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You Elect COBRA

Continuation Coverage

You may have a right under COBRA to continue to participate in the Plan after you would otherwise lose coverage by continu- ing to make payments to the Plan, plus an administrative charge, on an after-tax instead of a pre-tax basis. COBRA is a temporary extension of coverage under the Plan. This notice generally explains COBRA continua- tion coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it.

The right to COBRA continuation coverage was created by a federal law, the Consolidated

Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage may become available to you when you would otherwise lose your group health coverage. It is available to other members of your family who are covered under the Plan in certain circumstances where they would otherwise lose their group health coverage. Below is a summary of COBRA continuation coverage, when it may become available, and what you need to do to protect the right to receive it. For additional information about your rights and obligations under the Plan and under federal law, you should contact the Plan Adminis- trator. You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees. For more information about the Marketplace op- tions available, visit the New York State Health Plan Marketplace (the “NY Marketplace,” also known as the “New York State of Health”). You can access the NY Marketplace at https:// nystateofhealth.ny.gov/ or 1-855-355-5777. If you reside outside New York, visit the Federal Health Insurance Marketplace (the “Federal Marketplace”), accessible at

www.HealthCare.gov or 1-800-318-2596.

What Is COBRA Continuation Coverage?

COBRA continuation coverage is a continu- ation of Plan coverage when coverage would otherwise end because of a life event known as a qualifying event. Specific qualifying events are listed later in this section. After a qualifying event occurs and any required notice of the event is properly provided to the Plan Adminis- trator, COBRA continuation coverage must be offered to each person who is a qualified bene- ficiary. You, your spouse13_{, and your dependent}

13 Under federal law, COBRA is limited to spouses. However, the University extends continuation coverage to domestic partners on the same terms as spouses, to the extent permitted by law.

Important Things to Know

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children could become qualified beneficiaries if coverage under the plan is lost because of a qualifying event. (Certain newborns, newly ad- opted children, and alternate recipients under QMCSOs may also be qualified beneficiaries.) Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. You will be notified at the time you are offered COBRA continuation coverage of the amount and the date payment is due.

Who Is Entitled to Elect COBRA?

If you are an employee, you will become a qualified beneficiary if you lose your coverage under the Plan because one of the following qualifying events happens: • Your hours of employment are reduced,

or

• Your employment ends for any reason other than your gross misconduct. If you are the spouse13 _{of an employee,}

you will become a qualified beneficiary if you lose your coverage under the Plan because any of the following qualifying events hap- pens:

• Your spouse dies;

• Your spouse’s hours of employment are reduced;

• Your spouse’s employment ends for any reason other than his or her gross misconduct;

• Your spouse becomes entitled to Medi- care benefits (under Part A, Part B, or both); or

• You become divorced or legally separated from your spouse. Also, if your spouse (the employee) reduces or eliminates your group health coverage in anticipation of a divorce or legal separation, and a divorce or legal separation later occurs, then the di- vorce or legal separation may be considered a qualifying event for you even though your coverage was reduced or eliminated before the divorce or separation.

A person enrolled as the employee’s dependent child will be entitled to elect COBRA if they lose coverage under the Plan because any of the following qualifying events happens:

• The parent-employee dies;

• The parent-employee’s hours of employ- ment are reduced;

• The parent-employee’s employment ends for any reason other than his or her gross misconduct;

• The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);

• The parents become divorced or legally separated; or

• The child stops being eligible for coverage under the Plan as a dependent child.

When Is COBRA Coverage Available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the employee, or the employee becomes enti- tled to Medicare benefits (under Part A, Part B, or both), the employer must notify the Plan Administrator of the qualifying event.

You Must Give Notice of Some Qualifying Events

For the other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for cover- age as a dependent child), you must notify the Plan Administrator in writing within 60 days after the later of the date of the event or the date the individual would lose coverage under the Plan. The dependent or representative will be provided with instructions for continuing their portion of coverage.

If notice is not received within that 60- day period, all qualified beneficiaries will

lose their right to elect Cobra.

You must provide written notice to: University of Rochester

Benefits Office 44 Celebration Dr. Suite 2300

Rochester, NY 14627

Please include evidence of the qualify- ing event (e.g., certified copy of the divorce decree, court order of legal separation, dependent birth certificate, etc.).

How Is COBRA Coverage Provided?

Once the Plan 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 con- tinuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.

COBRA continuation coverage is a tem- porary continuation of coverage. When the qualifying event is the death of the employee, the employee becoming entitled to Medicare benefits (under Part A, Part B, or both), your divorce or legal separation, or a dependent child’s losing eligibility as a dependent child, COBRA continuation coverage lasts for up to a total of 36 months. When the qualifying event is the end of employment or reduction of the employee’s hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qual- ifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts up to 36 months after the date of Medicare entitlement. For example, if a covered employee becomes entitled to Medicare eight months before the date on which his employment terminates, COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus eight months). Oth- erwise, when the qualifying event is the end of employment or reduction of the employ- ee’s hours of employment, COBRA continu- ation coverage generally can last for only up to a total of 18 months. COBRA continuation coverage for the EAP will be provided auto- matically and free of charge.

Disability Extension of 18-Month Period of Continuation Coverage

If a qualified beneficiary is determined by the Social Security Administration to be disabled and you notify the Plan Administrator in a timely fashion, all of the qualified beneficia- ries in your family may be entitled to receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months. This extension is available only for qualified beneficiaries who are receiving COBRA coverage because of a qualifying event that was the covered employee’s termi- nation of employment or reduction of hours. The disability must have started at some time before the 61st day after the covered employ- ee’s termination of employment or reduction of hours and must last at least until the end of the period of COBRA coverage that would be available without the disability extension (generally 18 months, as described above). This notice must be made in writing and must include a copy of the Social Security Administration’s determination letter. This notice must be sent to:

University of Rochester Benefits Office 44 Celebration Dr. Suite 2300

Rochester, NY 14627

The disability extension is available only if you notify the Plan Administrator in writ- ing of the Social Security Administration’s determination of disability within 60 days after the latest of:

• The date of the Social Security Adminis- tration’s disability determination; • The date of the covered employee’s ter-

mination of employment or reduction of hours; and

• The date on which the qualified bene- ficiary loses (or would lose) coverage under the terms of the Plan as a result of the covered employee’s termination or reduction of hours.

You must also provide the Social Security Administration’s notice to the Plan Admin- istrator within 18 months after the covered employee’s termination of employment or reduction of hours in order to be entitled

to a disability extension. If the notice is not provided to the Plan Administrator during the 60-day notice period and within 18 months after the covered employee’s termina- tion of employment or reduction of hours, then there will be no disability extension of COBRA coverage.

If the qualified beneficiary is determined by the Social Security Administration to no longer be disabled, you must notify the Plan Administrator of that fact within 30 days after the Social Security Administration’s determination. If you do not notify the Plan Administrator, the plan reserves the right to retroactively cancel COBRA coverage and to seek reimbursement of all benefits paid after the first day of the month beginning 30 days after the Social Security Administration determines that the disabled qualified benefi- ciary is no longer disabled.

Second Qualifying Event Extension of 18-Month Period of Continuation Coverage

If your family experiences another quali- fying event while receiving 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualify- ing event is properly given to the Plan. This extension may be available to the spouse and dependent children receiving continuation coverage if the employee or former employee dies, becomes entitled to Medicare bene- fits (under Part A, Part B, or both), or gets divorced or legally separated, or if the depen- dent child stops being eligible under the Plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.

How Do I Elect and Pay for COBRA Con- tinuation Coverage?

COBRA coverage must be elected by com- pleting election forms and submitting them to the COBRA administrator by the deadline indicated on the form, which is generally 60 days from the later of the date the forms were received or when a qualified benefi- ciary would lose coverage as a result of the qualifying event.

If COBRA continuation coverage is elected, the qualified beneficiary must pay the initial premium (including all premiums due but not paid) within 45 days after the election. Thereafter, COBRA premiums must be paid monthly and within 30 days of each due date. The cost of COBRA coverage is 102% of the full cost of Plan coverage (with- out any employer subsidy).

If you elect COBRA continuation and then fail to pay the premiums due within the initial 45-day grace period or fail to pay any subsequent premium within 30 days after the date it is due, coverage will be terminated retroactively to the last day for which timely payment was made. Any unused balances will not be available for reimbursement after the end of the reimbursement deadline described in this SPD.

What Happens if Plan Coverage Changes During the Continuation Period?

If coverage under the Plan is changed for active employees, the same changes will apply to individuals on COBRA continuation coverage.

What Happens if I Give Notice of an Event but I Do Not Qualify for COBRA?

If the Plan Administrator receives notice of an event that it determines is not a qualifying event or receives notice with respect to an individual that the Plan Administrator deter- mines is not a qualified beneficiary, the Plan Administrator will provide written notice of unavailability of COBRA continuation coverage to the affected individual within the time periods required for COBRA Election Notices. The notice will be written in an understandable manner and will explain why COBRA coverage is not available.

Do I Have to Keep Family Coverage if That