COBRA (Adjuncts)

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If adjunct basic benefit coverage is lost, participants and covered eligible dependents may continue to receive benefits by paying a premium. The right to continuation coverage was created by federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985, otherwise known as COBRA.

COBRA provides for a continuation of benefits when coverage would otherwise terminate due to a "qualifying event." Specific qualifying events are listed below. After a qualifying event, COBRA coverage is made available to each person who is a "qualified beneficiary." Participants (employees), spouses and dependent children may become qualified beneficiaries. Those who elect COBRA continuation coverage must pay a premium which is established by the Fund actuaries is in accordance with Federal COBRA regulations.

Employee qualifying events include:

  • Hours of employment are reduced to the extent plan eligibility is lost, or
  • Employment is terminated for any reason other than gross misconduct.

Spouse qualifying events include:

  • The participant (employee) dies,
  • The participant (employee)'s hours of employment are reduced to the extent plan eligibility is lost,
  • The participant (employee)'s employment is terminated for any reason other than your gross misconduct, or
  • The participant (employee) and spouse divorce or legally separate resulting in a loss of coverage.

Dependent Child qualifying events include:

  • The participant (employee) dies,
  • The participant (employee)'s hours of employment are reduced to the extent plan eligibility is lost,
  • The participant (employee)'s employment is terminated for any reason other than your gross misconduct, or
  • The child loses eligibility as a "dependent child."

Qualified Beneficiaries and Duration of Benefit

Each qualified beneficiary has an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children. A spouse or child may elect COBRA coverage independent of a terminated employee's decision.

  • When the qualifying event is the end of employment or reduction of the employee's hours of employment, COBRA continuation coverage lasts for up to 18 months.

  • When the qualifying event is the death of the employee, divorce, termination of a domestic partnership or a dependent child's losing eligibility, COBRA continuation coverage lasts for up to 36 months for spouses and children who are qualified beneficiaries.

Other coverage options besides COBRA:Health Insurance Marketplace
Instead of enrolling in COBRA continuation coverage, there may be other insurance options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plans (such as a spouse’s plan) under what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage and provide greater flexibility. By obtaining coverage through the Health Insurance Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. You can learn more about many of these options at www.healthcare.gov.

Notification Responsibilities

The Fund can offer COBRA continuation coverage to qualified beneficiaries only if properly notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, reporting is the responsibility of the employer.

For some qualifying events, the responsibility for reporting rests with the participant. With a divorce or termination of domestic partnership or with a child losing dependency status due to age or school discontinuance, the participant or affected parties must notify the Fund Office within 60 days of the date that the qualified beneficiary would lose coverage after the qualifying event or of the qualifying event itself. The Fund Office requires supporting documentation.

Type of Coverage

  • If the COBRA event is the loss of coverage by the adjunct participant, the insurance coverage (carrier and contract size) in effect immediately prior to the event may be continued by paying the COBRA premium directly to the PSC-CUNY Welfare Fund.
  • If the COBRA event is the spouse's loss of coverage due to divorce or the death of the adjunct participant, the insurance coverage (carrier) in effect immediately prior to the event may be continued by paying the COBRA premium directly to the PSC-CUNY Welfare Fund. The spouse will have an individual COBRA contract.
  • If the COBRA event is the dependent child's loss of coverage due to the death of the adjunct participant, the child can join the surviving spouse on a family COBRA contract or elect individual coverage. If the COBRA event is the dependent child's loss of coverage due to exceeding the age limit or no longer being a full-time student, the child may elect an individual COBRA contract.

Premium

The premium is set by law at 102% of the premium paid by the Fund to the carrier.

Termination of COBRA Coverage

COBRA continuation coverage is terminated at the earliest of the following:

  • exhaustion of the benefit duration limit as defined herein,
  • failure to pay the COBRA premium on a timely basis. The premium is due the first day of the month of coverage (after the initial period). Benefits will be suspended with all vendors and carriers at the end of five business days. If the premium is not received by the end of the month, coverage is terminated permanently. The Fund does not bill.
  • Removal or reversal of the conditions of the qualifying event. This includes but is not limited to employment or re-employment or marriage that results in the opportunity for comparable group coverage.

COBRA regulations are voluminous and complex. Every effort has been made in this section to present highlights necessary to make appropriate decisions, but not to present all details of the program. Questions concerning COBRA continuation coverage rights may be addressed to the Fund Office, or for more information, participants may wish to contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) or visit the EBSA website.