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COBRA continuation of benefits, cont.

5. A determination by the Social Security Administration that a qualified
beneficiary is no longer disabled; beneficiary must notify us within 30 days
after the later of 1) the date of final determination by the Social Security
Administration that the beneficiary is no longer disabled or 2) the date
provided in the SPD or initial COBRA notice.

The above notices may be provided by the covered employee, a qualified
beneficiary with respect to the qualifying event, or a representative of the
employee or beneficiary. Notice by one individual will satisfy the notice
responsibility of all related qualifying beneficiaries with respect to the
qualifying event.
If the employee or qualified beneficiary does not provide notice of the
above-described events within the time limit provided above with respect to
each event, Texas Mutual Insurance Company is not required to make COBRA
coverage available.
Proper notification by a current employee would be the employee completing
a benefit change in Workday, or via a written notice. Proper notification by a
qualified beneficiary would be by written notice. The written notice must
include the name of the employee and qualifying beneficiaries, the applicable
qualifying event from the above-described list, the date the qualifying event
occurred, and the employee’s or qualifying beneficiaries’ contact information.
If notice is made in writing, it must be either hand-delivered or mailed by
United States mail, postage pre-paid, and addressed to:
Attn: Human Resources—Employee Benefits
2200 Aldrich Street
Austin, TX 78723
COBRA coverage
If you elect to continue coverage under the Consolidated Omnibus Budget
Reconciliation Act of 1985 (COBRA), you and/or your dependents will receive
the same medical and dental benefits you were entitled to as an employee
provided you pay the COBRA premium. Qualifying events for COBRA eligibility
are listed in the chart below.
Monthly COBRA premiums

Enrollment Level Medical Dental
Individual* $719.10 $35.70
Employee and Children $1,366.80 $99.96
Employee and Spouse $1,509.60 $75.48
Employee and Family $2,157.30 $139.74

*Individual refers to a former employee or a dependent eligible for COBRA

24 Employee Benefits Guide