice.
Date: Created: November 2005
Date Amended: April 2017