Policy Manual sample

MDT Home Health Care Agency, Inc. NOTICE OF RIGHT TO ELECT CONTINUATION COVERAGE Public Law 99-272, Title X, is the Consolidated Omnibus Budget Reconciliation Act, more commonly referred to as “COBRA”. COBRA affects most employers who sponsor group health plans. It requires that they offer continuation coverage to employees and their families in certain instances after coverage under the plan would otherwise end. The temporary extension of health coverage is offered at group rates plus a 2 percent administrative fee. Employers (excluding churches) who had more than 20 employees on a typical day in the previous year can offer COBRA coverage. This notice is a summary of your rights and obligations under the continuation coverage provisions of the law (if the economic situation of the Agency permit to provide Health insurance coverage). Both you (and your spouse) should take the time to read this notice carefully. For Employees covered by our group health plan have a right to choose this continuation coverage. You and your dependents can continue coverage for up to 18 months if you lose your group health coverage because of: A reduction in your hours of employment, The termination of your employment (for reasons other than gross misconduct on your part). Employees, spouses or dependent children who are disabled during the first 60 days of your COBRA eligibility and at the end of the 18-month continuation coverage period, this period may be extended for up to an additional 11 months (a total extension of 29 months) or until you become entitled to Medicare. However, you must give us 60 days notice to be eligible for this extended continuation coverage. You must also notify us within 30 days of any final determination that you are no longer disabled. Disability is determined under Title II (Old Age Survivor Disability Income) or XVI (Supplemental Security Income) of the Social Security Act. After the 18 th month of coverage, 150 percent of the applicable premium will be charged for this extension of continuation coverage. A spouse or dependent child of an employee covered by our group health plan has the right to continuation coverage if coverage under our plan is lost for any of the following reasons: Death of the Employee; Termination of the employee (for reasons other than gross misconduct) or a reduction in their hours of employment; Employee and spouse are divorced or legally separated; Employee becomes entitled to Medicare; or Dependent ceases to be a “dependent child” under the provisions of our group health plan. Spouses and dependent children have the right to continue coverage for up to 36 months, except when coverage is lost due the employee’s termination of employment or reduction in hours of employment. Rights similar to these may apply to retirees, spouses and dependents, if the employer commences a bankruptcy proceeding and those individuals lose coverage. Under the law, you (the Employee or your family member) have the responsibility to inform the employer of a divorce, legal separation, or a child losing dependent status under the group health plan. You must provide this information within 60 days of the event or within 60 days of the date on which coverage would be lost because of the event, whichever is later. We (the employer) are responsible for notifying our primary insurer within 14 days when an employee: Dies; Is terminated from employment, or if his hours are reduced; or Becomes entitled to Medicare. When you inform us that one of these events has happened, we will notify you that you have the right to choose continuation coverage. The law states that you must inform us that you want continuation coverage within at least 60 days from the date you would lose coverage because of one of the events described previously. If you do not choose continuation coverage within the time specified, your group health coverage will end. If you choose continuation coverage, we are required to make available to you coverage which is identical to the coverage currently provided under the plan. This coverage may be extended if other events (such as divorce, legal separation or death) occur during that initial period. Under no circumstances will coverage last beyond 36 months from the date of the event that originally made Home Health Agency. - - Personnel/Operations Policies B-126