If your coverage under the New England Carpenters Health Benefits Fund ends due to a “Qualifying Event” (see below), you and/or your covered dependents may be eligible to continue your health care coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).
To be eligible to elect COBRA Continuation Coverage, you (as the member) and/or your dependent(s) must lose coverage due to one of the Qualifying Events, which are listed in the first column in the table below. The last column indicates how individuals find out that they’re eligible for continuation coverage, which is explained below.
|Qualifying Event||Who May Purchase (Qualified Beneficiary)||Eligibility||Notification Requirements|
|Member terminated for other than gross misconduct (including retirement)||Member, spouse and/or dependent children||18 months||Fund Office will advise eligible participants|
|Member reduction in hours worked (making Member ineligible for coverage or the same coverage under the Plan||Member, spouse and/or dependent children||18 months||Fund Office|
|Member becomes entitled to Medicare||Spouse and/or dependent children||36 months||Fund Office will advise eligible participants when Member reaches age 65. If Member becomes eligible before 65, he or she must advise the Fund Office|
|Member becomes eligible for disability through Social Security||Member, spouse and/or children||11 months in addition to the 18 months||Member must advise the Fund Office|
|Death of Member||Spouse and/or dependent children||36 months||Family member must notify the Fund Office|
|Member is divorced or legally separated from spouse||Spouse and/or dependent children||36 months minus the number of months covered since the divorce||Member of Spouse must advise Fund Office so notification can occur|
|Child ceases to be a dependent child under Plan Definition||Dependent child||36 months||Member must advise Fund Office so notification can occur|
Who May Elect COBRA?
Under the law, only “Qualified Beneficiaries” are entitled to elect COBRA Continuation Coverage. A Qualified Beneficiary is any member, his or her spouse or dependent who was covered by the New England Carpenters Health Benefits Fund when a Qualifying Event occurs. A child who becomes a dependent child by birth, adoption or placement for adoption with the Member during a period of COBRA Continuation Coverage is also a qualified beneficiary.
However, a dependent purchasing COBRA who acquires a spouse during COBRA Continuation Coverage is not a qualified beneficiary.
One or more of your family members may elect COBRA even if you do not. Additionally, one member may elect COBRA for all Qualified Beneficiaries. However, in order to elect COBRA Continuation Coverage, the members of the family must have been covered by the Plan on the date of the Qualifying Event. A parent may elect or reject COBRA Continuation Coverage on behalf of dependent children living with him or her.
How to Elect COBRA Continuation Coverage
- In order to elect COBRA Continuation Coverage, the Fund Office must be notified when you experience a Qualifying Event. You must notify the Fund Office within 60 days from the date that the Qualifying Event occurs, or the date that you would lose coverage under the Fund because of the Qualifying Event, whichever is later. See the following Notification Procedures.
- When the Fund Administrator receives notice of the Qualifying Event, he or she will mail you an election form, information about COBRA and the date on which your coverage will end.
- Under the law, you and/or your covered dependents have 60 days from the later of the date:
- You would have lost coverage because of the Qualifying Event; or
- You and/or your covered dependents received the election form and COBRA information.
If you and/or any of your covered dependents do not elect COBRA within 60 days of the Qualifying Event (or, if later, within 63 days from the mailing date), you and/or your covered dependents will not have any group health coverage from this Fund after your coverage ends.
COBRA Notification Procedures
As a covered Member or Qualified Beneficiary you are responsible for providing the Fund Administrator with timely notice of certain qualifying events. You must provide the Fund Administrator notice of the following qualifying events:
- The divorce or legal separation of a covered Member from his or her spouse.
- A beneficiary ceasing to be covered under the Plan as a dependent child of a member.
- The occurrence of a second qualifying event after a Qualified Beneficiary has become entitled to COBRA with a maximum of 18 (or 29) months. This second qualifying event could include a Member’s death, entitlement to Medicare, divorce or legal separation or child losing dependent status.
In addition to these qualifying events, there are two other situations when a covered Member or Qualified Beneficiary is responsible for providing the Fund Administrator with notice within the timeframe noted in this section:
- When a Qualified Beneficiary entitled to receive COBRA coverage with a maximum of 18 months has been determined by the Social Security Administration to be disabled. If this determination is made at any time during the first 60 days of COBRA coverage, the Qualified Beneficiary may be eligible for an 11-month extension of the 18 months maximum coverage period, for a total of 29 months of COBRA coverage.
- When the Social Security Administration determines that a Qualified Beneficiary is no longer disabled.
You must make sure that the Fund Administrator is notified of any of these five occurrences listed above. Failure to provide this notice within the form and timeframes described below may prevent you and/or your dependents from obtaining or extending COBRA coverage.
How Should a Notice Be Provided?
In order to provide the Fund notice of any of these five situations you must complete and sign the Fund’s “COBRA Notice Form for Covered Employees and Qualified Beneficiaries.” You can obtain a copy of the form by calling the Fund Office at (800) 344-1515. Alternatively, you may send a letter to the Fund containing the following information:
- your name, for which of the five events listed above you are providing notice, the date of
- the event, the date in which the participant and/or beneficiary will lose coverage.
To Whom Should the Notice Be Sent?
Notice should be sent to the Fund at the following address:
The New England Carpenters Health Benefits Fund
Wilmington, MA 01887
Phone: (800) 344-1515
Fax: (978) 657-8724
When Should the Notice Be Sent?
If you are providing notice due to a divorce or legal separation, a dependent losing eligibility for coverage or a second qualifying event, you must send the notice no later than 60 days after the later of (1) the date upon which coverage would be lost under the Plan as a result of the qualifying event (2) the date of the qualifying event or (3) the date on which the Qualified Beneficiary is informed through the furnishing of a summary plan description or initial COBRA notice of the responsibility to provide the notice and the procedures for providing this notice to the Fund Administrator.
If you are providing notice of a Social Security Administration determination of disability, notice must be sent no later than the end of the first 18 months of continuation coverage.
If you are providing notice of a Social Security Administration determination that you are no longer disabled, notice must be sent no later than 30 days after the later of (1) the date of the determination by the Social Security Administration that you are no longer disabled or (2) the date on which the Qualified Beneficiary is informed through the furnishing of a summary plan description or initial COBRA notice of the responsibility to provide the notice and the procedures for providing this notice to the Fund Administrator.
Who Can Provide a Notice?
Notice may be provided by the covered Member, Qualified Beneficiary with respect to the qualifying event, or any representative acting on behalf of the covered Member or Qualified Beneficiary. Notice from one individual will satisfy the notice requirement for all related qualified beneficiaries affected by the same qualifying event. For example, if a member and his or her spouse and child are all covered by the Plan, and the child ceases to become a dependent under the Plan, a single notice sent by the spouse would satisfy this requirement. Where you or your dependents have provided notice to the Fund Administrator of a divorce or legal separation, beneficiary ceasing to be covered under the Plan as a dependent or a second qualifying event, but are not entitled to COBRA, the Fund Administrator will send you a written notice stating the reason why you are not eligible for COBRA.
Paying for COBRA Continuation Coverage
You are responsible for the entire cost of COBRA Continuation Coverage. When you and/or your dependents become eligible for this coverage, the Fund Administrator will notify you of the COBRA premium amounts that you must pay.
Your COBRA premiums may be as high as 102% of the Plan’s cost, except in the case of Social Security disability. (See the section below entitled “COBRA Continuation Coverage for Disabled Participants.”) You must send the first COBRA payment to the Fund Office within 45 days from the date on which the Fund Office receives your COBRA election form, as determined by postage cancellation. You must make payments so that coverage is continuous—there can be no lapse in coverage. If you choose COBRA within the election period but after the date on which your eligibility ended, you must pay the required COBRA premiums retroactively to cover the elapsed period.
Late COBRA Payments
Your monthly payments are due on the 1st day of each month. You will have 30 days in which to pay. Payments should be mailed to the Fund Office. If you do not make payment by the end of the 30 days, your coverage will be cancelled retroactively to the last day of the previous month and you will lose your right to continuation coverage.
Notify The Fund Office
You or a family member should notify the Fund Office when any Qualifying Event occurs to avoid confusion over the status of your health care in the event that your Employer does not provide prompt or correct information.
If you lose coverage due to a Qualifying Event:
- Inform the Fund Office of the Qualifying Event and request a COBRA election form.
- Complete and mail back the election form within 63 days of the date of the mailing, or 60 days of the date the Qualifying Event occurred, whichever is later.
- Make your first payment to the Fund Office within 45 days from the date the Fund Office receives your COBRA election form.
COBRA Continuation Coverage for Disabled Participants
If you are covered under COBRA for 18 months, and within the first 60 days of coverage you (or your covered dependent) become disabled, you (and your Qualified Beneficiaries who elected COBRA) may be eligible to continue your COBRA coverage for an additional 11 months for a total of 29 months. To be eligible, the Social Security Administration must make a formal determination that you (or your dependent) were disabled effective within the initial 60-day period of the start of your COBRA coverage and therefore entitled to Social Security Disability income benefits. You (or your dependent) must notify the Fund Office of the Social Security determination of disability by the end of the 18-month initial COBRA period if you wish to continue with the 11-month extension.
If you are eligible for the 11-month extension, your COBRA premiums may be as high as 150% of the regular premiums for the additional 11 months of coverage. This extended period of COBRA coverage will end on the earlier of:
- The last day of the month that occurs 30 days after Social Security has determined that you and/or your dependent(s) are no longer disabled;
- The end of the 29 months’ COBRA Continuation Coverage;
- The date the disabled person becomes entitled to Medicare. If you recover from your disability before the end of the initial 18 months of COBRA Continuation Coverage, you will not have the right to purchase extended coverage. You must notify the Fund Office within 30 days of:
- The date that you receive a final Social Security determination that you and/or your dependent(s) are no longer disabled; or
- The date that the disabled person becomes entitled to Medicare.
Multiple Qualifying Events While Covered Under COBRA
The maximum period of coverage under COBRA is 36 months, even if you experience another Qualifying Event while you’re already covered under COBRA. If you’re covered under COBRA for 18 months because of your termination of employment or reduction in hours, your affected spouse or dependent may extend coverage for another 18 months in the event of your death or if:
- You get divorced or legally separated;
- You become entitled to Medicare; or
- Your child is no longer a dependent under the Fund’s definition.
For example, you stop working (the first COBRA-Qualifying Event), and you enroll yourself and your dependents for COBRA Continuation Coverage for 18 months. Three months after your COBRA Continuation Coverage begins, your child turns 19 and no longer qualifies as a dependent child under the Fund’s definition. Your child then can continue COBRA coverage separately for an additional 33 months, for a total of 36 months’ COBRA Continuation Coverage.
You, as the member, are not entitled to COBRA Continuation Coverage for more than a total of 18 months if your employment is terminated or you have a reduction in hours (unless you are entitled to additional COBRA Continuation Coverage on account of disability). Therefore, if you experience a reduction in hours followed by a termination of employment, the termination of employment is not treated as a second Qualifying Event and you may not extend your coverage.
Coverage for Your Dependents if You’re Enrolled in Medicare
If you are entitled to or enrolled in Medicare and you have a termination of employment or reduction in hours, your eligible dependents would be entitled to COBRA for a period of 18 months (29 months if the 11-month Social Security Disability extension applies) from the date of your termination of employment or reduction in hours or 36 months from the date you became entitled to Medicare, whichever is longer.
Special COBRA Enrollment Rights
If you marry, have a newborn child, adopt a child or have a child placed with you for adoption while you are enrolled in COBRA, you may enroll that spouse or child for coverage for the balance of the period of COBRA Continuation Coverage. You must enroll your new dependent within 31 days of the marriage, birth, adoption or placement for adoption, with proper documentation.
In addition, if you are enrolled for COBRA Continuation Coverage and your spouse or dependent child loses coverage under another group health plan, you may enroll that spouse or child for coverage for the balance of the period of COBRA within 31 days after the termination of the other coverage.
To be eligible for this special enrollment right, your spouse or dependent child must have been eligible for coverage under the terms of the Plan but declined when enrollment was previously offered because they had coverage under another group health plan or had other health insurance coverage, with proper documentation.
Confirmation of Coverage to Health Care Providers
Under certain circumstances, federal rules require the Fund to inform your physician and health care providers as to whether you have elected and/or paid for COBRA Continuation Coverage. This rule only applies in certain situations where the physician or provider is requesting confirmation of coverage and you are eligible for, but have not yet elected, COBRA coverage, or you have elected COBRA coverage but have not yet paid for it.
Termination of COBRA Continuation Coverage
COBRA Continuation Coverage will terminate on the last day of the maximum period of coverage unless it is cut short for any of the following reasons:
- You do not make all required payments on time;
- The person receiving the coverage becomes covered by another group health plan that does not contain any legally applicable exclusion or limitation with respect to pre-existing conditions that the covered person may have;
- The person receiving the coverage becomes entitled to Medicare;
- The Plan terminates its group health plan and no longer provides group health insurance coverage to its members; or
- The Employer that employed you prior to the Qualifying Event has stopped contributing to the Plan; and
- The Employer establishes one or more group health plans covering a significant number of the employer’s employees formerly covered under this Plan; or
- The Employer starts contributing to another multiemployer plan that is a group health plan.
If continuation coverage is terminated before the end of the maximum coverage period, the Fund Administrator will send you a written notice as soon as practicable following the Fund Administrator’s determination that continuation coverage will terminate. The Notice will set out why continuation coverage will be terminated early, the date of termination, and your rights, if any, to alternative individual or group coverage.
If you have questions about COBRA Continuation Coverage, contact the Fund Office at (800) 334-1515.
Additional COBRA Election Period and Tax Credit in Cases of Eligibility for Benefits Under the Trade Act of 1974
If you are certified by the U.S. Department of Labor (DOL) as eligible for benefits under the Trade Act of 1974, you may be eligible for both a new opportunity to elect COBRA and an individual Health Insurance Act Credit. If you and/or your dependents did not elect COBRA during your election period, but are later certified by the DOL for Trade Act benefits or receive pensions managed by the Pension Benefit Guaranty Corporation (PBGC), you may be entitled to an additional 60-day COBRA election period beginning on the first day of the month in which you were certified. However, in no event would this benefit allow you to elect COBRA later than six months after your coverage ended under the Plan.
Also under the Trade Act, eligible individuals can either take a tax credit or get advance payment of 65% of premiums paid for qualified health insurance, including continuation coverage. If you have questions about these tax provisions, you may call the Health Care Tax Credit Customer Contact Center toll-free at 1-866-628-4282. TTD/TTY callers may call toll-free at 1-866-626-4282. More information about the Trade Act is also available at www.doleta.gov/tradeact/2002act_index.asp. The Fund Administrator may also be able to assist you with your questions.
Keep the Fund Informed of Address Changes
In order to protect your family’s rights, you should keep the Fund Administrator informed of any changes in the addresses of your family members. You should also keep a copy, for your records, of any notices that you send to the Fund Administrator.
Consequences of Failing to Elect COBRA
In considering whether to elect continuation coverage, you should take into account that a failure to continue your group health coverage will affect your future rights under federal law.
First, you can lose the right to avoid having pre-existing exclusions applied to you by other group plans if you have more than a 63-day gap in health coverage, and election of continuation coverage may help you prevent such a gap.
Second, you will lose the guaranteed right to purchase individual health insurance policies that do not impose these pre-existing condition exclusions if you do not get continuation coverage for the maximum time available to you.
Finally, you should take into account that you have special enrollment rights under federal law. You have the right to request special enrollment in another group health plan for which you are otherwise eligible (such as a plan sponsored by your spouse’s employer) within 30 days after your group health coverage ends because of the qualifying events listed above. You will also have the same special enrollment right at the end of continuation coverage if you get continuation coverage for the maximum time available to you.
Certificate of Creditable Coverage
When your coverage ends, the Fund Office will mail you and/or your dependents a Certificate of Creditable Coverage that indicates the period of time that you were covered under the New England Carpenters Health Benefits Fund. If you become eligible for coverage under another group health plan within 62 days of the date you lose coverage under the New England Carpenters Health Benefits Fund, this certificate may be necessary if your new group health plan has pre-existing condition limitations that apply to you.
The Fund Office will mail this certificate to you shortly after they learn that your coverage has ended. You may request a certificate from the Fund Office within two years from the date your coverage ended. To request a Certificate of Creditable Coverage, contact:
New England Carpenters Health Benefits Fund
Wilmington, MA 01887
Phone: (800) 344-1515
Fax: (978) 657-8724