Page 23 - Citizens Bank Benefit Guide 2020_Revised 12-11-2020

COBRA Notice

Continued

Are there other coverage options besides COBRA Continuation Coverage?

Yes. I stead of e rolli g i COBRA co ti uatio coverage, there may be other coverage optio s for you a d your family through
the Health I sura ce Mar etplace, Medicare, Medicaid, Childre ’s Health I sura ce Program (CHIP), or other group health pla
coverage optio s (such as a spouse’s pla ) through what is called a “special e rollme t period.” Some of these optio s may cost
less tha COBRA co ti uatio coverage. You ca lear more about ma y of these optio s at www.healthcare.gov.

Can I enroll in Medicare instead of COBRA continuation coverage after my group health
plan coverage ends?

I ge eral, if you do ’t e roll i Medicare Part A or B whe you are first eligible because you are still employed, after the Medicare
i itial e rollme t period, you have a 8-mo th special e rollme t period to sig up for Medicare Part A or B, begi i g o the
earlier of

• The mo th after your employme t e ds; or

The mo th after group health pla coverage based o curre t employme t e ds.

If you do ’t e roll i Medicare a d elect COBRA co ti uatio coverage i stead, you may have to pay a Part B late e rollme t
pe alty a d you may have a gap i coverage if you decide you wa t Part B later. If you elect COBRA co ti uatio coverage a d
later e roll i Medicare Part A or B before the COBRA co ti uatio coverage e ds, the Pla may termi ate your co ti uatio
coverage. However, if Medicare Part A or B is effective o or before the date of the COBRA electio , COBRA coverage may ot be
disco ti ued o accou t of Medicare e titleme t, eve if you e roll i the other part of Medicare after the date of the electio of
COBRA coverage.

If you are e rolled i both COBRA co ti uatio coverage a d Medicare, Medicare will ge erally pay first (primary payer) a d
COBRA co ti uatio coverage will pay seco d. Certai pla s may pay as if seco dary to Medicare, eve if you are ot e rolled i
Medicare.

For more i formatio visit https://www.medicare.gov/medicare-a d-you.

If you have questions

Questio s co cer i g your Pla or your COBRA co ti uatio coverage rights should be addressed to the co tact or co tacts
ide tified below. For more i formatio about your rights u der the Employee Retireme t I come Security Act (ERISA), i cludi g
COBRA, the Patie t Protectio a d Affordable Care Act, a d other laws affecti g group health pla s, co tact the earest Regio al
or District Office of the U.S. Departme t of Labor’s Employee Be efits Security Admi istratio (EBSA) i your area or visit
www.dol.gov/ebsa. (Addresses a d pho e umbers of Regio al a d District EBSA Offices are available through EBSA’s website.)
For more i formatio about the Mar etplace, visit www.HealthCare.gov.

Keep your Plan informed of address changes

To protect your family’s rights, let the Pla Admi istrator ow about a y cha ges i the addresses of family members. You
should also eep a copy, for your records, of a y otices you se d to the Pla Admi istrator.

Pla co tact i formatio is o the Co tact page.

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