Quick Links
Qualifying Events. If you are an Employee, you will become a qualified beneficiary under the Plan if you lose coverage because any of the following events happens:

  1. Your hours of employment are reduced, or
  2. Your employment ends for any reason.

If you are the Spouse of an Employee, you become a qualified beneficiary if you lose coverage because any of the following events happens:

  1. Your spouse dies;
  2. Your spouse’s hours of employment are reduced;
  3. Your spouse’s employment ends;
  4. Your spouse becomes entitled to Medicare benefits (Part A or B or both); or
  5. You become divorced or (in some cases) legally separated from your spouse.

Your Dependent children will become qualified beneficiaries if they lose coverage because any of the following events happens:

  1. The parent-employee dies;
  2. The parent-employee’s hours of employment are reduced;
  3. The parent-employee’s employment ends;
  4. The parent-employee becomes entitled to Medicare Part A or B, or both;
  5. The parents become divorced or legally separated; or
  6. The child no longer meets the definition of Dependent under the Plan.
 When is COBRA Coverage Available? The Plan will offer COBRA continuation coverage to qualified
beneficiaries only after the Claims Administrator has been notified that the qualifying event has occurred.
When the qualifying event is the end of employment or reduction of hours of employment, death of the
Employee, commencement of a proceeding in bankruptcy with respect to the Employer, or the
Employee’s becoming entitled to Medicare benefits under Part A, Part B or both, the Employer must notify
the Claims Administrator of the qualifying event.
You Must Give Notice of Some Qualifying Events. For other qualifying events (divorce or legal
separation of the Employee and spouse, or a Dependent child’s losing eligibility for coverage as a
dependent child), you must notify your Employer within 60 days after the qualifying event occurs, and
your Employer will notify the Claims Administrator.		 How is COBRA Coverage Provided? Once the Claims Administrator receives notice that a qualifying
event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries.
Each qualified beneficiary will have an independent right to elect COBRA continuation coverage.
Covered Employees may elect COBRA continuation coverage on behalf of their spouses, and parents
may elect COBRA continuation coverage on behalf of their children.
Length of Continuation of Coverage. COBRA continuation coverage is a temporary continuation of
coverage. Under federal COBRA or state continuation of coverage laws, you may be entitled to up to 36
months of COBRA coverage, unless your right to continue coverage terminates earlier for one of the
reasons described below.		 Early Termination of COBRA Coverage. The maximum period of COBRA coverage may be shortened,
and coverage terminated early for any of the following reasons:

  1. the Employer ceases to provide any group health coverage to any Employee (including successor plans);
  2. the qualified beneficiary fails to make timely payment of his required contribution for coverage;
  3. the qualified beneficiary becomes entitled to Medicare (after the date of his COBRA election); or
  4. the qualified beneficiary becomes covered, after the date of COBRA election, under another group health plan maintained by another Employer that does not exclude or limit coverage for a qualified beneficiary’s pre-existing medical condition.
Cost of COBRA Coverage Employees and other Covered Persons who elect to continue benefits
through COBRA will pay 102% of the combined Employee/Employer contribution. The initial payment must be received by the 45th day after the COBRA election.		 If You Have Questions. Questions concerning COBRA continuation coverage rights under this Plan
should be addressed to the Claims Administrator. For general information about your COBRA rights, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.)