Continuation of Coverage
Family and Medical Leave Act
An employee may continue membership in Dental Blue Freedom as provided by the Family and Medical Leave Act. (The Family and Medical Leave Act applies to you if your group has 50 or more employees.) An employee who has been employed at least one year and worked at least 1,250 hours within the previous 12 months is eligible to choose to continue coverage for up to 12 weeks of unpaid leave for the following reasons:
- The birth of the employee’s child.
- The placement of a child with the employee for the purpose of adoption or foster care.
- To care for a seriously ill spouse, child or parent.
- A serious health condition rendering the employee unable to perform his or her job.
If the employee chooses to continue coverage during the leave, the employee will be given the same health care benefits that would have been provided if the employee were working, with the same premium contribution ratio. If the employee’s premium for continued membership in Dental Blue Freedom is more than 30 days late, the plan sponsor will send written notice to the employee. It will tell the employee that his or her membership will be terminated and what the date of the termination will be if payment is not received by that date. This notice will be mailed at least 15 days before the termination date.
If membership in Dental Blue Freedom is discontinued for non-payment of premium, the employee’s coverage will be restored when he or she returns to work to the same level of benefits as those the employee would have had if the leave had not been taken and the premium payment(s) had not been missed. This includes coverage for eligible dependents. The employee will not be required to meet any qualification requirements imposed by Dental Blue Freedom when he or she returns to work. This includes: new or additional waiting periods; waiting for an open enrollment period; or passing a medical exam to reinstate coverage.
Consolidated Omnibus Budget Reconciliation Act (COBRA)
When you are no longer eligible for membership in Dental Blue Freedom, you may be eligible to continue this coverage as provided by the Consolidated Omnibus Budget Reconciliation Act (COBRA). To continue this coverage, you will pay up to 102% of the premium cost to your plan sponsor. These laws apply to you if you lose eligibility for coverage due to one of the following reasons:
- Termination of employment (for reasons other than gross misconduct).
- Reduction of work hours.
- Divorce or legal separation.
Note: In the event of divorce or legal separation, a spouse is eligible to keep coverage under the employee’s membership. This is the case only until the employee is no longer required by the divorce judgment to provide health insurance for the former spouse or the employee or former spouse remarries, whichever comes first. The former spouse’s eligibility for continued COBRA coverage will start on the date of divorce even if he or she continues coverage under the employee’s membership. While the former spouse continues coverage under the employee’s membership, there is no additional premium. After remarriage, under state and federal law, the former spouse may be eligible to continue coverage under an individual membership for additional premium.
- Death of the subscriber.
- Loss of status as an eligible dependent.
The period of this continued COBRA coverage begins with the date of your qualifying event. And, the length of this continued COBRA coverage will be up to 36 months from that qualifying event. This is true except for termination of employment or reduction of work hours, in which cases continued COBRA coverage is available for only 18 months or, if you are qualified for disability under Title II or Title XVI of the Social Security Act, up to 29 months. (See below for more information about continued coverage for disabled employees.)
Continuation of Coverage for Same-Sex Spouses
When a subscriber’s legal same-sex spouse is no longer eligible for membership in Dental Blue Freedom, that spouse (or if applicable, civil union spouse) and his or her dependent children may continue coverage in the subscriber’s group to the same extent that a legal opposite-sex spouse (and his or her dependent children) could continue coverage upon loss of eligibility for coverage in Dental Blue Freedom.
Additional COBRA Coverage for Disabled Employees
Within 60 days of the qualifying event, if an employee or his or her eligible dependent is determined to be disabled under Title II or Title XVI of the Social Security Act, continued coverage will remain in effect for up to 29 months from the date of the qualifying event. The premium cost for the additional 11 months may be up to 150% of the premium rate. If during the 11 additional months, eligibility for disability is lost, coverage may terminate before the 29 months is completed. You should contact your plan sponsor for more information about continued coverage.
Special Rules for Retired Employees
A retired employee, the spouse and/or eligible dependent children of a retired employee or a surviving spouse of a retired deceased employee who loses eligibility for membership in Dental Blue Freedom as a result of a bankruptcy proceeding (Title 11 of the United States Code) is also eligible for continued COBRA coverage. A retired employee and/or the surviving spouse of a deceased retired employee may enroll for lifetime COBRA coverage as of the date of the bankruptcy proceeding, provided that the loss of group eligibility occurs within one year before the date on which the bankruptcy proceeding begins. Or, if group eligibility is lost within one year after the date on which the bankruptcy proceeding begins, they may enroll for lifetime COBRA coverage as of the date group eligibility is lost. Spouses and/or eligible dependent children of these retired employees may enroll for continued COBRA coverage until the retired employee dies. Once the retired employee dies, his or her surviving spouse and/or eligible dependent children may enroll for up to an additional 36 months of continued COBRA coverage beyond the date of the retired employee’s death. (Lifetime COBRA coverage for retired employees will end if Dental Blue Freedom is terminated by the plan sponsor or for any of the other reasons described below. See “Termination of Continued Coverage.”)
Enrollment for COBRA Coverage
In order to enroll for continued coverage in Dental Blue Freedom, you must complete a COBRA Election Form. The completed election form must be returned to the office at the address on the form. The form must be returned within 60 days from your date of termination of coverage or your notification of COBRA eligibility, whichever is later. If you do not return the completed form, it will be considered a waiver. And, you will not be allowed to continue coverage in Dental Blue Freedom. (The 60 days will be counted from the date of the COBRA eligibility notice to the postmarked date of the mailed election form.)
Termination of COBRA Continued Coverage
Your COBRA coverage will end when:
- The length of time allowed for continued coverage is reached (for example, 18 months or 29 months or 36 months from the qualifying event).
- You fail to make timely payment of your COBRA premiums.
- You enroll in another employer sponsored health care plan and that plan does not include pre-existing condition limitations or waiting periods.
In addition, your continued coverage in Dental Blue Freedom will end when the group terminates its agreement with Blue Cross and Blue Shield to provide the coverage described in this Dental Blue Freedom Benefit Description. In this case, coverage may continue under another group health care plan. However, when your coverage in Dental Blue Freedom is terminated, you will not be offered a nongroup conversion plan. (The longer time allowed for continued coverage for disabled members will end when the member is no longer disabled.)