Page 43 - Aegion PPO SPDs
P. 43
Disability Extension of 18-Month Period of Continuation Coverage
If You or anyone in Your family covered under the Employer's health Plan is determined by the Social
Security Administration to be disabled and You notify the Employer 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 24 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.
Notification Period
You must notify within the 18-months COBRA continuation period and no later than 60-days from the later
of:
The date of SSA determination, or
The date of the qualifying event, or
The date coverage would end due to the qualifying event.
Information should be sent to Your Human Resources Department.
Second Qualifying Event
If Your family has another qualifying event (such as a legal separation, divorce, etc.) during the initial 18
months of COBRA continuation coverage, Your Spouse and dependent children can receive up to 18
additional months of COBRA continuation coverage, for a maximum of 36 months from the original
qualifying event. Such additional coverage is only available if the second qualifying event would have
caused Your Spouse or dependent children to lose coverage under the Plan had the first qualifying event
not occurred. A qualified beneficiary must give timely notice to the Plan Administrator in such a situation.
Termination
In certain cases, Continuation Coverage will stop before the time period specified earlier. It will stop if any
one of the following situations is true:
Employee contributions are not paid on time.
The person becomes entitled to Medicare.
The Employer stops providing a group health benefits plan for employees.
The person becomes covered under another group health plan.
Gap in Coverage
If You choose not to enroll in Continuation Coverage, You may have a gap in Your coverage. Then, if You
later become eligible for a group health plan, You may be subject to a waiting period before coverage
begins, and it will not exceed 90 days.
Other Coverage Options Besides COBRA Continuation Coverage
Instead of enrolling in COBRA continuation coverage, there may be other coverage options for You and
Your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage
options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these
options may cost less than COBRA continuation coverage. You can learn more about many of these
options at www.healthcare.gov.
If You Have Questions
Questions concerning Your Employer's health Plan and Your COBRA continuation coverage rights should
be addressed to the Employer. For more information about Your rights under ERISA, including COBRA,
the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting Employer 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 website at www.dol.gov/ebsa. (Addresses
and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.)
43
If You or anyone in Your family covered under the Employer's health Plan is determined by the Social
Security Administration to be disabled and You notify the Employer 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 24 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.
Notification Period
You must notify within the 18-months COBRA continuation period and no later than 60-days from the later
of:
The date of SSA determination, or
The date of the qualifying event, or
The date coverage would end due to the qualifying event.
Information should be sent to Your Human Resources Department.
Second Qualifying Event
If Your family has another qualifying event (such as a legal separation, divorce, etc.) during the initial 18
months of COBRA continuation coverage, Your Spouse and dependent children can receive up to 18
additional months of COBRA continuation coverage, for a maximum of 36 months from the original
qualifying event. Such additional coverage is only available if the second qualifying event would have
caused Your Spouse or dependent children to lose coverage under the Plan had the first qualifying event
not occurred. A qualified beneficiary must give timely notice to the Plan Administrator in such a situation.
Termination
In certain cases, Continuation Coverage will stop before the time period specified earlier. It will stop if any
one of the following situations is true:
Employee contributions are not paid on time.
The person becomes entitled to Medicare.
The Employer stops providing a group health benefits plan for employees.
The person becomes covered under another group health plan.
Gap in Coverage
If You choose not to enroll in Continuation Coverage, You may have a gap in Your coverage. Then, if You
later become eligible for a group health plan, You may be subject to a waiting period before coverage
begins, and it will not exceed 90 days.
Other Coverage Options Besides COBRA Continuation Coverage
Instead of enrolling in COBRA continuation coverage, there may be other coverage options for You and
Your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage
options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these
options may cost less than COBRA continuation coverage. You can learn more about many of these
options at www.healthcare.gov.
If You Have Questions
Questions concerning Your Employer's health Plan and Your COBRA continuation coverage rights should
be addressed to the Employer. For more information about Your rights under ERISA, including COBRA,
the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting Employer 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 website at www.dol.gov/ebsa. (Addresses
and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.)
43
