COBRA Coverage

Under the COBRA coverage rules, qualifying individuals can make self-payments for continued Plan coverage (called COBRA Coverage).

COBRA self-payments are different from short-hours self-payments in that with COBRA you pay for benefit months (coverage months) while short-hours self-payments (pages 17-18) are for eligibility (work months).

Qualifying Events/Maximum Coverage Period

  1. You and/or your dependents can elect COBRA coverage and make self-payments for the coverage for up to 18 months after coverage terminates if the coverage terminates due to one of the following events (called "qualifying events"):
    • A reduction in your hours; or
    • Termination of your employment (which includes retirement).
    If you or a covered dependent is disabled (as defined by the Social Security Administration for the purpose of Social Security disability benefits) on the date of one of the qualifying events listed above, or if you or a covered dependent becomes so disabled within 60 days after an 18-month COBRA period starts, the maximum coverage period will be 29 months for all members of your family who were covered under the Plan on the day before that qualifying event. The COBRA self-payment may be higher for the extra 11 months of coverage for the family. Also, you must notify the Fund Office within 60 days of such a determination by the Social Security Administration and within the initial 18-month period, and within 30 days of the date Social Security determines that the person is no longer disabled.
  2. Your dependents can elect COBRA coverage and make self-payments for the coverage for up to 36 months after coverage terminates if their coverage terminates due to one of the following events (called qualifying events):
    • Your divorce or legal separation from your spouse;
    • A child's failure to meet the definition of a dependent; or
    • Your death

Multiple Qualifying Events - If your dependents are covered under COBRA coverage under an 18-month maximum coverage period due to your termination of employment or reduction in hours and a second qualifying event (such as divorce or a child losing dependent status) occurs, your spouse or the child is entitled to elect COBRA coverage for up to a maximum of 36 months minus the number of months of COBRA coverage already received under the 18-month continuation. Only a person who was your dependent on the date of your termination of employment or reduction in hours is entitled to make an election for this extended period. Exception: If a child is born to you (employee), adopted by you or placed with you for adoption during the first 18-month continuation period, that child will have the same election rights when a second qualifying event occurs as those of a person who was your dependent on the day before the first qualifying event.

It is the affected dependent's responsibility to notify the Fund Office within 60 days after a second qualifying event occurs. If the Fund Office is not notified within 60 days, the dependent will lose the right to extend COBRA coverage beyond the original 18-month period.

COBRA Coverage During Military Service - Refer to Eligibility During Military Service on page 21.

Benefit Options Under COBRA Coverage

If you or a dependent elect COBRA coverage, you will have a choice of the following options:

  1. Medical benefits only, which includes the Routine Physical Exam Benefit, the Diagnostic X-Ray and Lab (DXL) Benefit, the Comprehensive Benefit, the Mental Health and Substance Abuse Benefit, and the Prescription Drug Programs. (Note - No Routine Physical Exam or DXL Benefits are payable for dependent children.)
  2. Medical benefits (as stated in No.1 above) plus the Dental Benefit and the Vision Care Benefit.
  3. Medical benefits (as stated in No. 1 above) plus the Dental and Vision Benefits plus Life Insurance. (This option is only for employees whose reduction in hours or termination of employment is due to reasons other than retirement, and only the employee is eligible for Life Insurance.)

AD&D Insurance and Weekly Income Benefits are not provided under COBRA coverage.

You must be enrolled in Medicare Part B if you are eligible for Medicare when your COBRA coverage begins.

You cannot change your coverage option after you have elected COBRA.

Notification Responsibilities

If you get divorced or legally separated or if a child loses dependent status—you, your spouse or the child must notify the Fund Office within 60 days of the date of the event or within 60 days of the date coverage for the affected person(s) would terminate, whichever date is later. If written notification is not provided within these time limits, your spouse or child will not be entitled to COBRA coverage.

Your employer must notify the Fund Office within 30 days of any other qualifying events that could cause loss of coverage. However, to make sure that you are sent notice of your election rights as soon as possible, you or the affected dependent should notify the Fund Office any time a qualifying event occurs.

Reminder - So that the Fund Office can give proper notification when coverage terminates, please be sure the Fund Office always has the current mailing address for you and all your covered dependents. You can call the Fund Office with the address change or you can fill out and mail in one of the change of address cards in this booklet.

Self-Payment Procedures and Rules

  1. When the Fund Office is notified of a qualifying event, you and/or your dependents will be sent an election notice that explains COBRA coverage election rights, the due dates, the amount of the self-payments, the benefit options that can be elected, etc.
  2. An election form will be sent along with the election notice. This is the form you or a dependent fill in and send back to the Fund Office if you want to elect COBRA coverage.
  3. The person electing COBRA coverage has 60 days after he is sent the election notice or 60 days after his coverage would terminate, whichever is later, to send back the completed election form. (However, it is strongly recommended that the form be sent back as soon as possible.) An election of COBRA coverage is considered to be made on the date of the postmark on the returned election form.
  4. If the election form is not mailed back to the Fund Office within the allowable period, you and/or your dependents will be considered to have waived your right to COBRA coverage.
  5. After the filled-in election form is returned to the Fund Office, the Fund Office will send the person electing the coverage a packet of payment coupons. A coupon should accompany each self-payment that is made.
  6. A person electing COBRA coverage has 45 days after the date of the mailing postmark on the signed election form to make his initial payment. (However, it is strongly recommended that the payment be made as soon as possible so that a number of months won't have to be paid for all at once.) You will not be considered to be eligible until the on-time payment is received.
  7. COBRA self-payments must be made monthly. After the initial self-payment, each subsequent monthly self-payment is due by the first day of the benefit month for which the self-payment is being made. A self-payment will be considered on time if it is received by the Fund Office within 30 days of the due date.
  8. If a self-payment is not made within the time allowed, COBRA coverage for all affected family members will terminate. The self-payment may not be made up nor may coverage be reinstated by making future self-payments.
  9. The amounts of the monthly self-payments are determined by the Trustees based on federal regulations. The amounts are subject to change.
  10. Once a self-payment has been accepted by the Fund Office, it will not be returned.
  11. If you, the employee, make COBRA self-payments because of reduced hours, you will be credited with 125 credited hours in the eligibility month corresponding to the benefit month for which you make the self-payment. These hours will be considered credited hours under the Continuing Eligibility rules.

Additional Rules Governing COBRA Coverage

  1. COBRA coverage may be elected for a person who is entitled to Medicare on his election date, however, if the person becomes covered under Medicare after he has elected COBRA coverage, the person's COBRA coverage will terminate. (Note: You must be enrolled in Medicare Part B if you are eligible for Medicare when your COBRA coverage begins.)
  2. COBRA coverage may be elected for a person who is covered under another group health care plan; however, if the person becomes covered under another group health care plan after he has elected COBRA coverage, the person's COBRA coverage will terminate unless the person has a preexisting condition that would cause benefits to be excluded or limited under the other plan.
  3. Each member of your family who would lose coverage because of a qualifying event is entitled to make a separate election of COBRA coverage. If you elect COBRA coverage for yourself and your dependents, your election is binding on your dependents. If you don't elect COBRA coverage for your dependents when they are entitled to COBRA coverage, your dependent spouse has the right to elect COBRA coverage for herself and any children, or the children may elect independently.
  4. You do not have to show that you or your dependents are insurable in order to elect COBRA coverage.

Termination of COBRA Coverage

COBRA coverage for a person will be terminated before the end of the applicable maximum coverage period when the first of the following events occurs:

  1. A correct and on-time self-payment is not made to the Fund;
  2. The Line Construction Benefit Fund no longer provides group health coverage to any employees;
  3. The person has been receiving extended COBRA coverage for up to an additional 11 months due to his or another family member's disability, and the Social Security Administration has determined that the previously disabled person is no longer disabled;
  4. The person becomes covered under another group health plan. Exception: This termination rule will not apply if the person has a preexisting medical condition that would cause benefits to be excluded or limited under the other Plan; or
  5. The person becomes entitled to Medicare.