Portland Community College | Portland, Oregon

COBRA

Eligible employees: Include full-time and part-time Faculty, Classified, Managerial, Academic Professionals and Confidentials.

Federal law (Consolidated Omnibus Budget Reconciliation Act, COBRA, Public Law 99-272. Title X and later amendments) requires Portland Community College to offer continued group healthcare coverage, dental coverage, and continuation of flexible spending accounts to qualified beneficiaries (employees and covered dependents entitled to elect continuation coverage) at group rates after those benefits would normally terminate due to a qualified status change. Both you and your spouse or domestic partner should take the time to read this notice carefully.

This notice is intended to inform you, in a summary fashion, of your rights and obligations under the continuation coverage provisions of the law. Please note, however, that the COBRA law remains somewhat unclear in certain areas and is subject to interpretation by the federal government and the courts. In addition, Congress often changes the law. Therefore, this summary is subject to change without notice as interpretations or changes in the law occur. Finally, this summary is intended to describe rights which are no greater than what the COBRA law requires and in the event of a conflict, the law will govern.

As an employee of Portland Community College covered by a group health insurance plan, you have a right to choose continuation coverage if you would otherwise lose your group health coverage due to one of the following qualified status changes:

1. A reduction in your hours of employment to less than those required to maintain eligibility for coverage; or
2. The termination of your employment (for reasons other than gross misconduct on your part).

If you are the spouse or domestic partner of an employee covered by one of PCC’s group health plans, you have the right to choose continuation coverage for yourself if you would otherwise lose coverage for any of the following qualified status changes:

1. The death of your spouse or domestic partner;
2. Termination of your spouse’s or domestic partner’s employment (for reasons other than gross misconduct) or reduction in your spouse’s or domestic partner’s hours of employment to less than those required to maintain eligibility for coverage;
3. Divorce or legal separation from your spouse or domestic partner; or
4. Your spouse or domestic partner becomes entitled to Medicare.

In the case of a dependent child of an employee covered by PCC group health insurance, they have the right to continuation coverage if group health coverage would otherwise be lost for any of the following qualified status changes:

1. The death of a parent;
2. The termination of a parent’s employment (for reasons other than gross misconduct) or reduction in a parent’s hours of employment to less than those required to maintain eligibility for coverage;
3. Parents’ divorce or legal separation;
4. A parent becomes entitled to Medicare; or
5. The dependent no longer qualifies as a dependent under the terms of the group health plan.

Under the law, a qualified beneficiary (the covered employee or affected family member) has the responsibility to give written notice to the Benefits Department of a divorce, legal separation, or a child losing dependent status. The qualified beneficiary must give this notice within 60 days of the event or within 60 days of the date coverage would end due to the event, whichever is later. Failure to give this notice during the 60 day period will result in the loss of the opportunity to elect continuation coverage. PCC has the responsibility to notify the Benefits Department of an employee’s death, reduction in hours, termination of employment or Medicare entitlement.

When the Benefits Department is notified that one of these qualified status changes has occurred, BenefitHelp Solutions (BHS), PCC’s third-party COBRA administrator, will in turn notify you that you have the right to elect continuation coverage. Under the law, you have 60 days from the date you would lose coverage due to one of the events described, or 60 days from the date of notification, whichever is later, to inform BHS in writing that you want continuation coverage. If you do not give notice of your election within the 60-day period, you lose your right to elect continuation coverage.

If you elect continuation coverage, PCC is required to offer you coverage which, as of the time coverage is being provided, is identical to the coverage provided to similarly situated employees or family members. If coverage is changed for similarly situated employees or family members, continuation coverage will be changed accordingly.

A covered employee, covered spouse or covered domestic partner may elect continuation coverage for all covered family members. The covered employee, spouse or domestic partner, and children, however, each have an independent right to elect continuation coverage. This means that a covered spouse, domestic partner, or child may elect continuation coverage even if the covered employee does not elect it.

The maximum period of continuation coverage for termination of employment or reduction of hours is 18 months. However, there is an exception. It pertains to those qualified beneficiaries that the Social Security Administration determines were disabled at the time of or within 60 days of termination or reduction in hours. Those individuals may have up to a total of 29 total months of continuation, but only if the Social Security Administration makes the determination within the first 18 months of the continuation coverage period and the qualified beneficiary notifies PCC Benefits both within the 18-month period and within 60 days of the determination. Thereafter, if there is a final determination of non-disability, the qualified beneficiary must so notify the Benefits Coordinator within 30 days. The extended continuation will end the month that begins more than 30 days from the final determination that the qualified beneficiary is no longer disabled.

For death, dissolution of marriage or legal separation of the covered employee, continuation coverage for a covered spouse or domestic partner and children may last for up to 36 months as long as they are otherwise eligible under the plan.

For a covered child ceasing to be eligible as a dependent under the plan, continuation may last for up to 36 months.

For the covered employee becoming entitled to Medicare and thereby causing a loss of coverage for covered dependents, continuation for dependents may last for up to 36 months.

In the case of multiple qualified status changes (a qualified status change followed by one or more qualified status changes) a qualified beneficiary shall upon proper notice (within 60 days of the event) to the Benefits Department of the succeeding qualified status change, continue for up to 36 months from the date the original continuation coverage began.

Extended Coverage for Surviving, Divorced or Legally Separated Spouses 55 or Older

You are eligible for special extended group health plan coverage if:

• You are the surviving spouse or a divorced or legally separated spouse of a covered employee and
• You are at least 55 years old at the time of your spouse’s death or the divorce or legal separation.

If you meet both these requirements, you can also elect to cover any dependent children who would lose coverage under the plan because of the death, divorce or legal separation.

When you initially enroll for special extended coverage, you will receive the same medical, dental, or vision benefits that you were receiving through your spouse or former spouse. Once you are on special extended coverage, you will continue to have the same benefits and coverage options that are available to active employees.

There are no set time limits on this special extended coverage, as there are for COBRA coverage. The special extended coverage will end when:

• You fail to pay the required premium on time;
• You become covered under another group health plan, whether as a covered employee or a covered spouse;
• You become eligible for Medicare; or
• We terminate the group health plan without replacing it.

To apply for this special extended coverage, you must notify OEBB, in writing, no later than the deadline shown below.

• Spouse’s death: 30 days after date of death
• Divorce or Legal Separation: 60 days after date of legal separation or entry of divorce decree

If you do not notify OEBB of the death, divorce or legal separation by the deadline, you lose the right to elect this coverage. When you write to OEBB, you must include your current mailing address.

Within 14 days of the date we receive your notice, we will send you a form for you to elect the special continuation coverage. We will also tell you the amount of the premiums charged and how to make your payments. You must return your election form within 60 days of the date we mailed it to you. If you miss this deadline, you lose the right to elect this coverage.

The rules on the amount and timing of your premium payments are the same as for regular COBRA coverage (see below).

You are responsible for payment of the continuation coverage premium. Premium payments for the initial months of continuation coverage are due by the 45th day after you elect continuation coverage. The initial months of continuation coverage are the months that end on or before the 45th day after you elect continuation coverage. All other premiums are due on the first of the month for which premium is paid, subject to a 30 day grace period.

Continuation coverage will end for any of the following reasons:

1. The premium for your continuation coverage is not paid on a timely basis; (by the end of the 30-day grace period)
2. Portland Community College no longer provides a group health plan for employees;
3. You become covered under another group health plan that does not limit or exclude your coverage for a pre-existing condition that you or your covered dependents have;
4. You become entitled to Medicare;
5. You extended continuation coverage beyond 18 months due to a disability and a final determination has been made that you are no longer disabled;
6. The 18, 29, or 36 month period of continuation ends.

You do not have to provide health evidence of insurability to elect continuation coverage. Oregon law also provides that, at the end of the 18, 29, or 36 month continuation coverage period, you may elect to enroll in the portability plan currently available through your carrier.

If your marital status changes, your child loses dependent status, or you have any questions about continuation coverage, please contact Benefits immediately (971-722-5872). Send written notification to: Portland Community College, Human Resources (Downtown Center 321), P.O. Box 19000, Portland OR 97280-0990.