COBRA participant information
COBRA- Monthly medical premiums, 2016
|Healthy Savings Plan||Custom Network Plan||PPO Plan|
|Coverage level||(tobacco-free discount)||(no discount)||(tobacco-free discount)||(no discount)||(tobacco-free discount)||(no discount)|
|Self* and spouse||$816.00||$867.00||$927.18||$978.18||$1,254.60||$1,305.60|
|Self* and child(ren)||$686.46||$737.46||$781.32||$832.32||
|Self,* spouse, and child(ren)||$1,162.80||$1,213.80||$1,318.86||$1,369.86||$1,776.84||$1,827.84|
COBRA- Monthly dental premiums, 2016
|Coverage level||Employee cost|
|Self* and spouse||$60.22|
|Self* and child(ren)||$73.07|
|Self,* spouse, and child(ren)||$103.18|
COBRA- Monthly vision premiums, 2016
|Coverage level||Employee cost|
|Self* and spouse||$11.96|
|Self* and child(ren)||$13.06|
|Self,* spouse, and child(ren)||$20.67|
Medical premium rates
|Healthy Savings Plan||Custom Network Plan
(in Columbia area only)
|Self* & spouse||$867.00||$978.18||$1,148.52|
|Self* & child(ren)||$737.46||$832.32||$976.14|
|Self* & family||$1,213.80||$1,369.86||$1,607.52|
Dental premium rates
|Self* & spouse||$60.22|
|Self* & child(ren)||$73.07|
|Self* & family||$103.18|
Vision premium rates
|Self* & spouse||$11.96|
|Self* & child(ren)||$13.06|
|Self* & family||$20.67|
* "Self" may be a former employee, a spouse, a sponsored adult dependent, a widow/er, a surviving sponsored adult dependent, an ex-spouse, an ex-sponsored adult dependent, or a child.
Please Note: The premium rates shown above are applicable during the initial COBRA continuation period. Premiums for extended COBRA coverage (totally disabled individuals and certain surviving or divorced spouses) are higher and may be obtained from ASI Cobra.
Continuation of Medical Plan coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
Federal law requires the plan to offer covered employees and dependents the opportunity to continue coverage when it ends for certain specified reasons. This law is called the Consolidated Omnibus Budget Reconciliation Act of 1985 — COBRA. The following provisions outline the requirements for continued coverage in accordance with the law. These provisions apply only to the extent that the required period of continued coverage has not already been provided under other plan provisions.
An employee and covered dependents may continue coverage for up to 18 months if coverage ends because of either a reduction in the number of hours worked or termination of employment for any reason other than gross misconduct.
Dependents may continue their coverage under the group plan for up to 36 months if their coverage ends for any of the following reasons:
- Divorce or legal separation from the employee.
- The death of the employee.
- The dependent child reaches the limiting age or otherwise ceases to qualify as a dependent under the plan.
These periods of continued coverage begin on the date of the event that caused loss of coverage; for instance, the date you leave the University or the date a dependent becomes ineligible.
In no event will more than a total of 36 months of continued coverage be provided to any individual, even if more than one of the above events occur.
Continued coverage ends automatically if any of the following occurs:
- The cost of continued coverage is not paid on or before the date it is due.
- An individual becomes covered under another group plan unless coverage under that other plan is limited due to the individual's pre-existing condition.
- An individual becomes entitled to Medicare.
- The plan terminates for all employees.
- The applicable maximum coverage period ends.
- Disabled individuals -- An exception applies if an employee or a dependent is determined to be totally disabled during the first 60 days of continued coverage due to reduction in hours worked or termination of employment. The maximum coverage period for the disabled individual will be 29 months, rather than 18 months. To be eligible for the extended period, the disabled individual must meet the definition of disability under the Social Security Act and notify the University during the first 18 months of continued coverage and within 60 days after the date of determination of disability has been made by Social Security. (The disabled individual is required to notify the University within 30 days after any final determination by the Social Security Administration that the individual is no longer disabled.)
- Divorced or widowed spouses at least age 55 -- Coverage can continue beyond the COBRA period if the continuation coverage under the plan expires when a divorced or widowed spouse is at least age 55. Coverage can continue for the spouse and eligible dependents until the spouse reaches age 65.
When your Campus Benefits Representative is notified that one of these events has happened, you will be sent an election form notifying you of the conditions that apply to continued coverage.
However, in the event you become divorced or legally separated, or when your dependent child no longer qualifies as a covered dependent under the plan, you or your covered spouse or your covered child must notify the Campus Benefits Representative within 60 days. If you fail to do this, your dependent's rights to continued coverage will be forfeited.
Continued coverage is not automatic. You must submit the completed election form within 60 days from the later of the following dates:
- The date you cease to be eligible under the group plan.
- The date you receive the election form.
Any person who elects to continue coverage under the plan must pay on a monthly basis the total of that coverage plus any additional amount permitted by law. Your first payment for continued coverage must be made within 45 days of the date you sign the election form. Your payment must be sufficient to pay the applicable costs retroactive to the day following the event which caused coverage to end.
Continued coverage will be exactly the same medical coverage you or your dependent would have been entitled to if your employment or his or her dependent status had not changed. Any future changes in the benefits or cost of coverage for the plan also will apply to you. A dependent child you acquire while covered by these provisions will also be entitled to coverage. The conversion privilege is available when the maximum period of continued coverage ends.
The plan permits certain individuals whose medical coverage has terminated to convert to an individual medical policy without medical examination. The privilege is available to you and your dependents if your employment terminates or if you cease to be eligible. Also, even though your own coverage may continue, your dependents can apply if they cease to meet the plan's definition of a dependent. However, no one who has been covered under the plan for fewer than three months may convert.
Application must be made for the individual policy within 31 days after coverage terminates. The claims administrator will arrange for the issuance of the individual policy, provided it does not result in over-insurance and does not violate any applicable laws.
- 2016 COBRA Benefits Guide
- COBRA enrollment forms can be obtained by contacting the HR Service Center.
- Medical Benefit Summary Plan Description (SPD)
- Full list of forms and guides about medical insurance …
Reviewed February 17, 2016.