The Consolidated Omnibus Budget Reconciliation Act of 1985, commonly called COBRA, as amended, allows you to extend health care coverage for yourself and your family under certain circumstances which would normally cause coverage to end. COBRA continuation consists of those benefits mandated by COBRA to be continued to you and your dependents through the FA Benefit Fund. In order to be eligible for the purchase of non-core benefits, you or your dependents will be required to purchase core benefits. The level of COBRA benefits to which you are entitled is based on the level of benefits you had before coverage ended.

Active Members - Core Benefits

• Hearing Aid
• Maternity
• Prescription Drug Co-Pay Reimbursement

Active Members - Non-Core Benefits

• Dental
• Optical

• Hearing Aid
• Maternity
• Prescription Drug Co-Pay Reimbursement

• Dental
• Optical

• Hearing Aid

• Dental
• Optical

The law permits the Fund to charge any person who elects to continue coverage the cost of the coverage, plus 2%. If the cost changes the Fund will revise the charge you are required to pay, but not more than once every 12 months. In addition, if the benefits change for active covered members, your coverage and the cost for same will change as well.

You do not have to show evidence of good health in order to continue coverage. However, you must make all of the payments from the date of the event that qualifies you to continue coverage. Future payments are payable in advance by the first of each month. Core benefits must be purchased in order to be eligible for non-core benefits.

You have the right to extend coverage for yourself, your spouse, domestic partner and your eligible dependents for up to 18 months if coverage ends because:

• your employment ends for any reason other than gross misconduct,
  
  
• you are no longer eligible for coverage (see Eligibility Section, beginning on page 9), or
  
  
• you are on leave of absence without pay.

A child who is born to, or placed for adoption with you during a period of COBRA coverage will be eligible to become a qualified beneficiary. These qualified beneficiaries can be added to COBRA coverage upon proper notification to the Fund of the birth or adoption.

If either you or an eligible dependent is classified as disabled under Social Security during the first 60 days of COBRA coverage, coverage may be continued for up to a total of 29 months. You must notify the Fund both before the end of the initial 18 months and within 60 days of such disability determination. If any qualified beneficiary becomes eligible for this 11 month disability extension, all qualified beneficiaries are also entitled to the 11 month extension of coverage. However, if you or your eligible dependent is no longer classified as disabled by Social Security, that person must notify the Fund within 30 days of the determination and the 11 month extension will end. The charge for this extended coverage may not exceed cost plus 50% for the 19th through 29th months.

Your spouse has the right to this continuation coverage for up to 36 months if his or her coverage under the Fund would otherwise end because:

• you are legally divorced or separated,
  
  
• you become entitled to Medicare, or
  
  
• you die.

Your eligible dependent children have the right to this continuation coverage for up to 36 months if their coverage under the Fund would otherwise end because:

• they are no longer considered dependents as described on pages 9 - 10,
  
  
• you and your spouse become legally divorced or legally separated,
  
  
• you become entitled to Medicare, or
  
  
• you die.

Notification

It is your responsibility to inform the Benefit Fund Administrator in writing of a divorce, legal separation, a child losing dependent status or your entitlement to Medicare, within 60 days of the date of the event that would cause loss of coverage. Your spouse or dependent must notify the Fund of your death. The County must notify the Fund of any change in employment status that would result in your loss of coverage (e.g., termination, unpaid leave of absence, retirement, etc.). All such notification must be made in writing.

Once the Benefit Fund Administrator is notified of an event that affects your coverage or your dependents’ coverage, you will be notified that you have the right to choose continuation coverage. You must let the Benefit Fund Administrator know that you want continuation coverage the later of 60 days after the date you or your dependent would lose coverage or from the date you receive notice from us of your right to elect continuation coverage. If you do not choose it, your health related benefits through the Fund will end. If you reject this continuation coverage, your spouse and dependent children will be given the opportunity to continue coverage independently from you.

The time periods during which coverage is extended may be shortened if:

• FA Benefit Fund no longer provides health related benefits for any participants or dependents;
  
  
• the person electing coverage does not make the required payment within 30 days of the date it is due;
  
  
• the person electing coverage becomes covered by another group health plan. (You may continue COBRA coverage if the other plan does not cover pre-existing conditions.);
  
  
• the person electing coverage is widowed or divorced, subsequently remarries and is covered under the new spouse’s group health plan; or
  
  
• the person electing coverage becomes entitled to Medicare.

BENEFITS QUESTIONS? PLEASE CONTACT MARY AT (631) 732-6500.

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