Ga. Comp. R. & Regs. R. 111-4-1-.08 - Extended Coverage Under Federal Law (COBRA)

(1) Extended Beneficiary. Persons who lose coverage under the Plan and who meet requirements as specified in these regulations or as specified by federal law are eligible to continue Coverage in the enrolled Option, without evidence of insurability. An Extended Beneficiary shall have the same opportunities for enrolling eligible Dependents and changing Coverage election as Active Employees. The SHBP will be administered in compliance with federal law or regulation under the Consolidated Omnibus Budget Reconciliation Act (COBRA).

(a) Terminated Employee. An enrolled Employee who terminates employment or is separated from his employment for any reason other than for gross misconduct, or whose Approved Leave Without Pay Coverage period expires shall be eligible to continue Coverage under the Plan for a period not longer than eighteen (18) calendar months following the termination of Coverage as an Employee.

(b) Reduction of Required Hours. An enrolled Employee who continues SHBP eligibility under the definition of Employee, except for working the required number of hours, shall be eligible to continue Coverage under the Plan for a period not longer than eighteen (18) calendar months following the end of the month in which the reduction of hours occurred. If the reduced hours take effect on a day other than the first work day of the month, the eighteen (18) calendar month period would begin on the first of the month following termination of Coverage through payroll Deductions.

(c) Laid-off Employee. An Enrolled Employee who is determined to be a laid-off Employee shall be eligible to continue Coverage under the Plan for a period not longer than eighteen (18) months. The extended period begins on the first of the month following termination of Coverage through payroll Deductions.

(d) Spouse of Deceased Employee. The spouse of a deceased enrolled Employee who is not eligible as a Surviving Spouse, an Employee, or an Annuitant shall be eligible to continue Coverage for the Spouse and any Covered, eligible dependents under the Plan for a period not longer than thirty-six (36) calendar months. The extended period of Coverage begins on the first of the month following termination of Coverage through the deceased Employee's payroll Deductions, or if the Employee is on an Approved Leave Without Pay, the later of the end of the month or the end of one month following the month in which the Employee died when Premium was paid in advance.

(e) Surviving Dependent Child. An eligible Dependent child of a deceased enrolled Employee who is not eligible as a Dependent of another Employee, a Surviving Beneficiary under Section 111-4-1-.04(10), and Employee, or an Annuitant shall be eligible to continue individual Coverage under the Plan for a period not longer than thirty-six (36) calendar months following the end of the month in which death occurred. Any months for which Coverage was granted under Section 111-4-1-.04 will be included in the maximum allowance under this provision. The Extended Coverage period begins on the first of the month following termination of the deceased Employee's Coverage through payroll Deductions.

(f) Dependent Child. An eligible Dependent child of an enrolled Employee who is not eligible as an Employee or an Annuitant shall be eligible to continue Coverage under the Plan for a period not longer than thirty-six (36) calendar months following the end of the month in which the child is no longer an eligible Dependent under the Plan.

(g) Legally Separated or Divorced Spouse. A legally separated or divorced Spouse of an enrolled Employee who is not eligible as a Surviving Spouse, an Employee, or an Annuitant shall be eligible to continue Coverage for a period not longer than thirty-six (36) calendar months for the Spouse and any Covered dependents, who are no longer Covered Dependents of the Employee, under the SHBP. The Extended Coverage period begins on the first of the month following the month in which the legal separation documents were approved by a court of competent jurisdiction or the divorce was final.

(h) Disability under Social Security. An additional eleven (11) calendar months of Coverage may be provided to an Extended Beneficiary who meets the definition of disability under Title II or XVI of the Social Security Act prior to or within sixty (60) calendar days of the Qualifying Event. The eleven (11) additional months of Coverage applies to all Beneficiaries eligible under the contract. Eligibility for the additional eleven (11) months is based on the Beneficiary notifying the Administrator of the determination of disability no later than sixty (60) calendar days following the date of the determination. Such notices must be given within the initial eighteen (18) month continuation period. Additionally, the Extended Beneficiary must notify the Administrator within thirty (30) calendar days of the date of any final determination that the Beneficiary is no longer disabled. The Administrator is authorized to charge one hundred fifty percent (150%) of the applicable Premium as outlined in this section.

(i) Multiple qualifying events. If additional Qualifying Events occur which provide for a thirty-six (36) calendar month maximum period during the period when an Extended Beneficiary is covered, the maximum period of Coverage may be extended to a maximum of thirty-six (36) calendar months for Spouse or Dependent Child.

(j) Beginning of the maximum period. The maximum period of Extended Coverage as a result of one or more Qualifying Events shall begin on the day following termination of Coverage as a result of the first Qualifying Event.

(k) Limitation for Individuals Added to Coverage of Extended Beneficiary. Individuals enrolled under an Extended Beneficiary's Coverage shall not be eligible to become an Extended Beneficiary as a result of the enrollment.

(l) Payment for Extended Beneficiary Coverages. The applicable Premium for any Coverage election shall include the total Employer and Employee cost plus two percent (2%) of the total Premium cost as established by the Board for Active Employees with eligibility under this section, except that the Extended Beneficiary shall pay this Premium on a monthly basis. An additional forty eight percent (48%) of the total Premium for the Coverage election under the Plan shall be required for the eleven (11) months extension as a result of disability under the Social Security Act. One (1) advance monthly premium plus any retroactive premiums for unpaid periods of Coverage will, however, be requested as a part of the application. Failure to pay the full Premium within the allotted time shall result in suspension of benefit payments and/or termination of Coverage and forfeit all eligibility for continued Coverage.

(m) Notice Requirements. At the time of implementation of the Extended Beneficiary provisions, the Administrator shall distribute to the Employing Entities, having Active Employees, a notice of reasons for the extended eligibility. The Employing Entities shall distribute this notice to each eligible Employee. The Administrator shall incorporate the Extended Beneficiary eligibility provisions in the Employee Summary Plan Description.

1. The Employing Entity must notify the Administrator of the Employee's termination, death, layoff, or reduce hours within thirty (30) calendar days following the event.

2. The enrolled Employee or eligible Beneficiary must notify the Administrator of a Qualifying Event in case of divorce, legal separation, or the Dependent child's loss of eligibility within sixty (60) calendar days of the later of the Qualifying Event or termination of Coverage as a result of the Qualifying Event. Failure to notify the Administrator within the sixty (60) calendar days will forfeit eligibility to enroll as an Extended Beneficiary.

3. The Administrator shall notify the Extended Beneficiary at the known address. The Administrator shall provide notice of the continuation rights within fourteen (14) calendar days following notification from the Employing Entity of the enrolled Employee's death, termination of employment, or reduction of hours. Notice to the Employee's Spouse other than upon the Employee's termination or reduction of hours shall be deemed to be notification to all other Beneficiaries under the contract.

4. The Administrator shall notify the Extended Beneficiary of the continuation rights at the address specified by the Employee or Extended Beneficiary within fourteen (14) calendar days following notification from the Employee of a divorce, legal separation, or the Dependent child's Coverage ineligibility as a Dependent.

5. The Administrator shall notify each newly covered Spouse of the Plans Extended Beneficiary continuation rights within fourteen (14) calendar days of the Spouse's effective date.

6. If the Administrator fails to notify the Extended Beneficiary of the continuation rights within the required time limits as a result of failure of the Employing Entity to notify the Administrator, any penalty required of the Administrator shall be billed to the Employing Entity who failed to notify the Administrator.

(n) Extended Beneficiary's Election Period. The Extended Beneficiary may elect to continue Coverage during the later of sixty (60) calendar days following the Administrator's notification to the Extended Beneficiary or the sixty (60) calendar days following Coverage termination. Coverage will be continued from the Coverage termination date through the months for which payment is received, provided payment is received no later than forty-five (45) calendar days following the Beneficiary's election to continue Coverage.

(o) Extended Beneficiary's Independent Election. Each Beneficiary eligible for Extended Coverage shall be afforded the opportunity to make an independent election to continue Coverage in the enrolled Option, provided the Beneficiary is not enrolled under the SHBP as an Employee, Spouse, Dependent, or Annuitant. If a Beneficiary, either the Employee or Spouse of a enrolled Employee makes an election to provide Coverage for the other Extended Beneficiary, the election shall be binding on that other Beneficiary. An election on behalf of a minor child can be made by the child's parent or legal guardian. An election on behalf of an eligible Beneficiary who is incapacitated can be made by the legal representative of the Beneficiary. Except for any child who is born to or placed with an Extended Beneficiary, Dependents enrolled in the Plan during a period of Extended Coverage under federal law do not themselves become Extended Beneficiaries and may not make separate Coverage elections or participate in Open Enrollment.

(p) Required Documentation. The Administrator may require a monthly certification on the Premium billing by the Extended Beneficiary that the conditions as outlined in Section 111-4-1-.09(11) have not occurred.

(q) Recovery of Paid Benefits. The Administrator shall have the right to recover all benefit payments made on behalf of any Extended Beneficiary as a result of and after the occurrence of any of the conditions outlined in Section 111-4-1-.09(11).

Notes

Ga. Comp. R. & Regs. R. 111-4-1-.08

U.S. Internal Revenue Code and Consolidated Omnibus Budget Reconciliation Act (COBRA).

Original Rule entitled "Extended Coverage Under Federal Law (COBRA)" adopted. F. Apr. 18, 2005; eff. May 8, 2005. Repealed: New Rule of same title adopted. F. Jan. 22, 2007; eff. Feb. 11, 2007.