Dear MBL Group Health Care Participant and Eligible Dependents:
This notice contains important information about your right to continue your health care coverage in the Marine Biological Laboratory Group Health Plan (“the Plan”) as well as other health coverage alternatives that may be available to you through the Health Insurance Marketplace.
Please read the information contained in this notice very carefully. If you have any questions concerning the information in this notice or your rights to coverage, you should contact the Marine Biological Laboratory’s Department of Human Resources at (508) 289-7422.
If you (or your covered spouse or covered dependent children) experience one of the following Qualifying Events, you may be entitled to continue your group health care coverage by paying the appropriate premium for up to 18 months (for events 1-2) or 36 months (for events 3-6) or for 29 months in the event of disability (see Page 2 for more information on Disability). For Qualifying Events 5-6 you must notify Human Resources within 60 days after the Qualifying Event occurs.
- End of employment
- Reduction in hours of employment
- Covered employees coverage by Medicare
- Death of employee
- Divorce or legal separation
- Loss of dependent child status
Cost of Continued Coverage, 2014
Cost of Continued Coverage for member of the Collective Bargaining Unit is available from the Human Resources office.
|Plan Name||Level of Coverage||Monthly Premium|
|HMO Blue New England||Individual||$ 645.64|
|Blue Choice New England||Individual||$ 680.71|
|Blue Care Elect (outside NE only)||Individual||$ 636.27|
|Dental Blue||Individual||$ 32.59|
|Individual +1||$ 75.89|
Important Information About Your COBRA Continuation Coverage Rights
What is continuation coverage?
Federal law requires that most group health plans (including this Plan) give employees and their families the opportunity to continue their health care coverage when there is a “qualifying event” that would result in a loss of coverage under an employer’s plan. Depending on the type of qualifying event, “qualified beneficiaries” can include the employee covered under the group health plan, a covered employee’s spouse, and dependent children of the covered employee.
Continuation coverage is the same coverage that the Plan gives to other participants or beneficiaries under the Plan who are not receiving continuation coverage. Each qualified beneficiary who elects continuation coverage will have the same rights under the Plan as other participants or beneficiaries covered under the Plan, including open enrollment and special enrollment rights. Specific information describing continuation coverage can be found in the Plan’s Subscriber Certificate of Coverage, which can be obtained from Blue Cross Blue Shield of Massachusetts by calling 1-800-262-BLUE.
How long will continuation coverage last?
In the case of a loss of coverage due to end of employment or reduction in hours of employment, coverage generally may be continued for up to a total of 18 months. In the case of losses of coverage due to an employee’s death, divorce or legal separation, the employee’s becoming entitled to Medicare benefits or a dependent child ceasing to be a dependent under the terms of the plan, coverage may be continued for up to a total of 36 months. When the qualifying event is the end of employment or reduction of the employee’s hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. This notice shows the maximum period of continuation coverage available to the qualified beneficiaries.
Continuation coverage will be terminated before the end of the maximum period if:
• any required premium is not paid in full on time,
• a qualified beneficiary becomes covered, after electing continuation coverage, under another group health plan that does not impose any pre-existing condition exclusion for a pre-existing condition of the qualified beneficiary (note: there are limitations on plans’ imposing a preexisting condition exclusion and such exclusions will become prohibited beginning in 2014 under the Affordable Care Act),
• a qualified beneficiary becomes entitled to Medicare benefits (under Part A, Part B, or both) after electing continuation coverage, or
• the employer ceases to provide any group health plan for its employees.
Continuation coverage may also be terminated for any reason the Plan would terminate coverage of a participant or beneficiary not receiving continuation coverage (such as fraud).
* How can you extend the length of continuation coverage (if your length of continued coverage is maximized at 18 months)?
If you elect continuation coverage, an extension beyond the maximum period of 18 months of coverage may be available if a qualified beneficiary is disabled or a second qualifying event occurs. You must notify The Marine Biological Laboratory Human Resources Department of a disability or a second qualifying event in order to extend the period of continuation coverage. Failure to provide notice of a disability or second qualifying event may affect the right to extend the period of continuation coverage.
An 11-month extension of coverage, beyond the initial 18 months, may be available if any of the qualified beneficiaries is disabled. The Social Security Administration (SSA) must determine that the qualified beneficiary was disabled at some time during the first 60 days of continuation coverage, and you must notify the MBL’s Human Resources Department of that fact within 60 days of the SSA’s determination and before the end of the first 18 months of continuation coverage. All of the qualified beneficiaries listed who have elected continuation coverage will be entitled to the 11-month disability extension if one of them qualifies. If the qualified beneficiary is determined by SSA to no longer be disabled, you must notify The Marine Biological Laboratory Human Resources Department of that fact within 30 days of SSA’s determination.
Second Qualifying Event
An 18-month extension of coverage, beyond the initial 18 months, will be available to spouses and dependent children who elect continuation coverage if a second qualifying event occurs during the first 18 months of continuation coverage. The maximum amount of continuation coverage available when a second qualifying event occurs is 36 months. Such second qualifying events include the death of a covered employee, divorce or separation from the covered employee, the covered employee’s enrolling in Medicare, or a dependent child’s ceasing to be eligible for coverage as a dependent under the Plan. You must notify The Marine Biological Laboratory Human Resources Department within 60 days after a second qualifying event occurs.
How can you elect continuation coverage?
To elect continuation coverage, you must complete the Election Form and furnish it according to the directions on the form. Each qualified beneficiary has a separate right to elect continuation coverage. For example, the employee’s spouse may elect continuation coverage even if the employee does not. Continuation coverage may be elected for only one, several, or for all dependent children who are qualified beneficiaries. A parent may elect to continue coverage on behalf of any dependent children. The employee or the employee’s spouse can elect continuation coverage on behalf of all of the qualified beneficiaries.
In considering whether to elect continuation coverage, you should take into account that you have special enrollment rights under federal law. You have the right to request special enrollment in another group health plan for which you are otherwise eligible (such as a plan sponsored by your spouse’s employer) within 30 days after your group health coverage ends because of the qualifying event listed above. You will also have the same special enrollment right at the end of continuation coverage if you get continuation coverage for the maximum time available to you.
How much does continuation coverage cost?
Generally, each qualified beneficiary may be required to pay the entire cost of continuation coverage. The amount a qualified beneficiary may be required to pay may not exceed 102 percent of the cost to the group health plan (including both employer and employee contributions) for coverage of a similarly situated plan participant or beneficiary who is not receiving continuation coverage (or, in the case of an extension of continuation coverage due to a disability, 150 percent). The required payment for continuation coverage is described above.
When and how must payment for continuation coverage be made?
Payments must be paid by check or money order and payable to The Marine Biological Laboratory. Please do not send cash.
First payment for continuation coverage
If you elect continuation coverage, you do not have to send any payment for continuation coverage with the Election Form. However you must make your first payment for continuation coverage within 45 days after the date of your election. (This is the date the Election Notice is post-marked, if mailed.) If you do not make your first payment for continuation coverage within that 45 days, you will lose all continuation coverage rights under the Plan.
Your first payment must cover the cost of continuation coverage from the time your coverage under the Plan would have otherwise terminated up to the time you make the first payment. You are responsible for making sure that the amount of your first payment is enough to cover this entire period. You may contact The Marine Biological Laboratory Human Resources Department at (508)289-7422 to confirm the correct amount of your first payment.
Periodic payments for continuation coverage
After you make your first payment for continuation coverage, you will be required to pay for continuation coverage for each subsequent month of coverage. Under the Plan, these periodic payments for continuation coverage are due on the first day of the month for each month of coverage. If you make a periodic payment on or before its due date, your coverage under the Plan will continue for that coverage period without any break. The Plan will send periodic notices of payments due for these coverage periods.
Grace periods for periodic payments
Although periodic payments are due on the dates shown above, you will be given a grace period of 30 days to make each periodic payment. Your continuation coverage will be provided for each coverage period as long as payment for that coverage period is made before the end of the grace period for that payment. However, if you pay a periodic payment later than its due date but during its grace period, your coverage under the Plan will be suspended as of the due date and then retroactively reinstated (going back to the due date) when the periodic payment is made. This means that any claim you submit for benefits while your coverage is suspended may be denied and may have to be resubmitted once your coverage is reinstated.
If you fail to make a periodic payment before the end of the grace period for that payment, you will lose all rights to continuation coverage under the Plan.
For more information
This notice does not fully describe continuation coverage or other rights under the Plan. More information about continuation coverage and your rights under the Plan is available in your Subscribers Certificate of Coverage or from the Plan Administrator.
For more information about your rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, visit the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) website at www.dol.gov/ebsa or call their toll-free number at 1-866-444-3272. For more information about health insurance options available through a Health Insurance Marketplace, visit www.healthcare.gov.
Keep Your Plan Informed of Address Changes
In order to protect your and your family’s rights, you should keep the Marine Biological Laboratory Human Resources Department informed of any changes of address for you or your family members. You should also keep a copy, for your records, of any notices you send to the Marine Biological Laboratory.
If you have any questions, please do not hesitate to contact Human Resources at (508) 289-7422 or firstname.lastname@example.org.
Human Resources Coordinator