Group Health Continuation Coverage Under COBRA

Qualifying Events - Subscriber
If you are an employee of the State of Missouri covered by a group health plan offered through MCHCP, you have a right to choose this continuation coverage if you lose your group health plan coverage because of a reduction in your hours of employment or the termination of your employment (for reasons other than gross misconduct on your part).

Qualifying Events - Spouse
If you are the spouse of an employee covered by a group health plan offered through MCHCP, you have the right to choose continuation coverage for yourself if you lose group health coverage under a plan offered through MCHCP for any of the following reasons:

• The death of your spouse.
• A termination of your spouse’s employment (for reasons other than gross misconduct) or reduction in your spouse’s hours of employment with the State of Missouri.
• Divorce or legal separation from your spouse.
• Your spouse becomes entitled to Medicare.

Qualifying Events - Dependent Children
In the case of a dependent child of an employee covered by a group health plan offered by MCHCP, he or she has the right to continuation coverage if group health coverage under a plan offered through MCHCP is lost for any of the following reasons:

• The death of the employee.
• A termination of the employee’s employment (for reasons other than gross misconduct) or reduction in your hours of employment with the State of Missouri.
• The employee’s divorce or legal separation.
• The employee becomes entitled to Medicare.
• The dependent child ceases to be a “dependent child” under MCHCP’s eligibility rules.

Required Notifications
Under the law, the employee or a family member has the responsibility to inform MCHCP of a divorce, legal separation, or a child losing dependent status under MCHCP within 60 days of the date of the event.

The State of Missouri has the responsibility to notify MCHCP of the employee’s death, termination, reduction of hours of employment, or Medicare entitlement.

Election Period
When MCHCP is notified that one of these events has occurred, MCHCP notifies you that you have the right to choose continuation coverage. Under the law, you have at least 60 days from the date you would lose coverage (because of one of the events described above) to inform MCHCP that you want continuation coverage. The initial premium payment for continuation coverage must be received within 45 days of your election of that coverage.

If you choose continuation coverage, MCHCP is required to give you coverage which, at the time coverage is being provided, is identical to the coverage provided under the plan to similarly situated employees or family members.

If you do not choose continuation coverage in a timely basis, your group health insurance coverage ends and is not reinstated.

If you have Medicare prior to becoming eligible for COBRA coverage, you are entitled to coverage under both. However, Medicare is always primary, and COBRA is secondary.

Length of Continuation Coverage
The law requires that you be given the opportunity to maintain continuation coverage for 36 months, unless you lost group health coverage because of a termination of employment or reduction in hours. In that case, the required continuation coverage period is 18 months. This 18 months may be extended for affected individuals to 36 months from termination of employment if other events (such as a death, divorce, legal separation or Medicare entitlement) occur during the 18-month period. In no event will continuation coverage last beyond 36 months from the date of the event that originally made a qualified beneficiary eligible to elect coverage. The 18 months may be extended to 29 months if a qualified beneficiary is determined by the Social Security Administration to be disabled (for Social Security disability purposes) at any time during the first 60 days of COBRA coverage. This 11-month extension is available to all individuals who are qualified beneficiaries due to a termination or reduction in hours of employment. To benefit from this extension, a qualified beneficiary must notify MCHCP of that determination within 60 days and before the end of the original 18-month period. The affected individual must also notify MCHCP within 30 days of any final determination that the individual is no longer disabled.

New Dependents
A child who is born to or placed for adoption with a covered member during a period of COBRA coverage is eligible to become a qualified beneficiary. In accordance with the terms of MCHCP and the requirements of federal and state laws, these qualified beneficiaries can be added to COBRA coverage upon proper notification. Further details can be found at Enrollment Guidelines.

Termination of Continuation Coverage
The law also provides that continuation coverage may be cut short for any of these reasons:

• The State of Missouri no longer provides group health coverage to any of its employees.
• The premium for continuation coverage is not paid on time.
• The qualified beneficiary becomes covered (after the date he or she elects COBRA coverage) under another group health plan that does not contain any exclusion or limitation with respect to any pre-existing condition he or she may have.
• The qualified beneficiary becomes entitled to Medicare after the date he/she elects COBRA coverage.
• The qualified beneficiary extends coverage for up to 29 months due to disability and there has been a final determination that the individual is no longer disabled.

Premium Payment
Under the law, you are responsible for payment of all applicable premiums from the date coverage was initially lost, even if the election is made after that date. In addition to the normal premium, MCHCP charges a 2% administration charge for continuation coverage. Once the initial premium payment has been received, MCHCP bills you monthly. There is a grace period of 31 days for payment of the regularly scheduled monthly premiums.

Spousal Continuation Coverage (COBRA Wrap-Around)
Missouri law provides that if you lose your group health insurance coverage because of a divorce, legal separation, or the death of your spouse, you may continue until age 65 if:

• You continue and maintain coverage under the 36 month provision of COBRA, AND
• You are at least 55 years old when your COBRA benefits end.

Within 60 days of legal separation or the entry of a decree of dissolution of marriage or prior to the expiration of a 36 month COBRA period, the legally separated or divorced spouse who seeks such coverage shall give MCHCP written notice of the qualifying event including his/her mailing address. Within 30 days of the death of an employee whose surviving spouse is eligible for continued coverage or prior to the expiration of a 36 month COBRA period, the human resource/payroll representative shall give MCHCP written notice of the death and the mailing address of the surviving spouse.

Within 14 days of receipt of the notice, MCHCP shall notify the legally separated, divorced or surviving spouse that coverage may be continued. The notice shall include:

1. A form for election to continue the coverage.
2. The amount of premiums to be charged, the method and place of payment.
3. Instructions for returning the elections form by mail within 60 days after the plan administrator mails the notice.

The principal qualified beneficiary must apply for continuation coverage through the spousal continuation provisions and has to pay all of the applicable premiums. MCHCP may charge up to an additional 25% of the applicable premium.

The right to continuation coverage shall terminate upon the earliest of any of the following:

• The failure to pay premiums when due, including any grace period allowed by the policy.
• The date that the State of Missouri’s insurance is terminated to all group members.
• The date on which the legally separated, divorced or surviving spouse becomes insured under any other group health plan.
• The date on which the legally separated, divorced or surviving spouse remarries and becomes insured under another group health plan.
• The date on which the legally separated, divorced, or surviving spouse attains his/her 65th birthday.