Active Health Summary Plan Description
As of September 1, 2017
En Español (PDF)

17.1 COBRA

A. Introduction

The Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (commonly referred to as "COBRA), requires that this Administrative Office offer you and your eligible Dependents the opportunity to continue health care coverage at group rates when coverage under this Plan would otherwise end due to the occurrence of what are called "qualifying events". Continued coverage under COBRA applies to the health care benefits (medical, dental, and prescription drug and vision benefits) described in this Summary Plan Description.

Your group health benefits under COBRA will be the same as those covering you on the day before you lose coverage under this Plan. (COBRA does not apply to your life insurance benefits under this Summary Plan Description.) You should also keep in mind that each individual entitled to COBRA coverage as the result of a loss of group coverage due to the occurrence of a qualifying event has a separate and independent right to make his or her own election of coverage. For example, your spouse or other covered Dependent could elect COBRA coverage even if you do not.

IMPORTANT: If you choose to continue your health care coverage as explained below, you will have to make a payment each month to the Administrative Office within the time periods explained below. The Administrative Office does not send bills for COBRA coverage. It is your responsibility to make COBRA payments on time. If you don't make your payment on time, your coverage will end.

Under COBRA, you have 60 days from the date you lose coverage because of the occurrence of certain qualifying events to inform the Administrative Office that you want to elect COBRA continuation coverage. Once you receive the COBRA election notice from the Administrative Office you will then have sixty days to notify the Administrative Office that you are electing COBRA continuation coverage. If you don't elect COBRA within that 60-day period, you will forfeit your rights as a qualified beneficiary to elect COBRA. You must make your first payment for COBRA continuation coverage to the Administrative Office within 45 days after you first elect COBRA coverage. If you do not make your initial COBRA premium payment in full within the 45-day period, the Administrative Office will terminate your COBRA coverage and you will not be able to reinstate that COBRA coverage.

When you make your first COBRA premium payment, you must pay for all months of coverage which are due through the end of the month in which you make your first payment. Your payment for subsequent months is due on the first of each month. The Administrative Office will terminate your COBRA coverage for non-payment if the Administrative Office does not receive your COBRA premium payment within 30 days after the applicable month's due date. For example, a payment for the coverage month of January is due January 1st. If payment is not received in the Administrative Office by January 30th, the Administrative Office will terminate your COBRA continuation coverage. If this happens, there would be no coverage for the month of January, or any additional months for which COBRA benefits may have been available.

You, your spouse, and children should read this section carefully. The following information explains both your rights and your obligations under COBRA. If you have any questions, contact the Administrative Office. The telephone number and address are printed under the "Summary Plan Description General Information" in the front of this booklet.

B. Subsidized COBRA

The subsidized COBRA program is partially funded through employer contributions. There is no vested right to subsidized COBRA benefits and the Trustees may change, modify, reduce or terminate these subsidized benefits at any time as a result of conditions or events requiring such action.

For certain Participants and beneficiaries, the required COBRA self-payment is $50.00 per month for the first three (3) consecutive months of continuation of "Basic Coverage" consisting of hospital/medical and prescription drug benefits. If you are eligible to do so, you may also choose to continue dental and vision benefits under COBRA for an additional cost. Thereafter, on the fourth month of COBRA continuation coverage, you must self-pay at the full premium cost allowed by COBRA. COBRA does not apply to any life insurance benefits you may have under the SPD.

The eligible dependents of an eligible Participant losing coverage due to the Participant's death are eligible for the subsidized rate (if the Participant would have been eligible for this rate) for the first three (3) consecutive months of continuation of "Basic Coverage," consisting of Hospital, Medical and Prescription Drug benefits. If the eligible dependents choose to continue dental and vision benefits under COBRA, there is an additional cost. Thereafter, on the fourth month, the eligible dependents must self-pay at the full premium cost allowed by COBRA.

The following are examples of persons who are not eligible for the subsidized rate:

  1. Participants receiving a pension from the Southern California IBEW-NECA Pension Plan and their Dependents;
  2. Participants who are classified as Designated Working Members;
  3. Spouses and stepchildren losing coverage due to divorce;
  4. Children losing coverage due to attainment of an age beyond a maximum age permitted for dependent coverage under this Plan;
  5. Participants who are employed by an employer who are permitted to receive increased wages in lieu of health coverage;
  6. Participants who decline to reciprocate Contributions to the Southern California IBEW-NECA Health Trust Fund while employed by an Employer that contributes to a trust fund or fund that is signatory to the International Reciprocal Agreement;
  7. Participants whose eligibility is terminated due to Non-Covered Electrical Employment.

It is important to remember that while Participants, spouses and children have separate and distinct COBRA election rights, the election of COBRA by a Participant automatically provides COBRA coverage for the Participant's eligible Dependents and the election of COBRA by any parent automatically provides COBRA coverage for the parent's eligible children.

You will again be eligible for the COBRA self-payment of $50.00 per month after you have reestablished your Hours Bank Reserve to a maximum of 600 hours. The Hours Bank Reserve is explained in Article 4.3: Hours Bank Reserve.

The Trustees will not necessarily continue to offer the subsidized COBRA self-payment of $50 for the first three (3) consecutive months. The Trustees do not guarantee to subsidize the cost of COBRA coverage, and they may discontinue or reduce the amount of the subsidy at any time, provided they give all Plan Participants with 60 days' notice of any change to the subsidy program. You can pay the monthly premium. However, a third party such as a hospital or your new employer may also to pay the premium.

C. At a Glance - Qualifying Events That Entitle You to COBRA

If you Lose Coverage Because of This Reason
(a "qualifying event")

These People Would Be Eligible If Covered Under the Plan on the Day Before the Qualifying Event

For COBRA Coverage Up To
(Measured from the date coverage is lost)

Your employment terminates*

You and your covered spouse and covered children

18 months**

Your working hours are reduced

You and your covered spouse and covered children

18 months**

You die

Your covered spouse and covered children

18 months to a maximum of 36 months

You divorce or legally separate

Your former spouse and your covered stepchildren

18 months to a maximum of 36 months

Your dependent child (who reaches age 26), no longer qualifies as an eligible dependent

Your covered child

18 months to a maximum of 36 months

You become permanently disabled

Your covered spouse and covered children

18 months to a maximum of 29 months

*For any reason (and including military leave and approved leaves granted under the Family and Medical Leave Act (FMLA). Note that under FMLA, your employment terminates at the end of the approved leave if you do not return to work.

** Continued coverage for up to 29 months from the date of the initial event may be available to those who are or become totally disabled within the meaning of Title II, or Title XVI of the Social Security Act at any time during the first 60 days of COBRA continuation coverage. This additional 11 months of COBRA coverage is available to Employees and enrolled Dependents if notice of disability is provided within 60 days after the Social Security determination of disability is issued and before the 18-month continuation period runs out. The cost of the additional 11 months of COBRA coverage may increase to a maximum of 150% of the full cost of the elected coverage. Additionally, coverage can be extended for eligible Dependents for up to a maximum of 36 months in the event of a second qualifying event prior to the initial termination of COBRA coverage if the second qualifying event results in a loss of coverage. Examples would be the death of the Employee, the divorce or legal separation of the Employee if the divorce or legal separation results in a loss of coverage under the Plan, or the Employee attaining initial eligibility for Medicare coverage.

D. Notification

A Participant or a Family Member has the responsibility to inform the Administrative Office of a divorce, legal separation, or a child losing dependent status under the Plan within 60 days of the qualifying event. If you fail to notify the Administrative Office of a divorce, legal separation, or a child losing dependent status within the 60-day period, the affected dependent will lose the right to elect COBRA continuation coverage. A qualifying event means the reason you are losing eligibility under one of the situations described above, such as termination of a Participant's employment. Another example of a qualifying event for a legal spouse would be divorce. For a dependent, he or she may turn age 26 and no longer be an eligible dependent under Plan rules.

When the Administrative Office is notified that one of these events has happened, the Administrative Office will, in turn, notify you that you have the right to elect COBRA continuation coverage. This notice will also explain the monthly payment you must pay to continue your health coverage. Under COBRA, you have at least 60 days from the date you would lose coverage, because of one of the qualifying events described above, to inform the Administrative Office that you want to elect COBRA continuation coverage.

Children born or adopted during the Participant's period of continuation coverage are considered Dependents, the same as those of active eligible Participants. Remember, you must enroll your newborn or adopted child within 31 days of the birth or placement for adoption. Contact the Administrative Office for the necessary forms to enroll this new Dependent.

If you do not elect to continue coverage or if you do not make the required self-payment by the applicable due date, your coverage under this Plan will end. You will not be able to elect COBRA Continuation Coverage at a later date.

E. Benefits and Length of Coverage

If you choose "Basic" COBRA coverage, it will be the same hospital/medical/prescription drug coverage that you had under the Plan on the day before the occurrence of the qualifying event which resulted in your loss of coverage under this SPD. A qualified beneficiary is entitled to up to 18 months of COBRA coverage if the qualifying event is termination of employment or a reduction of employment hours. This may be extended for up to an additional 11 months, for a total of 29 months if the Social Security Administration finds that a qualified beneficiary (either the Participant or the spouse or dependent child) is disabled at any time during the first 60 days of COBRA coverage. To implement this special 11-month extension, the disabled qualified beneficiary must notify the Administrative Office within 60 days following the latest of the date on which the individual receives the initial COBRA notice following a qualifying event, the date Social Security determines that the individual is disabled, the date of the qualifying event, or the date on which the qualified beneficiary loses (or would lose) coverage due to the occurrence of the qualifying event. In any event, you must provide the notice of disability before the end of the initial 18-month COBRA coverage period arising from the Participant's termination of employment or reduction in hours of employment. The occurrence of another qualifying event during the initial 18-month (or 29 month) COBRA coverage period may increase the maximum COBRA coverage period to 36 months (maximum).

If another qualifying event (such as a divorce or legal separation or the death of the Participant) occurs during the 18-month COBRA coverage period (or during the 29-month COBRA coverage period in the case of a disability extension), the spouse or dependent children may be entitled to an extension of the COBRA coverage period to up to a total of 36 months (the maximum COBRA coverage period under the law). In no case, may the total maximum COBRA coverage period arising from an initial or related qualifying event be more than 36 months.

F. Cancellation of Your COBRA Coverage

Your COBRA coverage will be terminated at the end of the maximum applicable COBRA coverage period or prior to the end of the maximum COBRA coverage period for any of the reasons explained below.

  1. The Board of Trustees terminates a particular coverage for all Participants of the Plan. If coverage is changed or eliminated, persons on COBRA only have the right to choose among the options offered to similarly situated non-COBRA beneficiaries;

    For example, if the Trustees were to terminate an HMO contract under which you were covered under COBRA, and another HMO was offered to all other Plan participants who were previously enrolled in the canceled HMO, you would be allowed to enroll in the replacement HMO.
  2. You request that your COBRA coverage be canceled. If you request termination, the COBRA coverage will generally end on the first day of the month following completion of a 30-day period beginning on the date the Administrative Office received your written request to cancel the COBRA coverage. For example, if the Administrative Office received your letter on May 15, the 30-day period would end on June 15, and the COBRA coverage would end July 1. In this situation, you would be required to pay for the COBRA coverage through the month of June;
  3. If your COBRA premium is not paid in a timely manner, your coverage will be canceled. The cancellation will be retroactive to the beginning of the month following the end of the month for which you last made a timely COBRA premium payment. If you have received any benefits or services in the period of time following the cancellation of your COBRA coverage, you may be required to repay to the carrier the amount of the benefits received or the cost of the services rendered;
  4. The date on which the qualified beneficiary first becomes, after the date of election, covered under any other group trust fund (as an employee or otherwise) provided that the other trust fund does not contain any exclusion or limitation for any pre-existing condition which affects the coverage of the qualified beneficiary covered under the new trust fund. Note that a qualified beneficiary may not be denied the right to elect COBRA coverage because they are covered under another group trust fund at or before the time they make their COBRA election under this Plan;
  5. You become entitled to Medicare benefits after COBRA coverage has been elected;
  6. You are no longer disabled. If a qualified beneficiary is determined to no longer be disabled under the Social Security Act before the end of the 29-month maximum coverage period, COBRA coverage may be terminated at the beginning of the first month that begins more than 30 days after such determination is made;
  7. The signatory Employers to the Plan no longer provide group health coverage benefits to any of its Employees;
  8. The Plan is terminated.

G. Dependent/Spouse Address Change

Contact the Administrative Office if you or your dependents change address(es).