UFCW Midwest - Midwest Health and Pension Funds

United Food & Commercial Workers

Unions and Employers

Midwest Health and Pension Funds

COBRA—Continuation of Coverage

In compliance with the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), the Health Plan offers you and your eligible dependents the opportunity to continue health coverage by making self-payments when coverage would otherwise end.

You may elect to continue coverage for Medical Benefits only or Medical, Dental and Vision Benefits. Life Insurance, Accidental Death and Dismemberment (AD&D) Benefits and Income Protection Benefits cannot be continued.

If you have any questions regarding COBRA, contact the Fund Office.

Qualifying for COBRA

To qualify for COBRA coverage, you or your eligible dependent must experience a qualifying event.

A qualifying event for you is:

  • a reduction in the number of hours worked; or
  • a termination of employment for any reason (including retirement) other than gross misconduct.

For an eligible dependent, a qualifying event may be:

  • your death;
  • a reduction in the number of hours you work;
  • termination of your employment (including retirement) for any reason other than gross misconduct;
  • your divorce or legal separation;
  • your entitlement to Medicare; or
  • the loss of dependent status.

If you or your eligible dependent have a qualifying event, you need to notify the Fund Office within 60 days. Notice procedures are described below.

If you have a newborn child, adopt a child or have a child placed with you for adoption (for whom you have financial responsibility) while your COBRA continuation coverage is in effect, you may add this child to your coverage if you were eligible for Dependent Coverage when you elected COBRA coverage. You must submit an original, certified birth certificate issued by the appropriate governmental agency. In the case of adoption, you must submit legal documentation indicating the initiation and/or finalization of the adoption process.

If you get married while your COBRA coverage is in effect, you may add your spouse to your coverage if you were eligible for Dependent Coverage when you elected COBRA coverage. A copy of your marriage license will be required by the Fund Office.

Proof of good health is not required to obtain COBRA coverage.

Continuation Coverage Period

The COBRA coverage period depends on the type of qualifying event that caused loss of eligibility under the Plan.

Generally, COBRA coverage will remain in effect for a period of 18 months (or up to 29 months for disabled individuals, as described below) if the qualifying event is:

  • a reduction in the number of hours you work; or
  • termination of your employment (including retirement) for any reason other than gross misconduct.

COBRA coverage will continue for a maximum period of 36 months if the qualifying event is:

  • your death;
  • divorce or legal separation;
  • your entitlement to Medicare; or
  • the loss of dependent status.

Any period of extended coverage provided at no cost under the “Extension of Coverage During Disability” provisions (see the “Miscellaneous Eligibility Provisions” section on the Election of Coverage and Eligibility Provisions page of your plan—either Plan D5 or Plan B5), will reduce the period allowed for self-payment of contributions for continuation coverage under the COBRA provisions by a period equal to the extended coverage.

Extension of Coverage Period for a Second Qualifying Event

If your family experiences a second qualifying event while receiving 18 months of COBRA coverage because of a reduction in the number of hours you work or termination of employment, your eligible dependents can get up to 18 additional months of COBRA coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the Fund Office.

This extension is available to your eligible dependents if one of the following events occurs and would have caused the eligible dependent to lose coverage under the Plan if the first qualifying event had not occurred:

  • your death;
  • divorce or legal separation;
  • your entitlement to Medicare; or
  • the loss of dependent status.

Coverage for Disabled Individuals

If you or any of your eligible dependents are disabled (as determined by Social Security) at the time or within 60 days of the date your employment ends or your hours are reduced, COBRA coverage can be extended an additional 11 months, to a maximum period of 29 months. The extension applies to the disabled person and any other covered family members. For coverage to continue, the Fund Office must be properly notified:

  • before the 18 month period ends; and
  • within 60 days of the date of disability.

Any period of extended coverage during disability provided at no cost will reduce the period allowed for COBRA coverage by a period equal to the extended coverage.

Proof of disability must be given. The premium payment for this extended coverage may be higher than that for COBRA coverage.

The Fund Office must also be notified within 30 days of any subsequent determination by Social Security that the disabled individual is no longer disabled.

Termination of COBRA Coverage

Once COBRA coverage is elected, it will stay in effect until the earliest of the following:

  • the date you or your eligible dependent complete the maximum period of COBRA coverage for which you or your eligible dependent are eligible;
  • the date a self-payment is not paid on time;
  • the date after your COBRA election date that you or your eligible dependent become covered under any other group health plan;
  • the date after your COBRA election date that you or your eligible dependent become entitled to Medicare;
  • the date the Plan terminates; or
  • the date your employer ceases to provide any group health plan to any employee.

Note: If you or your eligible dependent become covered under another group health plan that has a pre-existing condition limitation or exclusion of coverage period, COBRA coverage provided under this Plan will remain in effect until the pre-existing condition waiting period is satisfied. However, in no event will COBRA remain in effect longer than the maximum period to which the individual is entitled.

COBRA Premium Payments

After the Fund Office receives your form electing COBRA coverage, you will be mailed a statement showing the amount due. You will then have 45 days from the date of election to pay the full amount due. COBRA coverage will not be effective until full payment is made.

When you elect COBRA coverage, you must make your COBRA payments on time in order to keep your coverage in effect. If you are late with your payments, your coverage will be terminated. You will receive more information regarding premium amounts and due dates after you experience a qualifying event.

Premium payments must be sent to the Fund Office at: 18861 90th Avenue, Suite A, Mokena, IL  60448-8178.

The Fund Office has the capability to collect your monthly COBRA payment directly from your bank account through electronic transfer. You may wish to consider this option. Don’t let a late or lost COBRA check jeopardize your coverage.

You can download and print the Authorization Agreement for Electronic Transfer of Payments for COBRA or you can contact the Fund Office to request the form.

COBRA Notice Procedures

General Notice of Continuation Coverage

An initial general notice describing COBRA rights will be given to you (and your spouse if you are married) when you become covered under the Plan and will contain the information required by COBRA. The Fund Office may provide this notice in a summary plan description (“SPD”) furnished in accordance with the paragraph below.

The general notice will be provided no later than 90 days after you become covered under the Plan. If, on the basis of the most recent information available to the Fund Office, you and your spouse reside at the same location, and your spouse becomes covered under the Plan on or after the date you become covered (but not later than the date on which the notice required by this section is required to be provided to the participant), the Fund Office may mail you and your spouse a single notice or SPD.

Notice of Qualifying Events

If the qualifying event that occurs is the termination of employment or reduction of hours of employment, your death or entitlement to Medicare benefits, the employer must notify the Fund Office of the qualifying event. However, you or another family member should notify the Fund Office if any of these qualifying events occurs to assure that you receive COBRA election materials as soon as possible.

If you or your eligible dependent have a qualifying event or second qualifying event that is a divorce or legal separation or a dependent child’s loss of eligibility for coverage as a dependent, you need to notify the Fund Office in writing within 60 days. You may be asked to provide verification in the form of a copy of your divorce decree, certified copy of your marriage certificate, etc. You or your eligible dependent will be ineligible for COBRA coverage or extended COBRA coverage (in the case of a second qualifying event) if you or your dependent fail to timely notify the Fund Office.

You must promptly notify the Fund Office if you and your spouse become divorced. If you fail to do so and your former spouse continues to claim or receive benefits under the Plan, you and your spouse can be subject to loss of benefits, lawsuits and criminal charges. In addition, it is your responsibility to understand your marital status and to inform the Fund Office when a qualifying event has occurred.

As noted above, you must also notify the Fund Office of a disability determination before the 18-month period ends and within 60 days of the date of disability. In addition, the Fund Office must be notified within 30 days of any subsequent determination by Social Security that the disabled individual is no longer disabled.

The notice of a qualifying event or disability determination must be in writing and must include sufficient information to enable the Plan Administrator to determine the following information:

  • the Plan,
  • the covered participant and qualified beneficiaries,
  • the type of qualifying event or disability determination, and
  • the date on which the qualifying event occurred or the disability determination was made.

A notice that does not contain all of the required information will not be considered notice of a qualifying event. If you do not timely provide all of the information necessary to meet the content requirements, you will lose the right to elect or extend continuation coverage.

Notice of Right to Elect COBRA Coverage

Once notified, the Fund Office will mail you the necessary forms to enable you to elect the COBRA coverage. When you receive the forms, you will have 60 days from the date of the Fund Office’s notification letter in which to elect or decline COBRA coverage. You or your eligible dependent will be ineligible for COBRA coverage if you do not timely elect COBRA coverage.

This notice will be written in a manner calculated to be understood by the average Plan participant and shall contain the information required by COBRA. The notice will be provided by first class mail no later than 14 days after the Fund Office receives notice that a qualifying event has occurred.

If, on the basis of the most recent information available to the Fund Office, you and your spouse reside at the same location, the Fund Office may provide a single notice addressed to both you and your spouse.

The Fund Office may provide notice to a dependent child by furnishing a single notice to you or your spouse if, on the basis of the most recent information available, the dependent child resides at the same location as the parent to whom the notice is provided.

Address Changes

To protect your family’s rights, you should keep the Fund Office informed of any address changes of family members.

More Information

This notice may not contain all information about your rights under the Plan. If you have any questions or need more information, contact the Fund Office.
  

(Updated 10/13/17)