Page 23 - 2016 WFF Guide 1
P. 23
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I mportant Y ou must mak e sure that the P lan
F or the other q uali f yi n g ev en ts ( di v orc e or legal sep arati on of the em p loyee Administrator or its designee is notiied
an d sp ouse or an eli gi b le c hi ld’ s losi n g eli gi b i li ty f or c ov erage as an eli gi b le in w riting of the S ocial S ecurity
c hi ld) , you or som eon e on your b ehalf m ust n oti f y the Plan A dm i n i strator A d ministration’ s d etermination w ithin
or i ts desi gn ee i n w ri ti n g w i thi n 6 0 days af ter the q uali f yi n g ev en t oc c urs, 6 0 d ays after ( i) of the d ate of the
using the procedures speciied below. If these procedures are not followed d etermination or ( ii) the d ate of the
or i f the n oti c e i s n ot p rov i ded i n w ri ti n g to the Plan A dm i n i strator or i ts q ualifying ev ent or ( iii) the d ate cov erage
desi gn ee duri n g the 6 0 - day n oti c e p eri od, an y sp ouse or eli gi b le c hi ld w ho is lost d ue to the q ualifying ev ent,
loses c ov erage w i ll n ot b e of f ered the op ti on to elec t c on ti n uati on c ov erage. w hichev er occurs last. B ut in any ev ent
the notice must be prov id ed before the
O nce the P lan A d ministrator receiv es timely notice that a q ualifying ev ent has end of the 1 8 - month period of C O B R A
occurred, COBRA continuation coverage will be offered to each of the qualiied continuation cov erage. The plan req uires
beneiciaries. Each qualiied beneiciary will have an independent right to elect you to follow the procedures speciied
C O B R A continuation cov erage. C ov ered employees may elect C O B R A continuation in the box abov e, und er the head ing
cov erage for their spouses, and parents may elect C O B R A continuation cov erage on entitled “ N otice P roced ures.” I n ad d ition,
behalf of their children. For each qualiied beneiciary who elects COBRA continuation your notice must includ e
cov erage, C O B R A continuation cov erage w ill begin on the d ate that plan cov erage the name of the disabled qualiied
w ould otherw ise hav e been lost. I f you or your spouse or eligible child ren d o not elect beneiciary,
continuation cov erage w ithin the 6 0 - d ay election period d escribed abov e, you w ill lose the date that the qualiied
your right to elect continuation cov erage. beneiciary became disabled, and
D uration of C O B R A C ov erage the d ate that the S ocial S ecurity
A d ministration mad e its
C O B R A continuation cov erage is a temporary continuation of cov erage. W hen the d etermination
q ualifying ev ent is the d eath of the employee, enrollment of the employee in any part Y our notice must also includ e a copy
of M ed icare, your d iv orce or legal separation, or an eligible child losing eligibility as an of the S ocial S ecurity A d ministration’ s
eligible child , C O B R A continuation cov erage lasts for up to 3 6 months.
d etermination. I f these proced ures
W hen the q ualifying ev ent is the end of employment or red uction of the employee’ s are not follow ed or if the notice is
hours of employment, C O B R A continuation cov erage lasts for up to 1 8 months. not prov id ed in w riting to the P lan
A d ministrator or its d esignee w ithin
There are three w ays in w hich the period of C O B R A continuation cov erage can be the req uired period , then there w ill
ex tend ed . be no d isability ex tension of C O B R A
D isability E x tension of 1 8 - M onth P eriod of C obra C ontinuation continuation cov erage.
C ov erage S econd Q ualifying E v ent
I f you or anyone in your family cov ered und er the plan is d etermined by the S ocial E x tension of 1 8 - M onth P eriod of
S ecurity A d ministration to be d isabled as of the d ate of the q ualifying ev ent or at any C ontinuation C ov erage
time during the irst 60 days of COBRA continuation coverage and you notify the Plan I f your family ex periences another
A d ministrator or its d esignee in w riting and in a timely fashion, you and your entire q ualifying ev ent w hile receiv ing C O B R A
family can receiv e up to an ad d itional 1 1 months of C O B R A continuation cov erage, for continuation cov erage, the spouse and
a total max imum of 2 9 months. eligible child ren in your family can get
ad d itional months of C O B R A continuation
cov erage, up to a max imum of 3 6
months ( includ ing the initial period of
C O B R A cov erage) .
2016 Open Enrollment
I mportant Y ou must mak e sure that the P lan
F or the other q uali f yi n g ev en ts ( di v orc e or legal sep arati on of the em p loyee Administrator or its designee is notiied
an d sp ouse or an eli gi b le c hi ld’ s losi n g eli gi b i li ty f or c ov erage as an eli gi b le in w riting of the S ocial S ecurity
c hi ld) , you or som eon e on your b ehalf m ust n oti f y the Plan A dm i n i strator A d ministration’ s d etermination w ithin
or i ts desi gn ee i n w ri ti n g w i thi n 6 0 days af ter the q uali f yi n g ev en t oc c urs, 6 0 d ays after ( i) of the d ate of the
using the procedures speciied below. If these procedures are not followed d etermination or ( ii) the d ate of the
or i f the n oti c e i s n ot p rov i ded i n w ri ti n g to the Plan A dm i n i strator or i ts q ualifying ev ent or ( iii) the d ate cov erage
desi gn ee duri n g the 6 0 - day n oti c e p eri od, an y sp ouse or eli gi b le c hi ld w ho is lost d ue to the q ualifying ev ent,
loses c ov erage w i ll n ot b e of f ered the op ti on to elec t c on ti n uati on c ov erage. w hichev er occurs last. B ut in any ev ent
the notice must be prov id ed before the
O nce the P lan A d ministrator receiv es timely notice that a q ualifying ev ent has end of the 1 8 - month period of C O B R A
occurred, COBRA continuation coverage will be offered to each of the qualiied continuation cov erage. The plan req uires
beneiciaries. Each qualiied beneiciary will have an independent right to elect you to follow the procedures speciied
C O B R A continuation cov erage. C ov ered employees may elect C O B R A continuation in the box abov e, und er the head ing
cov erage for their spouses, and parents may elect C O B R A continuation cov erage on entitled “ N otice P roced ures.” I n ad d ition,
behalf of their children. For each qualiied beneiciary who elects COBRA continuation your notice must includ e
cov erage, C O B R A continuation cov erage w ill begin on the d ate that plan cov erage the name of the disabled qualiied
w ould otherw ise hav e been lost. I f you or your spouse or eligible child ren d o not elect beneiciary,
continuation cov erage w ithin the 6 0 - d ay election period d escribed abov e, you w ill lose the date that the qualiied
your right to elect continuation cov erage. beneiciary became disabled, and
D uration of C O B R A C ov erage the d ate that the S ocial S ecurity
A d ministration mad e its
C O B R A continuation cov erage is a temporary continuation of cov erage. W hen the d etermination
q ualifying ev ent is the d eath of the employee, enrollment of the employee in any part Y our notice must also includ e a copy
of M ed icare, your d iv orce or legal separation, or an eligible child losing eligibility as an of the S ocial S ecurity A d ministration’ s
eligible child , C O B R A continuation cov erage lasts for up to 3 6 months.
d etermination. I f these proced ures
W hen the q ualifying ev ent is the end of employment or red uction of the employee’ s are not follow ed or if the notice is
hours of employment, C O B R A continuation cov erage lasts for up to 1 8 months. not prov id ed in w riting to the P lan
A d ministrator or its d esignee w ithin
There are three w ays in w hich the period of C O B R A continuation cov erage can be the req uired period , then there w ill
ex tend ed . be no d isability ex tension of C O B R A
D isability E x tension of 1 8 - M onth P eriod of C obra C ontinuation continuation cov erage.
C ov erage S econd Q ualifying E v ent
I f you or anyone in your family cov ered und er the plan is d etermined by the S ocial E x tension of 1 8 - M onth P eriod of
S ecurity A d ministration to be d isabled as of the d ate of the q ualifying ev ent or at any C ontinuation C ov erage
time during the irst 60 days of COBRA continuation coverage and you notify the Plan I f your family ex periences another
A d ministrator or its d esignee in w riting and in a timely fashion, you and your entire q ualifying ev ent w hile receiv ing C O B R A
family can receiv e up to an ad d itional 1 1 months of C O B R A continuation cov erage, for continuation cov erage, the spouse and
a total max imum of 2 9 months. eligible child ren in your family can get
ad d itional months of C O B R A continuation
cov erage, up to a max imum of 3 6
months ( includ ing the initial period of
C O B R A cov erage) .
2016 Open Enrollment
