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• COBRA Benefits

COBRA Benefits

Note: PayFlex is now Inspira Financial

Coverage ends for you and/or your dependent(s) at the end of the month in which:

• Your employment ends or you retire;
• You transition to a non-benefits eligible position;
• You divorce your spouse; or
• Your dependent child turns age 26.

Our group health plan is required to give employees and their families the opportunity to continue their health care coverage when there is a “qualifying event” that would result in a loss of coverage under our Plan. See more information about termination of benefits.

Qualified beneficiaries may include the employee (or retired employee) covered under the group health plan, the covered employee’s spouse, and the dependent children of the covered employee.

Each qualified beneficiary who elects continuation coverage will have the same rights under the Plan as other participants or beneficiaries covered under the Plan, including open enrollment.

2024 monthly COBRA premiums

Medical

Dental

Vision

Elect COBRA continuation coverage

• To elect continuation coverage, you must complete the election form within 60 days of the date of the offer letter or your last day of coverage, whichever is later.
• Each qualified beneficiary has a separate right to elect continuation coverage. For example, the employee’s spouse or child(ren) may elect continuation coverage even if the employee does not.

Failure to continue your group health coverage will affect your future rights under federal law.

• You can lose the right to avoid preexisting condition exclusions by other group health plans if you have a gap in health coverage of 63 days or more.
• You will lose the guaranteed right to purchase individual health coverage without a preexisting condition exclusion if you do not elect continuation coverage for the maximum time available to you.
• You have the right to request special enrollment in another group health plan for which you are eligible within 30 days after the end of continuation coverage.

Maximum coverage period

The maximum coverage period is based on the qualifying event causing a loss of eligibility.

• End of employment or reduction in hours allows coverage continuation for up to 18 months.
• The employee became eligible for Medicare less than 18 months prior to the COBRA qualifying event; continuation coverage for qualified beneficiaries lasts until 36 months after the date of Medicare eligibility.
• Employee’s death, divorce or legal separation, or the employee’s becoming entitled to Medicare benefits allows coverage continuation for up to a total of 36 months.
• A dependent child ceasing to be a dependent under the terms of the plan may be eligible for coverage continuation for up to 36 months.

COBRA termination

Continuation coverage will be terminated before the end of the maximum period if:

• Any required premium is not paid in full on time
• A qualified beneficiary first becomes covered, after electing continuation coverage, under another group health plan that does not impose any preexisting condition exclusion for a preexisting condition of the qualified beneficiary
• A qualified beneficiary first becomes entitled to Medicare benefits after electing continuation coverage
• The employer ceases to provide any group health plan for its employees
• For any reason the Plan would terminate coverage of an active employee or beneficiary not receiving continuation coverage (such as fraud)

Continuation extension

• If you elect continuation coverage, an extension of the maximum period of coverage may be available if a qualified beneficiary is disabled or a second qualifying event occurs.
• Notify the Inspira Financial (formerly PayFlex) at (800) 359-3921 of a disability or a second qualifying event in order to extend the period of continuation coverage.
• Failure to provide notice of a disability or second qualifying event may affect the right to extend the period of continuation coverage.

Disability

• An 11-month extension of coverage may be available if any of the qualified beneficiaries is determined under the Social Security Act (SSA) to be disabled.
• The disability has to have started at some time on or before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage.
• Each qualified beneficiary who has elected continuation coverage will be entitled to the 11-month disability extension if one of them qualifies.
• If the qualified beneficiary is determined to no longer be disabled under the SSA, you must notify the Plan of that fact within 30 days after that determination.

Second qualifying event

• Second qualifying events may include the death of a covered employee, divorce or legal separation from the covered employee, the covered employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both), or a dependent child’s ceasing to be eligible for coverage as a dependent under the Plan.
• Events can be a second qualifying event only if they would have caused the qualified beneficiary to lose coverage under the Plan if the first qualifying event had not occurred.
• An 18-month extension of coverage will be available to spouses and dependent children who elect continuation coverage if a second qualifying event occurs during the first 18 months of continuation coverage.
• The maximum amount of continuation coverage available when a second qualifying event occurs is 36 months.
• If you want to extend your continuation coverage notify the Plan within 60 days after a second qualifying event occurs.

COBRA payments

• Continuation coverage costs 102 percent of the cost to the group health plan (including both employer and employee contributions) for coverage of a similarly situated plan participant or beneficiary who is not receiving continuation coverage.
• Payments for continuation coverage should be made payable to Inspira Financial (formerly PayFlex) and sent to:
  Inspira Financial (formerly PayFlex)
  Benefit Billing DepartmentP.O. Box 953374St. Louis, MO 63195-3374
• For more information on COBRA enrollment or payments, contact Inspira Financial (formerly PayFlex) at 800-359-3921 or visit https://inspirafinancial.com/.

Initial payment

• Your benefits will not be reinstated until payment is received.
• You must make your first payment for continuation coverage no later than 45 days after the date of your election. The date of your election is considered the date the Election Notice is post-marked, if mailed.
• If you have not paid in full after 45 days after the date of your election, you will lose all continuation coverage rights under the Plan. You are responsible for making sure that the amount of your first payment is correct.

Periodic payments

• You will be required to make monthly payments for each subsequent coverage period. Under the Plan, each of these periodic payments for continuation coverage is due on the 1st day of the month for that coverage period.
• You will be given a grace period of 30 days after the first day of the coverage to make each periodic payment.
• If you fail to make a periodic payment before the end of the grace period for that coverage period, you will lose all rights to continuation coverage under the Plan.