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If a spouse or other dependent loses coverage under the Welfare Fund due to your death or divorce or your child's loss of eligibility due to age, he or she may be eligible to continue some or all of the benefits under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) by paying a premium. Under COBRA, coverage for an eligible dependent can generally continue for up to 36 months. Depending on the qualifying event, it may be your spouse's or child's responsibility to notify the Fund within 60 days of the event.
The premium for COBRA coverage will depend on a number of factors, including whether or not your spouse is eligible for Medicare, your basic health insurance and whether the COBRA coverage is for an individual or family.
Welfare Fund COBRA coverage is separate from Health Insurance COBRA coverage, and each must be applied for independently of the other. To apply to the Welfare Fund for COBRA coverage, your spouse or other dependent must submit a COBRA Enrollment Form. The CUNY Benefits Office should be contacted for information and a form for Health Insurance COBRA.
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What is COBRA?
The right to continuation coverage was created by federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 otherwise known as COBRA. COBRA refers to the Consolidated Omnibus Budget Reconciliation Act, a federal law that may let you keep your employer group health plan coverage for a limited time after your employment ends or after you would otherwise lose coverage. This is called “continuation coverage,” according to the Center for Medicare & Medicaid Services. Group coverage under COBRA usually lasts up to 18 months, although it may be extended to 36 months under certain circumstances.
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." A retiree's -spouse and eligible dependent children may become qualified beneficiaries. Those who elect COBRA continuation coverage must pay a premium which is established by the Fund actuaries in accordance with Federal COBRA regulations.
Welfare Fund COBRA coverage is separate and apart from basic Health Insurance COBRA coverage. Information on (CUNY) basic Health Insurance COBRA is available from the offices of the New York City Retiree Health Insurance Program. Enrolling in the (CUNY) New York City basic Health insurance COBRA does not assure enrollment in Welfare Fund COBRA and vice versa.
Spouse qualifying events include:
- The participant (retiree) dies, or
- The participant (retiree) obtains a divorce or termination of domestic partnership.
Dependent Child qualifying events include:
- The participant (retiree) dies, 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. A spouse or eligible child may elect COBRA coverage separately.
Because the qualifying event is either the death of the retiree, a divorce, termination of a domestic partnership or a dependent child's loss of eligibility, COBRA continuation coverage lasts for up to 36 months for qualified beneficiaries.
How is the Fund notified?
The Fund can offer COBRA continuation coverage to qualified beneficiaries only if properly notified that a qualifying event has occurred. The responsibility for notification rests with the surviving spouse or child(ren). In the case of a divorce, either party may notify the Fund. The Fund Office must be notified with 60 days of the qualifying event.
The CUNY (New York City) Retiree Health Insurance Program requires separate notification.
What benefits am I entitled to under COBRA?
Benefits are the same as those covered before the COBRA event, but with the Medicare status of the qualified beneficiary as the factor determining basic health coverage. The Welfare Fund offers Dental, Drug*, Extended Medical**, Hearing Aid and Vision benefits.
*Diabetic, "PICA," and ACA Preventative Medications will continue to be available only through NYC HBP basic health insurance and will require COBRA continuation of those policies.
** Only for Non-Medicare enrollees in the GHI-CBP program.
Cost of Coverage
What determines the cost of COBRA Coverage?
- Medicare status of the spouse/dependent(s), which determines whether coverage is
- New York City Basic Health Insurance (if under 65) or
- Medicare Supplemental (such as GHI SeniorCare)
- NYC HBP insurance planof the participant:
- GHI-CBP/Blue Cross
- All other carriers or
- Contract size
- Individual or
The combination of the three factors determines the monthly premium. The Welfare Fund supplemental benefits rates are available from campus benefit offices or from the PSC-CUNY Welfare Fund, or at the PSC-CUNY Welfare Fund’s website, psccunywf.org
Termination of COBRA Coverage
When does COBRA continuation coverage end?
It is terminated at the earlier of the following:
- Exhaustion of the basic and (if applicable) extended periods 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 eight (8) business days. If premium is not received by the end of the month, coverage is terminated permanently. The Fund does not bill.
- Re-marriage that results in the opportunity for comparable group coverage.
Upon expiration of the 36-month COBRA period, a spouse may be eligible to continue coverage through the Survivor Benefit. This is for the Welfare Fund only. Coverage through the CUNY basic program typically expires with finality when COBRA reaches the time limitation.
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.
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