WHAT IS A QUALIFYING EVENT?
A qualifying event is any of the following events that results in you or a dependent child or spouse to lose coverage under any of the District’s health plans:
- A covered employee's termination of employment for any reason other than gross misconduct or reduction in hours to fewer than the number required for plan participation
- A covered employee's death
- A covered employee's divorce or legal separation from the spouse
- A covered child's loss of dependent status under a plan
CAN I HAVE MORE THAN ONE QUALIFYING EVENT?
Sometimes, a spouse or dependent child can have more than one qualifying event. A secondary qualifying event occurs if the following three conditions are met:
- The first event qualified for 18 months of coverage (such as termination of employment).
- The secondary event occurs which would extend coverage up to 36 months (e.g., a covered employee's death or divorce).
- The secondary event takes place while continuation coverage is effective.
If a secondary qualifying event occurs, we will extend the maximum coverage period from 18 months to 36 months, measured from the date of the first qualifying event.
DO I HAVE TO NOTIFY THE DISTRICT OF ANY QUALIFYING EVENTS?
In general, the District will notify you of a qualifying event. However, employees or their families must notify the District in the event of a death, divorce, legal separation, or when a child no longer qualifies as a covered dependent under the plan within 60 days after these events occur or, if later, within 60 days of the date coverage would otherwise terminate.
Individuals failing to notify the District of these events within the 60-day period will not be permitted to continue coverage.
WHAT IS CONTINUATION COVERAGE?
If you or a dependent child or spouse have a qualifying event, you may continue the health coverage you had immediately before the event occurred. However, persons who become Medicare eligible while on COBRA coverage are no longer eligible and will be removed from coverage.
If you continue coverage, we will credit all expenses accumulated towards your deductible (if applicable) as though the qualifying event never took place. Further, during Open Enrollment periods, you will have the same rights as Active employees to change your coverage.
HOW DO I ELECT CONTINUATION COVERAGE?
If you have a qualifying event, we will send you information in the mail of your continuation rights along with enrollment instructions. At that time, you will have at least 60 days to decide whether you want to continue your health coverage through the District’s plan. This election period will end 60 days from the later of the following two dates:
- The date coverage would otherwise terminate
- The date the District notifies you of your continuation rights
For families that lose coverage, each family member can separately elect continuation coverage. However, unless otherwise specified in the election, an employee's election to continue coverage will be deemed to include an election of continuation for the employee's spouse and dependent children. Similarly, a spouse's election to continue coverage will be deemed to include an election of continuation for any dependent child covered by the plan. An election on behalf of a family member is binding on the family member.
Although an employee and spouse can continue coverage on behalf of other family members, if the employee or spouse declines coverage, this does not preclude family members from electing coverage. For example, if an employee declines continuation coverage, the spouse or dependent child can still elect to continue their coverage.
HOW LONG CAN I CONTINUE COVERAGE?
In general, you can continue coverage for 18 months to a maximum of 36 months, depending on the qualifying event.
If the qualifying event is employment termination or reduction in hours, the maximum period of time you can continue coverage is 18 months under Federal COBRA. However, an additional 18 months can be continued under Cal-COBRA (est. January 1, 2003). You will be notified of this offer by your medical plan prior to the termination of your Federal COBRA (the first 18 months.) If you have elected dental and vision coverage, this will cease at the end of Federal COBRA.
For other qualifying events, the maximum period you can extend coverage under Federal COBRA is 36 months.
DO I HAVE TO PAY FOR MY CONTINUATION COVERAGE?
You must pay the full premium cost of continuation coverage, plus 2 percent of the premium to cover the District's administrative costs during the the Federal COBRA period of 18 or 36 months. If the original COBRA period was 18 months and coverage is extended beyond 18 months under Cal-COBRA, you may have to pay a higher premium.
We will include information on the cost of continuation coverage and the payment terms in notices to individuals who have a qualifying event.
CAN THE DISTRICT TERMINATE MY CONTINUATION COVERAGE BEFORE THE MAXIMUM COVERAGE PERIOD ENDS?
The District can terminate a person's continuation coverage before the maximum coverage period ends for any of the following reasons:
- Payment for the person's coverage is not received on a timely basis
- The person becomes covered by another group health plan maintained by another employer that does not limit or exclude coverage for any pre-existing medical condition of the person
- The person becomes covered by Medicare or is Medicare eligible
- The District ceases to provide group health plan coverage for all active employees
WHO CAN I CONTACT IF I HAVE QUESTIONS ABOUT CONTINUATION COVERAGE?
If you have any questions about continuation coverage, please contact a Benefits Technician at 949-234-9403 or 234-9401 in the District Insurance Department.
MAY I OBTAIN CONVERSION COVERAGE WHEN MY CONTINUATION COVERAGE TERMINATES?
When continuation coverage terminates, you can purchase an individual medical policy without proof of insurability. This conversion privilege is also available if you decline continuation coverage.
DO SPECIAL PROVISIONS APPLY TO THE DISABLED?
Persons whom Social Security determines are disabled (under Title II or XVI of the Social Security Act) at the time of employment termination or reduction in hours, or, who become disabled during the first 60 days of continuation coverage, can request an extension in the maximum coverage period from 18 to 29 months.
To obtain this extended coverage, you must notify the plan administrator of Social Security's disability determination within 60 days of the determination and 18 months of the qualifying event.
If you receive this extended coverage, you must pay 102 % of the full cost of the continuation coverage for the first 18 months. Payment of up to 150% of coverage for the next 11 months.
If you receive the extended coverage, you are required by law to notify the plan administrator that you are no longer disabled within 30 days of any final determination made by Social Security. Once notified, your extended coverage will be terminated effective the first month beginning more than 30 days after Social Security's determination.
- What is a qualifying event?
- Can I have more than one qualifying event?
- Do I have to notify the District of any qualifying events?
- What is Continuation coverage?
- How do I elect Continuation coverage?
- How long can I continue coverage?
- Do I have to pay for my Continuation Coverage?
- Can the District terminate my Continuous Coverage before the Maximum coverage period ends?
- Who can I contact if I have questions about Continuation Coverage?
- May I obtain Conversion Coverage when my Continuation Coverage Terminates?
- Do special provisions apply to the disabled?