Page 21 - Citizens Bank Benefit Guide 2020_Revised 12-11-2020

COBRA Notice

General Notice of COBRA Continuation Coverage Rights

** Continuation Coverage Rights Under COBRA**

Introduction

You’re getti g this otice because you rece tly gai ed coverage u der a group health pla (the Pla ). This otice has importa t
i formatio about your right to COBRA co ti uatio coverage, which is a temporary exte sio of coverage u der the Pla . This
notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do
to protect your right to get it. Whe you become eligible for COBRA, you may also become eligible for other coverage optio s that
may cost less tha COBRA co ti uatio coverage.
The right to COBRA co ti uatio coverage was created by a federal law, the Co solidated Om ibus Budget Reco ciliatio Act of
1985 (COBRA). COBRA co ti uatio coverage ca become available to you a d other members of your family whe group health
coverage would otherwise e d. For more i formatio about your rights a d obligatio s u der the Pla a d u der federal law, you
should review the Pla ’s Summary Pla Descriptio or co tact the Pla Admi istrator.
You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy a
i dividual pla through the Health I sura ce Mar etplace. By e rolli g i coverage through the Mar etplace, you may qualify for
lower costs o your mo thly premiums a d lower out-of-poc et costs. Additio ally, you may qualify for a 30-day special e roll-
me t period for a other group health pla for which you are eligible (such as a spouse’s pla ), eve if that pla ge erally does ’t
accept late e rollees.

What is COBRA continuation coverage?

COBRA co ti uatio coverage is a co ti uatio of Pla coverage whe it would otherwise e d because of a life eve t. This is also
called a “qualifyi g eve t.” Specific qualifyi g eve ts are listed later i this otice. After a qualifyi g eve t, COBRA co ti uatio
coverage must be offered to each perso who is a “qualified be eficiary.” You, your spouse, a d your depe de t childre could
become qualified be eficiaries if coverage u der the Pla is lost because of the qualifyi g eve t. U der the Pla , qualified
be eficiaries who elect COBRA co ti uatio coverage you must pay for COBRA co ti uatio coverage.
If you’re a employee, you’ll become a qualified be eficiary if you lose your coverage u der the Pla because of the followi g
qualifyi g eve ts:
• Your hours of employme t are reduced, or
• Your employme t e ds for a y reaso other tha your gross misco duct.

If you’re the spouse of a employee, you’ll become a qualified be eficiary if you lose your coverage u der the Pla because of the
followi g qualifyi g eve ts:
• Your spouse dies;
• Your spouse’s hours of employme t are reduced;
• Your spouse’s employme t e ds for a y reaso other tha his or her gross misco duct;
• Your spouse becomes e titled to Medicare be efits (u der Part A, Part B, or both); or
• You become divorced or legally separated from your spouse.
• The child stops bei g eligible for coverage u der the Pla as a “depe de t child.”

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