Continuing Coverage

Options for continuing coverage

 
COBRA

(Consolidated Omnibus Budget Reconciliation Act – U.S. Public Law 99-272)

You are receiving this notice because you are covered under the Teamsters Local 170 Health and Welfare Benefit Plan (the plan). This notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the plan. This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It also can become available to other members of your family who are covered under the plan when they would otherwise lose their group health coverage. For additional information about your rights and obligations under the plan and under federal law, you should review the plan’s summary plan description or contact the Plan Administrator.

What is COBRA continuation coverage?
COBRA continuation coverage is a continuation of plan coverage when coverage would otherwise end because of a life event known as a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse and your dependent children could become qualified beneficiaries if coverage under the plan is lost because of the qualifying event. Under the plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.

Who is eligible for COBRA coverage?
If you are a member of Teamsters Local 170 Health and Welfare Fund, you will become a qualified beneficiary if you lose your coverage under the plan because either one of the following qualifying events happens:

  • Your hours of employment are reduced.
  • Your employment ends for any reason other than your gross misconduct.

If you are the spouse of a member of Teamsters Local 170 Health and Welfare Fund, you will become a qualified beneficiary if you lose your coverage under the plan because any of the following qualifying events happens:

  • Your spouse dies.
  • Your spouse’s hours of employment are reduced.
  • Your spouse’s employment ends for any reason other than his or her gross misconduct.
  • Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both).
  • You become divorced or legally separated from your spouse.

Your dependent children will become qualified beneficiaries if they lose coverage under the plan because any of the following qualifying events happens:

  • The parent-member dies.
  • The parent-member’s hours of employment are reduced.
  • The parent-member’s employment ends for any reason other than his or her gross misconduct.
  • The parent-member becomes entitled to Medicare benefits (Part A, Part B, or both);
  • The parents become divorced or legally separated.
  • The child stops being eligible for coverage under the plan as a “dependent child.”

When is COBRA coverage available?
The plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the Teamsters Local 170 Health and Welfare Fund member, or the member’s becoming entitled to Medicare benefits (under Part A, Part B, or both), the employer must notify the Plan Administrator of the qualifying event.

You must give notice of some qualifying events
For the other qualifying events (divorce or legal separation of the Teamsters Local 170 Health and Welfare Fund member and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to the Plan Administrator.

How is COBRA coverage provided?
Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered members may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.

COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the Teamsters Local 170 Health and Welfare Fund member, the member’s becoming entitled to Medicare benefits (under Part A, Part B, or both), your divorce or legal separation, or a dependent child’s losing eligibility as a dependent child, COBRA continuation coverage lasts for up to a total of 36 months. When the qualifying event is the end of membership or reduction of the Teamsters Local 170 Health and Welfare Fund member’s hours of employment, and the member became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the member lasts until 36 months after the date of Medicare entitlement. For example, if a covered member becomes entitled to Medicare eight months before the date on which his employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus eight months). Otherwise, when the qualifying event is the end of membership or reduction of the member’s hours of employment, COBRA continuation coverage generally lasts for only up to a total of 18 months. There are two ways in which this 18-month period of COBRA continuation coverage can be extended.

Disability extension of 18-month period of continuation coverage
If you or anyone in your family covered under the plan is determined by the Social Security Administration to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage.

Second qualifying event extension of 18-month period of continuation coverage
If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the plan. This extension may be available to the spouse and any dependent children receiving continuation coverage if the member or former member dies, becomes entitled to Medicare benefits (under Part A, Part B, or both), or gets divorced or legally separated, or if the dependent child stops being eligible under the plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the plan had the first qualifying event not occurred.

If you have questions
Questions concerning your plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under COBRA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit the EBSA Web site at www.dol.gov/ebsa.

Keep your plan informed of address changes
In order to protect your family’s rights, you should keep the Plan Administrator informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.

Plan contact information
If you have questions about the plan or about COBRA continuation coverage, contact the Plan Administrator at the following address:

Teamsters Local 170 Health and Welfare Fund
330 Southwest Cutoff
P.O. Box 1046
Worcester, MA 01613
1-508-791-3416

Family and medical leave act

Under the Family and Medical Leave Act, you may be able to take up to 12 weeks of unpaid leave from your employment due to certain family or medical circumstances. Contact the Plan Administrator to find out if you qualify. If you do, you may continue health coverage during your leave, but you must continue to pay the portion of the premium that you would pay if you were actively working. Your coverage will be subject to suspension or cancellation if you fail to pay your premium on time (see How your coverage works). If you take a leave and coverage is cancelled for any reason during your leave, you may resume coverage when you return to work without waiting for an open enrollment period.

Your coverage under the FMLA will cease if Teamsters Local 170 Health and Welfare Fund is notified or otherwise determines that you have ended your employment, exhausted your 12-week FMLA leave entitlement or do not intend to return from leave. Your coverage also will cease if either you or your employer fails to maintain coverage on your behalf by making the required contribution/premium. Once Teamsters Local 170 Health and Welfare Fund determines that you are ending your employment following a period of FMLA leave, you may elect to continue your coverage under the COBRA continuation health coverage rules, as described in the previous section. The qualifying event entitling you to COBRA continuation health coverage is the last day of your FMLA leave.

Uniformed services employment and re-employment rights act of 1994 (USERRA)

USERRA requires that the plan provide you the right to elect continuous health coverage for you and your dependents for up to 24 months, beginning on the date your absence begins from employment due to military service, including Reserve and National Guard Duty, as described below.

If you are absent from employment by reason of service in the uniformed services, you can elect to continue coverage for yourself and your eligible dependent(s) under the provisions of USERRA. The period of coverage for you and your eligible dependent(s) ends on the earlier of:

  1. The end of the 24-month period on the date on which your absence begins; or
  2. The day after the date on which you are required but fail to apply for return to a position of employment for which coverage under this plan would be extended (for example, for periods of military service over 181 days, generally you must re-apply for employment with 90 days of discharge).

You may be required to pay a portion of the cost of your benefits. The cost that you must pay to continue benefits will be determined with the provisions of the USERRA.

You must notify your employer or FHLAC that you will be absent from employment due to military service unless you cannot give notice because of military necessity or unless, under all relevant circumstances, notice is impossible or unreasonable. You must notify FHLAC that you wish to elect continuation coverage for yourself or your eligible dependents under the provisions of USERRA.

Changing to a consumer plan

If your eligibility for health insurance coverage through Teamsters Local 170 Health and Welfare Fund ends, you may be eligible to join a consumer plan. In order to be eligible to enroll in a consumer plan you must first be an eligible individual. An eligible individual is defined as: a Massachusetts resident who is not seeking individual coverage to replace an employer-sponsored health plan for which the individual is eligible and which provides coverage that is a least actuarially equivalent to minimum creditable coverage.

If you are an eligible individual who does not meet the standards for immediate enrollment into a consumer plan, you may only enroll during the mandated open enrollment period. The annual mandated open enrollment time period runs from July 1 through August 15.

In order to be eligible for immediate enrollment you must have:

  • had a prior health plan that was terminated no more than 63 days before the date of submission of the application; and
  • whose prior health plan was a group health plan (including COBRA or mini-COBRA), government health plan (including Commonwealth Care), church plan, or health insurance plan offered in connection with ny such plan; and
  • whose prior coverage was “creditable coverage” as defined in 42 U.S.C. section 300gg-3(c) of HIPAA that was in effect for 18 or more months as of the date of submission of the application; so long as that individual, at the time of submission of the application, is not eligible for coverage under a group health plan, Medicare Part A or B, Medicaid, and was not terminated from the prior coverage due to fraud or non-payment of premium

Contact FCHP at 1-888-797-3247 to find out more about the options available to you.