Page 39 - 2022 DPR Construction Benefit Guide_Administrative Employees

Special enrollment rights also may exist in the following called a “qualifying event.” Specific qualifying events are listed later
circumstances: in this notice. After a qualifying event, COBRA continuation coverage
• If you or your dependents experience a loss of eligibility for must be offered to each person who is a “qualified beneficiary.”
Medicaid or a state Children’s Health Insurance Program (CHIP) You, your spouse, and your dependent children could become
coverage and you request enrollment within 60 days after that qualified beneficiaries if coverage under the Plan is lost because
coverage ends; or of the qualifying event. Under the Plan, qualified beneficiaries
who elect COBRA continuation coverage must pay for COBRA
• If you or your dependents become eligible for a state premium
assistance subsidy through Medicaid or a state CHIP with continuation coverage.
respect to coverage under this plan and you request enrollment If you’re an employee, you’ll become a qualified beneficiary if
within 60 days after the determination of eligibility for such you lose your coverage under the Plan because of the following
assistance. qualifying events:
Note: The 60-day period for requesting enrollment applies only in • Your hours of employment are reduced, or
these last two listed circumstances relating to Medicaid and state • Your employment ends for any reason other than your
CHIP. As described above, a 30 day period applies to most special gross misconduct.
enrollments.
If you’re the spouse of an employee, you’ll become a qualified
To request special enrollment or obtain more information, contact: beneficiary if you lose your coverage under the Plan because of the
Name: Anne Anderson following qualifying events:
Address: 1450 Veterans Blvd. Redwood City, CA 94063 • Your spouse dies;
Phone Number: 650-306-7700
• Your spouse’s hours of employment are reduced;
Continuation Coverage Rights • Your spouse’s employment ends for any reason other than his or
Under COBRA her gross misconduct;
• Your spouse becomes entitled to Medicare benefits (under Part
Introduction A, Part B, or both); or

You’re getting this notice because you recently gained coverage • You become divorced or legally separated from
under a group health plan (the Plan). This notice has important your spouse.
information about your right to COBRA continuation coverage, which Your dependent children will become qualified beneficiaries if they
is a temporary extension of coverage under the Plan. This notice lose coverage under the Plan because of the following qualifying
explains COBRA continuation coverage, when it may become events:
available to you and your family, and what you need to do • The parent-employee dies;
to protect your right to get it. When you become eligible for
COBRA, you may also become eligible for other coverage options • The parent-employee’s hours of employment are reduced;
that may cost less than COBRA continuation coverage. • The parent-employee’s employment ends for any reason other
than his or her gross misconduct;
The right to COBRA continuation coverage was created by a federal • The parent-employee becomes entitled to Medicare benefits
law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (Part A, Part B, or both);
(COBRA). COBRA continuation coverage can become available
to you and other members of your family when group health • The parents become divorced or legally separated; or
coverage would otherwise end. For more information about your • The child stops being eligible for coverage under the Plan as a
rights and obligations under the Plan and under federal law, you “dependent child.”
should review the Plan’s Summary Plan Description or contact the When is COBRA continuation coverage available?
Plan Administrator.
The Plan will offer COBRA continuation coverage to qualified
You may have other options available to you when you lose beneficiaries only after the Plan Administrator has been notified that
group health coverage. For example, you may be eligible to buy a qualifying event has occurred. The employer must notify the Plan
an individual plan through the Health Insurance Marketplace. By Administrator of the following qualifying events:
enrolling in coverage through the Marketplace, you may qualify for
lower costs on your monthly premiums and lower out-of-pocket • The end of employment or reduction of hours of employment;
costs. Additionally, you may qualify for a 30-day special enrollment • Death of the employee; or
period for another group health plan for which you are eligible (such • The employee’s becoming entitled to Medicare benefits (under
as a spouse’s plan), even if that plan generally doesn’t accept Part A, Part B, or both).
late enrollees.
For all other qualifying events (divorce or legal separation
of the employee and spouse or a dependent child’s losing
What is COBRA continuation coverage?
eligibility for coverage as a dependent child), you must
COBRA continuation coverage is a continuation of Plan coverage notify the Plan Administrator within 60 days after the
when it would otherwise end because of a life event. This is also qualifying event occurs. You must provide this notice to:
Anne Anderson, Human Resources, 650-306-7700.

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