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COBRA

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When you must contact your group member/dependent 

Notify Member/Eligible Dependent of their right to continue your group's coverage.

You have 30 days to notify your plan administrator after you learn of the qualifying event that qualified the member, or eligible dependent, for continued coverage under COBRA.

The plan administrator has 14 days from learning of the qualifying event to notify the member or eligible dependent.

Responsibility for notification rests solely with your group and the plan administrator.

 
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When your group member/dependent must notify you 

Election of continued coverage.

Death of a member, divorce, legal separation, when a covered child no longer qualifies as a dependent under your contract.

Within 60 days or the later of the qualifying event (divorce, cessation of dependent status) or date that such coverage would be lost due to such an event.

Group members or eligible dependents who qualify for continued coverage generally must notify you.

 
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When you must notify us 

When a member leaves the group.

See the back of your group's bill for detailed information on notification time frames following the member's termination.

A member elects COBRA coverage.

Within 60 days from the later of the date the coverage would be terminated or the date the member was given notice for continued coverage.

It is your group's and the plan administrator's responsibility to notify Empire about a COBRA add-on or to request a member reinstatement.

The member/dependent should complete an Enrollment Form. Submit that information either by logging in to Employer Online Services or by faxing the form to Membership and Billing at 1-800-780-1224.

 
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Charging for Continuation of Coverage 

If group members or eligible dependents choose to continue coverage under COBRA, you may charge them premiums that do not exceed 102% of the group member rate.

If coverage is continued due to disability, you may charge up to 150% of the group member rate for the 19th through the 29th month, if applicable.

 
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When Continuation of Coverage Ends 
Continued coverage under COBRA ends when any of the following occur:  

The member or eligible dependent becomes newly covered under another group contract. If the other group has a pre-existing conditions limitation or exclusion, continued coverage may continue until either the end of the applicable 18th, 29th or 36th month of continued coverage or the other group contract's pre-existing conditions limitation or exclusion is fulfilled, whichever is earlier.

The member or eligible dependent fails to pay premiums to you when due or when you fail to provide premiums to Empire by the due date.

The group ceases to provide health insurance to any of its employees.

The member or eligible dependent becomes entitled to Medicare (if they weren't previously eligible).

The applicable 18th, 29th or 36th month of coverage ends.

The member or eligible dependent is determined to be no longer disabled under the Social Security Act.

 
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Continuation of Coverage and State Law 

The previous information about continued coverage under COBRA is based on federal law.

If members and/or eligible dependents are not entitled to continuation of coverage under COBRA, they may be entitled to Continuation of Coverage under the provisions of the New York State Insurance Law.

 
 
 
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