Employees Not Eligible for Medicare — Employees whose health and/or welfare fund coverages are terminated due to a reduction in hours of employment or termination of employment (for reasons other than gross misconduct). Termination of employment includes unpaid leaves of absence of any kind. More information concerning situations involving termination due to gross misconduct is available from your agency benefits representative.

Spouse/Domestic Partner Not Eligible for Medicare — A Spouse/Domestic Partner who loses coverage for any of the following reasons: 1) death of the City employee or retiree;  2) termination of the employee’s City employment (for reasons other than gross misconduct); 3) loss of health coverage due to a reduction in the employee’s hours of employment;  4) divorce from the City employee or retiree; 5) termination of domestic partnership with the City employee or retiree; 6) retirement of the employee.

Dependent Children Not Eligible for Medicare — Dependent children who lose coverage for any of the following reasons: 1) death of a covered parent (the City employee or retiree); 2) the termination of a covered parent’s employment (for reasons other than gross misconduct); 3) loss of health coverage due to the covered parent’s reduction in hours of employment; 4) the dependent ceases to be a “dependent child” under the terms of the Health Benefits Program; 5) retirement of the covered parent.

If dependents lose benefits as a result of death, divorce, domestic partnership termination, or loss of coverage due to the Medicare-eligibility of the contract holder, or due to the loss of dependent child status, the maximum period for which COBRA can continue coverage is 36 months. This period will be calculated from the date of the loss of coverage under the City program.

The definition of a qualified beneficiary includes a child born to or adopted by certain qualified beneficiaries during the COBRA continuation period. Only if you are a qualified beneficiary by reason of having been an employee, will a child born to or adopted by you during the COBRA continuation period become a qualified beneficiary in his or her own right. This means that if you should lose your COBRA coverage, your new child may have an independent right to continue his or her coverage for the remainder of the otherwise applicable continuation period. However, you must cover your new child as a dependent within 30 days of the child’s birth or adoption in order to have this added protection.

Any increase in COBRA premium due to this change must be paid during the period for which the coverage is in effect.

Continuation of coverage can never exceed 36 months in total, regardless of the number of events that relate to a loss in coverage. Coverage during the continuation period will terminate if the enrollee fails to make timely premium payments or becomes enrolled in another group health plan.

Under the law, the employee or family member has the responsibility of notifying the City agency payroll or personnel office and the applicable welfare fund within 60 days of the death, divorce, domestic partnership termination, or change of address of an employee, or of a child’s losing dependent status.

When a qualifying event (such as an employee’s death, termination of employment, or reduction in hours) occurs, the employee and family will receive a COBRA information packet from the City describing continuation coverage options.

To elect Fund COBRA continuation coverage, the member or his/her spouse/domestic partner or dependent child should complete a Management Benefits Fund COBRA Application and submit it to the Fund within 60 days of the date of benefit coverage termination.  The member may be eligible to receive full COBRA continuation coverage from their basic City health plan.  Please contact your agency benefit manager or your health carrier directly within 60 days of your benefit coverage termination to apply for this coverage.