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> Employee Benefits > Benefits > Continuation of Coverage <-- You are Here
Continuation of Coverage
General Description of Continuing Coverage
If you take a leave of absence without
pay (LAWP), or leave University service, or if one of your dependents becomes
ineligible to continue coverage under the University Health Benefits Program,
you or your dependent may be eligible to continue health benefits coverage
under a variety of regulations.
Leave of Absence Without Pay (LAWP)
Short Term LAWP:
If you
are on a short term LAWP (two pay periods or less for employees who are paid
bi-weekly), you must continue all benefits and you will be billed by the
Employee Benefits Division for your missed premiums. You will be sent
a bill for 100% of the premium because you are not eligible, during a short
term
LAWP, to receive the University subsidy.
If your short term LAWP is due to a
job-related accident or injury or approved family medical leave, you are
entitled to a University subsidy and are responsible for the employee share
of the premium only. Contact the Office of Employee Benefits and request
a staff member to return the no-pay bill to the State Employee Benefits
Division along with a copy
of the first report of accident or injury or family medical leave approval,
a retroactive adjustment form, and your check for your share of the
premiums.
Long Term LAWP:
If you
are on leave of absence without pay for more than two bi-weekly pay periods
(including employees on suspension pending charges for removal), your leave is
considered a long-term LAWP. If you are on an approved long-term LAWP,
you may elect to continue or discontinue health insurance for the duration of
the LAWP.
You must complete a COBRA/LAWP
enrollment form and submit it to the Office of Employee Benefits. This form
should be completed as soon as you know you will miss two pay periods or more.
The form will not be accepted any later than 60 days after the effective date
of the LAWP.
You may continue any or all health
benefits options, and you may reduce your coverage level when enrolling for
LAWP benefits. Otherwise, you are subject to the same limitations in
changing coverage as an active employee.
When enrolled in LAWP, the employee is
responsible for 100% of the premium unless the LAWP is due to a job-related
accident or injury or approved family medical leave. An employee on long
term LAWP due to a job-related accident or injury or family medical leave
is
entitled to the University subsidy. In this case, the Office of Employee Benefits must have the Fiscal Officer complete the applicable section
of the COBRA/LAWP Enrollment Form. You will be billed by the Employee
Benefits Division for the appropriate amount due.
Note: If you discontinue your
coverage during a long-term LAWP, you may not re-enroll if you return to
University service within the same year that you took your leave of
absence.
Consolidated Omnibus Budget Reconciliation Act (COBRA)
Under the provisions of the Federal
Consolidated Omnibus Budget Reconciliation Act (COBRA), you, or your
departments may elect to continue health benefits (medical, prescription,
vision, and dental) when certain qualifying events occur.
|
QUALIFYING EVENT
|
PERSONS AFFECTED BY
|
LENGTH OF CONTINUATION OF COVERAGE
|
| Termination of employee's employment (other than for gross
mis-conduct) |
Employee
Spouse
Dependent (Children) |
18 months or until eligible for coverage elsewhere, including
Medicare, whichever is less |
| Lay-off or resignation of employee |
Employee
Spouse
Dependent (Children) |
18 months or until eligible for coverage elsewhere, including
Medicare, whichever is less |
| Involuntary reduction of employee's work hours |
Employee
Spouse
Dependent (Children) |
18 months or until eligible for coverage elsewhere, including
Medicare, whichever is less |
| Birth of employee's child or legal adoption (If the State employee
or retiree elected retirement option 2, 3, 5, or 6, COBRA coverage is
not necessary.) |
Dependent child ( This coverage has been mandated by the Health
Insurance Portability and Accountability Act of 1996.) |
Dependent child may be added to an existing COBRA account |
| Employee or retiree's dependent child turns 19 and is not a full
time student |
Child |
36 months or until eligible for coverage elsewhere including
Medicare, whichever is less |
| Employee or retiree's dependent child over 19 ceases to be a full
time student or turns 25, whichever occurs first |
Child |
36 months or until eligible for coverage elsewhere including
Medicare, whichever is less |
| Death of State Employee or retiree |
Spouse |
36 months or until eligible for coverage elsewhere including
Medicare, whichever is less (If the State employee or retiree elected
retirement option 2, 3, 5, or 6, COBRA coverage is not necessary.) |
| Election of Medicare as primary coverage by the State employee and
spouse or dependent children are not eligible for Medicare |
Spouse
Dependent children |
36 months or until eligible for coverage elsewhere including
Medicare, whichever is less |
| Divorce or legal separation from employee or retiree |
Legally separated spouse
Former spouse
Dependent children |
Indefinitely or until eligible for coverage elsewhere, including
remarriage or Medicare, whichever is less |
| Disability of employee (as defined by the Social Security Act)
within the first 60 days of COBRA coverage |
Employee ( This coverage has been mandated by the Health Insurance
Portability and Accountability Act of 1996.)
Spouse
Dependent
children |
The 18 months of coverage can be extended to 29 months at increased
premiums equal to 150 percent of usual
premiums |
Enrollment:
To enroll
in COBRA, you must complete and sign a COBRA/LAWP Enrollment Form and return
it to the Employee Benefits Division within 60 days of the qualifying event.
You will then be billed by the Employee Benefits Division for Continuation
of Coverage premiums. These bills are in the form of pre-printed coupons
for
each
month of coverage. The COBRA participant must certify that the participant
is not covered, and is not eligible to be covered, under another group
health
plan.
Conversion Privilege:
When Active, LAWP or COBRA eligibility ends, and you
have exhausted the continuation of coverage options available as described
above, you may be eligible to convert your coverage to a non-group health
insurance policy, billed directly through the health care
plan.
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