Introduction
You’re getting this notice because you recently gained coverage under the State of Wisconsin or Wisconsin Public Employers Group Health Insurance Program (GHIP). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the GHIP. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage.
The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health insurance coverage would otherwise end. For more information about your rights and obligations under the GHIP and under federal law, you should review the GHIP’s Summary Plan Description (or Certificate of Coverage) on ETF’s website or contact your health plan.
You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.
What is COBRA Continuation Coverage?
COBRA continuation coverage is a continuation of GHIP coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary”. You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the GHIP is lost because of the qualifying event. Under the GHIP, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.
Retired employees and surviving spouses of an active or retired deceased employee may continue for life. The surviving children of an active or retired deceased employee may continue coverage for only as long as they meet the definition of a dependent child. This is not considered to be continuation of coverage as discussed below.
If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the GHIP because of the following qualifying events:
- Your hours of employment are reduced, or
- Your employment ends for any reason other than your gross misconduct.
If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the GHIP because of the following qualifying events:
- Your spouse dies;
- Your spouse’s hours of employment are reduced;
- Your spouse’s employment ends for any reason other than his or her gross misconduct;
- Your spouse who covers you under COBRA becomes entitled to Medicare benefits (under Part A, Part B, or both); or
- You become divorced or legally separated from your spouse.
Your dependent children will become qualified beneficiaries if they lose coverage under the GHIP because of the following qualifying events:
- The parent-employee dies;
- The parent-employee’s hours of employment are reduced;
- The parent-employee’s employment ends for any reason other than his or her gross misconduct;
- The parent-employee who covers you under COBRA becomes entitled to Medicare benefits (Part A, Part B, or both);
- The parents become divorced or legally separated; or
- The child stops being eligible for coverage under the GHIP as a “dependent child”.
When is COBRA Continuation Coverage Available?
Your employer (for retirees, this is the Department of Employee Trust Funds) will offer COBRA continuation coverage to qualified beneficiaries after a qualifying event has occurred. Your employer must notify ETF of the following qualifying events:
- The end of employment or reduction of hours of employment; or
- Death of the employee.
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify your employer (retirees should notify ETF) within 60 after the qualifying event occurs.
How is COBRA Continuation Coverage Provided?
Once your employer (ETF for retirees) receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.
COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events may permit a beneficiary to receive a maximum of 36 months of coverage.
There are also ways in which this 18-month period of COBRA continuation coverage can be extended:
Disability Extension of 18-month Period of COBRA Continuation Coverage
If you or anyone in your family covered under the GHIP is determined by Social Security to be disabled and you notify ETF in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage. You must send to ETF a copy of Social Security’s letter granting disability, listing the effective date of the determination and coverage.
Second Qualifying Event Extension of 18-month Period of Continuation Coverage
If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if ETF is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the GHIP as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the GHIP had the first qualifying event not occurred.
Are There Other Coverage Options Besides COBRA Continuation Coverage?
Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicare, Medicaid, Children’s Health Insurance Program (CHIP), or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.
Can I Enroll in Medicare Instead of COBRA Continuation Coverage After my Group Health Plan Coverage Ends?
If you are no longer covered under an employee contract in the GHIP, you must enroll in Medicare when you are first eligible.
In general, if you don’t enroll in Medicare Part A or B when you are first eligible because you are still employed, after the Medicare initial enrollment period, you have an 8-month special enrollment period to sign up for Medicare Part A or B, beginning on the earlier of:
- The month after your employment ends; or
- The month after group health plan coverage based on current employment ends.
If you don’t enroll in Medicare when you are first eligible, you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later become eligible for Medicare Part A or B, your GHIP continuation coverage will terminate. However, if Medicare Part A or B is effective on or before the date of the COBRA election, COBRA coverage may not be discontinued on account of Medicare entitlement, even if you enroll in the other part of Medicare after the date of the election of COBRA coverage.
If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare.
For more information visit Medicare & You and this Medicare.gov page explaining when Medicare coverage starts.
Questions
Questions concerning the GHIP or your COBRA continuation coverage rights should be addressed to ETF. For more information about your rights under COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website. For more information about the Marketplace, visit www.HealthCare.gov.
Address Changes
To protect your family’s rights, let ETF know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to ETF.
Plan Contact Information
The Department of Employee Trust Funds
PO Box 7931
Madison WI 53707-7931