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COBRA continuation of benefits

When medical, dental, and FSA coverage ends
Your medical, dental, and/or flexible spending account benefit coverage will
end on the earliest of the following dates:
■ The last day of the calendar month in which you and/or your
dependent are no longer eligible.
■ The last day of the calendar month in which you are no longer
employed by Texas Mutual. Note: premium deductions for medical
and dental coverage, flexible spending account contributions, as well
as those for elected optional benefits will be taken for the full month
in which employment ends.
■ The date Texas Mutual terminates the benefits as described in this
Resource Guide.
Employees and qualified beneficiaries notice requirements
To preserve COBRA rights, covered employees and qualified beneficiaries are
required to provide notice to Texas Mutual Insurance Company of the
following qualifying events:

1. The divorce of the covered employee from his or her spouse; employee
must notify us within 60 days after the latest of 1) the date this qualifying
event occurred, 2) the date that employee would lose coverage as result of
this event or 3) the date provided in the Summary Plan Description (SPD) or
initial COBRA notice.
2. The beneficiary ceases to be covered under the plan as a dependent child
of a participant; beneficiary must notify us within 60 days after the latest of 1)
the date this qualifying event occurred, 2) the date that the beneficiary would
lose coverage as result of this event or 3) the date provided in the SPD or
initial COBRA notice.

3. The occurrence of a second qualifying event after a qualified beneficiary has
become entitled to continuation coverage based on employee termination or
reduction in work hours with a maximum duration of 18 or 29 months;
beneficiary must notify us within 60 days after the latest of 1) the date this
qualifying event occurred, 2) the date that the beneficiary would lose
coverage as result of this event or 3) the date provided in the SPD or initial
COBRA notice.

4. A determination by the Social Security Administration that a qualified
beneficiary, entitled to receive continuation coverage with a maximum of 18
months, is disabled at any time during the first 60 days of continuation
coverage; beneficiary must notify us within 60 days after the latest of 1) the
date of disability determination by the Social Security Administration, 2) the
date this qualifying event occurred, 3) the date the beneficiary would lose
coverage as a result of this event, or 4) the date provided in the SPD or initial
COBRA notice, but in no event later than the first 18 months of continuation
coverage.

Employee Benefits Guide 23