412 Continued Group Health Insurance
Original Approval Date: April 19, 1995
Revision Effective: May 20, 2009
Supersedes:
Employees who separate from service and/or their spouses and children may be eligible for continuation of health insurance coverage, at their own expense, as described herein. The same health insurance coverage shall continue for eligible employees and individuals under this policy as is provided to other employees who maintain employment with the Tri-County Board.
Employees, spouses and dependent children covered under Miami County's health insurance plan shall be offered the opportunity to continue health insurance coverage according to the following schedule:
a. An employee who is terminated (other than by discharge for gross misconduct) shall be eligible to purchase health insurance coverage for up to eighteen (18) months following the termination.
b. An employee whose total hours worked are reduced, which reduction causes the employee to be ineligible for continued health insurance coverage, shall be eligible to purchase health insurance coverage for up to eighteen (18) months following such reduction.
c. If a second qualifying event (i.e. reduction in hours, disability, death) occurs during this eighteen (18) month period, coverage may be extended for an additional eighteen (18) months.
d. If an employee experiences a disability within 60 days of opting for continued health coverage under COBRA, the employee may elect to continue coverage for an additional 11 months for a total of 29 months.
e. If any beneficiary becomes disabled under the Social Security Act and provides timely notice of that status to the Employer, coverage may be extended for up to twenty-nine (29) months.
f. The spouse and dependent children of an employee shall be eligible to purchase health insurance coverage for up to thirty-six (36) months when the employee:
(1) Dies;
(2) Would otherwise lose coverage due to termination and/or reduction as described in the above paragraphs; or
(3) Becomes entitled to Medicare coverage.
g. The spouse and/or dependent children shall be eligible to purchase health insurance coverage for up to thirty-six (36) months when:
(1) The spouse and dependent children would lose eligibility for continued coverage due to a divorce or legal separation; or
(2) The dependent child would otherwise lose coverage by ceasing to satisfy the plan's coverage requirements applicable to dependent children.
These policies are developed by Miami County and are subject to change.
Full-time employees, spouses and dependent children shall be notified of the provisions of this policy as follows:
a. Employees shall be notified of this policy at the time they begin coverage under Miami County's health insurance plan or in the event they are either terminated or reduced.
b. Spouses shall be notified of this policy at the time family or spouse coverage begins under Miami County's health insurance plan or in the event the employee is either terminated or reduced.
c. Service of Notification on the employee's spouse shall be deemed notice to dependent children.
d. Miami County’s HR department will be contacted so that the COBRA compliance officer can provide the proper notice.
Each employee shall be responsible for notifying the Board of any action which might trigger a spouse's or dependent child's eligibility for continuation of insurance coverage under this policy. Such notice shall be given by the employee to the Director of Finance and Administration and Miami County Benefits Office immediately upon gaining knowledge of the event and shall include divorce, legal separation, or loss of dependent eligibility under the County plan.
The Miami County Benefits Office shall notify the individual(s) who are eligible for continued health insurance plan coverage of their rights and obligations under this policy, within fourteen (14) days after the occurrence of a triggering event. The notice shall contain a final date by which the employee, spouse, or dependent child must respond to the notice.
The eligible employee or other covered individual shall notify the COBRA compliance officer of his/her decision to continue or not continue coverage within sixty (30) days of the triggering event.
As used in this policy, termination shall include any separation from employment, except those instances where an employee has been separated for acts of gross misconduct, but including layoff, resignation, voluntary/involuntary leave without pay, discharge and any other termination which results in the employee's ineligibility for continued health insurance benefits. Employees who are separated in accordance with civil service law for gross misconduct are not eligible for continuation of health insurance plan coverage.
An employee, spouse or dependent child who elects continued health insurance coverage shall only be eligible until the earliest date that any of the following occur:
a. coverage expires either eighteen (18), twenty-nine (29) or thirty-six (36) months after the triggering event;
b. The group health care plan is terminated by the County;
c. The individual fails to pay the required premium in a timely manner;
d. The employee becomes covered under another group health care plan; or
e. The individual becomes eligible for Medicare benefits.
Revision Effective: May 20, 2009
Supersedes:
Employees who separate from service and/or their spouses and children may be eligible for continuation of health insurance coverage, at their own expense, as described herein. The same health insurance coverage shall continue for eligible employees and individuals under this policy as is provided to other employees who maintain employment with the Tri-County Board.
Employees, spouses and dependent children covered under Miami County's health insurance plan shall be offered the opportunity to continue health insurance coverage according to the following schedule:
a. An employee who is terminated (other than by discharge for gross misconduct) shall be eligible to purchase health insurance coverage for up to eighteen (18) months following the termination.
b. An employee whose total hours worked are reduced, which reduction causes the employee to be ineligible for continued health insurance coverage, shall be eligible to purchase health insurance coverage for up to eighteen (18) months following such reduction.
c. If a second qualifying event (i.e. reduction in hours, disability, death) occurs during this eighteen (18) month period, coverage may be extended for an additional eighteen (18) months.
d. If an employee experiences a disability within 60 days of opting for continued health coverage under COBRA, the employee may elect to continue coverage for an additional 11 months for a total of 29 months.
e. If any beneficiary becomes disabled under the Social Security Act and provides timely notice of that status to the Employer, coverage may be extended for up to twenty-nine (29) months.
f. The spouse and dependent children of an employee shall be eligible to purchase health insurance coverage for up to thirty-six (36) months when the employee:
(1) Dies;
(2) Would otherwise lose coverage due to termination and/or reduction as described in the above paragraphs; or
(3) Becomes entitled to Medicare coverage.
g. The spouse and/or dependent children shall be eligible to purchase health insurance coverage for up to thirty-six (36) months when:
(1) The spouse and dependent children would lose eligibility for continued coverage due to a divorce or legal separation; or
(2) The dependent child would otherwise lose coverage by ceasing to satisfy the plan's coverage requirements applicable to dependent children.
These policies are developed by Miami County and are subject to change.
Full-time employees, spouses and dependent children shall be notified of the provisions of this policy as follows:
a. Employees shall be notified of this policy at the time they begin coverage under Miami County's health insurance plan or in the event they are either terminated or reduced.
b. Spouses shall be notified of this policy at the time family or spouse coverage begins under Miami County's health insurance plan or in the event the employee is either terminated or reduced.
c. Service of Notification on the employee's spouse shall be deemed notice to dependent children.
d. Miami County’s HR department will be contacted so that the COBRA compliance officer can provide the proper notice.
Each employee shall be responsible for notifying the Board of any action which might trigger a spouse's or dependent child's eligibility for continuation of insurance coverage under this policy. Such notice shall be given by the employee to the Director of Finance and Administration and Miami County Benefits Office immediately upon gaining knowledge of the event and shall include divorce, legal separation, or loss of dependent eligibility under the County plan.
The Miami County Benefits Office shall notify the individual(s) who are eligible for continued health insurance plan coverage of their rights and obligations under this policy, within fourteen (14) days after the occurrence of a triggering event. The notice shall contain a final date by which the employee, spouse, or dependent child must respond to the notice.
The eligible employee or other covered individual shall notify the COBRA compliance officer of his/her decision to continue or not continue coverage within sixty (30) days of the triggering event.
As used in this policy, termination shall include any separation from employment, except those instances where an employee has been separated for acts of gross misconduct, but including layoff, resignation, voluntary/involuntary leave without pay, discharge and any other termination which results in the employee's ineligibility for continued health insurance benefits. Employees who are separated in accordance with civil service law for gross misconduct are not eligible for continuation of health insurance plan coverage.
An employee, spouse or dependent child who elects continued health insurance coverage shall only be eligible until the earliest date that any of the following occur:
a. coverage expires either eighteen (18), twenty-nine (29) or thirty-six (36) months after the triggering event;
b. The group health care plan is terminated by the County;
c. The individual fails to pay the required premium in a timely manner;
d. The employee becomes covered under another group health care plan; or
e. The individual becomes eligible for Medicare benefits.
