§ 70-130. Continuance of medical coverage (COBRA).

(a)

Employee and/or dependent medical coverage under the current plan may cease as a result of one of the following events:

(1)

Termination of employment.

(2)

Change to nonparticipating employment status.

(3)

Divorce or legal separation.

(4)

Dependent child became ineligible.

(b)

Employees or dependents may elect to continue medical coverage beyond the date that it would otherwise terminate by doing one of the following:

(1)

Convert the group medical coverage to an individual policy provided directly by the insurance carrier. Employees will be sent benefit information and rates regarding conversion options directly from the insurance company.

(2)

Continue to participate in the group medical coverage plan under the criteria outlined below:

a.

Rights of employee. Employees presently covered by the insurance plan or health maintenance organization (HMO) may continue this coverage for up to 18 months from the date that employment terminates or status changed to a nonparticipating (noninsured) employment status provided that the employee pays the full cost of premium and any administrative fee (up to two percent) that may be imposed.

b.

Rights of a spouse of employee. The spouse of an employee covered by the medical plan or a sponsored HMO has the right to continue coverage if the employee was terminated or changed to nonparticipating employment status, or if a divorce or legal court-decreed separation from the employee took place. Coverage under these circumstances may continue for a period up to 36 months provided that the spouse pay the premium in full and any administrative fee (up to two percent) that may be imposed.

c.

Rights of children. Dependent children of an employee covered by the medical plan or a sponsored HMO have the right to continue coverage if group health coverage under the medical plan is lost because of termination of a parent's employment or change to nonparticipating employment status; parents' divorce or legal court-decreed separation; or the dependent ceases to be a dependent child under the medical plan. Coverage under these circumstances may continue for a period up to 36 months provided that the spouse pay the premium in full and any administrative fee (up to two percent) that may be imposed.

(3)

A child born to or placed for adoption with the member who is on COBRA is defined as a qualified person. As a qualified person, the child:

a.

May be eligible for independent election rights.

b.

May be eligible for an additional 18 months of COBRA continuation if a second qualifying event occurs during the member's original 18-month continuation period.

c.

May qualify for an 11-month extension due to disability.

If a dependent is added, the premium will be adjusted accordingly. Dependent coverage must be elected within the plan's normal enrollment period.

(c)

If an employee or eligible spouse or dependent does not elect to continue coverage, group health insurance will end as scheduled under the plan.

(d)

If an employee elects to continue group medical coverage, the employee or eligible spouse or dependent is responsible for paying the entire cost (both employer and employee share). This cost will be subject to periodic rate changes. Employees are not required to show that they are insurable (by taking a medical exam) to continue the coverage.

(e)

Continued coverage may be terminated earlier than the 18-month or 36-month period if group medical plans for all other employees are terminated, or if the employee or eligible spouse or dependent:

(1)

Fails to remit the required monthly payments within 31 days of the due date;

(2)

Becomes eligible under any other group medical plan and has satisfied the pre-existing exclusion provision under the new plan;

(3)

A covered spouse remarries and becomes eligible to be covered under a group medical plan and has satisfied the pre-existing exclusion provision under the new plan;

(4)

Becomes eligible for medicare.

Under the Health Insurance Portability and Accountability Act of 1996, if you have a break in coverage of more than 63 days, you may have to satisfy a pre-existing exclusion under a new group health plan.

(f)

A member or dependent may extend COBRA continuation if determined by the Social Security Administration (SSA) to be disabled before a qualifying event or within 60 days after a qualifying event.

(g)

To request an 11-month extension due to disability, a member must submit a copy of the social security disability determination notice to the city within 60 days after the date the notice is received. The request must be made within the 18-month COBRA continuation period.

(Code 1989, § 2-5-50)