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COBRA
(Consolidated Omnibus Budget Reconciliation Act)

General Description of Rights and Obligations
When Electing COBRA Continuation Coverage

COBRA continuation coverage is a continuation of health plan coverage when coverage would otherwise end
because of a life event known as a “qualifying event.” Specific qualifying events are listed later in this notice.
COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” A qualified
beneficiary is someone who will lose coverage under the Plan because of a qualifying event. Depending on
the type of qualifying event, employees, spouses of employees, and dependent children of employees may be
qualified beneficiaries. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must
pay for COBRA continuation coverage.

If, during the course of employment, a “qualifying event” occurs, HR must be notified in writing of the
“qualifying event” within 60 days of the event. Appropriate forms can be obtained from the HR department.

“QUALIFYING EVENTS” are:
Termination of the employee’s employment (other than for gross misconduct) or reduction of hours worked
which renders loss of coverage to the employee and/or covered dependents;

 Death of the employee;
 Divorce or legal separation;
 For a spouse and eligible dependent – loss of coverage due to the employee’s entitlement to Medicare; or
 For a dependent child – ceasing to qualify as a dependent under the Plan.

More detailed information will be mailed to eligible employees and covered dependents at the home address.
It should be made available for all covered dependents to review. If a copy needs to be mailed to another
address, that address must be provided to the HR department. The HR department must always be notified of
any change of address for any covered dependent.

Coverage can only be continued for dependents that are covered at the time of the qualifying event; that is, if
the spouse and/or children are not covered during employment, coverage cannot be elected at termination.
Domestic Partners cannot independently select COBRA due to the dissolution of the partnership or other
reasons; they can only be covered if the terminating employee selects coverage for him/herself and the
partner.

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