When Coverage Ends Plan Year

Transcription

1 When Coverage Ends 2009 Plan Year

2 W H E N C O V E R A G E E N D S 2 WHAT IS INSIDE When Coverage Ends...1 When Your Dependents Coverage Ends... 2 COBRA... 2 General Rules...3 Who Is Covered...3 Newly Eligible Child...3 Qualified Medical Child Support Order...3 Family Medical Leave Act...3 Notification Requirements...5 How To Elect COBRA Coverage... 6 Medicare And Other Coverage... 6 Health Care Reimbursement Account... 6 Cost Of COBRA Coverage... 6 Length Of Coverage...7 Summary Of The COBRA Premium Reduction Provisions Under ARRA... 6 Early Termination Of COBRA... 6 Trade Act Credit...12 Certificates Of Coverage...12 Keep Your Plan Informed Of Changes...12 Questions About Your COBRA Rights? This booklet has been created using simple terms and in an easy-to-understand format. If you have any questions after reading this booklet, please contact the Employee Resource Center by phone ( ). Embarq intends to continue to provide coverage under the Flexible Benefits Plan. However, the Company reserves the right to change or discontinue any or all benefits at any time without notice. In the event that a benefit is to be discontinued, EMBARQ will notify participants as soon as reasonably possible. If there is any difference between the summary plan description and the plan document or insurance contract, the plan document or insurance contract will govern.

3 1 W H E N C O V E R A G E E N D S This section provides information on when your EMBARQ TM Flexible Benefits Plan coverages end. Generally, coverage ends on the last day of the month in which the status change takes place that makes you or your dependents ineligible. Here are some specific ending dates per option WHEN COVERAGE ENDS Benefit Option Me d i cal De ntal P re sc ri pti o n Dr u g P r o g ram V i sio n Health Care Reimb u r se me nt A c c o u nt De pe n de nt Day Care Reimb u r se me nt A c c o u nt E m p l o yee Life De pe n de nt S p o u se Life De pe n de nt C h i l d Life A D & D Basi c Lo n g - Ter m Di sability Su p p leme ntal Lo n g- Te r m Disability Coverage End Dates Coverage for you and your dependents ends on the last day of the month you are eligible to participate. You may convert to an individual policy, if enrolled in a fullyinsured HMO health care option. Coverage for you and your dependents ends on the last day of the month you are eligible to participate. Coverage for you and your dependents ends on the last day of the month you are eligible to participate. Coverage for you and your dependents ends on the last day of the month you are eligible to participate. Coverage for you and your dependents ends on the last day of the month you are eligible to participate. You may continue to submit claims for reimbursement for up to three months after the end of the plan year for eligible expenses incurred through the end of the month in which you were employed. Coverage ends on the last day of the month you are eligible to participate. You may continue to submit claims for reimbursement for up to three months after the end of the plan year for eligible expenses incurred during the plan year. Coverage ends on the last day of the month you are eligible to participate. Conversion to an individual policy may be available. Coverage ends on the last day of the month you are eligible to participate. Conversion to an individual policy may be available. Coverage ends on the last day of the month you are eligible to participate. Conversion to an individual policy may be available. Coverage ends on the last day of the month you are eligible to participate except where state law supersedes. Conversion to an individual policy may be available until age 70, at which time the conversion privilege ends. Coverage ends on your last day of active employment. Coverage ends on your last day of active employment.

4 W H E N C O V E R A G E E N D S 2 In addition to the dates listed in the prior chart, coverage will end on the earliest of the following: The date that your coverage is terminated by amendment of the Plan by whole or partial termination of the Plan, termination of the insurance contract or agreement, or by discontinuance of contributions by Embarq; The end of the period for which you paid your required contribution if the contribution for the next period is not paid when due; The date you report for active military service, unless coverage is continued through the Uniformed Services Employment and Reemployment Rights Act (USERRA) as explained in the Military Leave section of USERRA. Other circumstances that can result in the termination, reduction, loss or denial of benefits (for instance, exclusions due to pre-existing conditions, and exclusions for certain medical procedures) are described in the Benefit Booklets. WHEN YOUR DEPENDENTS COVERAGE ENDS Coverage for your covered dependents ends on the: Same day your coverage ends, while you are living; Last day of the month of your death if you are an active employee when you die; Last day of the month in which your covered dependents become ineligible under the terms of the plan; Last day of the year, if you fail to re-enroll them during the annual enrollment period for coverage for the coming year; Day a covered dependent child becomes covered as an employee by any group plan; or Last day of the month in which your divorce becomes final or you become legally separated this applies to the end of coverage for your spouse only. When Coverage Ends... COBRA enables you to continue participating in certain benefit options. COBRA The Consolidated Omnibus Budget Reconciliation Act of 1985 (Public , Title X), as amended, requires most employers sponsoring group health plans offer employees and their families the opportunity for a temporary extension of health coverage (called continuation coverage and also generally referred to as COBRA ) at group rates in certain instances where coverage under the plan would otherwise end. The following paragraphs generally explain COBRA coverage, when it may become available to you and your spouse and dependent children, and what you need to do to protect the right to receive it. Both you and your spouse should take the time to read this notice carefully.

5 3 W H E N C O V E R A G E E N D S General Rules COBRA continuation coverage is a continuation of group plan coverage when coverage would otherwise end because of a life event known as 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 group plan is lost because of the qualifying event. A child who is born to or placed for adoption with the covered employee during a period of COBRA coverage will be eligible to become a qualified beneficiary. Qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. Federal law does not recognize your same-sex domestic partner/spouse as your spouse and a same-sex domestic partner/spouse is not recognized as a COBRA qualified beneficiary. However, Embarq will extend COBRA-like coverage to your same-sex domestic partner/spouse and his or her covered children. In addition, COBRA rights and protections do not apply to this extension of same-sex domestic partner/spouse coverage. COBRA coverage is the same coverage that the Plan provides to other participants or beneficiaries under the Plan who are not receiving COBRA coverage. Each qualified beneficiary who elects COBRA will have the same rights under the Plan as other participants or beneficiaries covered under the Plan s group health coverage elected by the qualified beneficiaries, including annual enrollment and special enrollment rights. Under the Plan, qualified beneficiaries who elect COBRA must pay the full cost for COBRA coverage. The Plan provides no greater COBRA rights than what COBRA requires nothing in this Summary Plan Description is intended to expand your rights beyond COBRA s requirements. Please examine your options carefully before declining this coverage. You should be aware that companies selling individual health insurance typically require a review of your medical history that could result in a higher premium or you could be denied coverage entirely. For additional information about your rights and obligations under the Plan and under federal law, you should contact Embarq (the Employee Resource Center ) at the number listed in the Questions About Your Cobra Rights section. You do not have to show that you are insurable to choose continuation coverage. However, continuation coverage under COBRA is provided subject to your eligibility for coverage; the Plan Administrator reserves the right to terminate your COBRA coverage retroactively if you are determined to be ineligible.

6 W H E N C O V E R A G E E N D S 4 Who Is Covered If you are an employee of a participating company under the Flexible Benefits Plan (see the Legal Information section for a list of participating companies) covered by the Embarq Medical Plan, the Embarq Prescription Drug Program, the Embarq Dental Plan, the Embarq Vision Care Plan or the Embarq Health Care Reimbursement Account Plan, you have a right to choose this continuation coverage if you lose your group health coverage for any of the following qualifying events: Termination of your employment (for reasons other than gross misconduct on your part); Reduction in your hours of employment; Absence from employment by reason of approved military service leave under the Uniformed Services Employment and Reemployment Rights Act ( USERRA ). If you are the spouse of an employee and are covered by the Embarq Medical Plan, the Embarq Prescription Drug Program, the Embarq Dental Plan, or the Embarq Vision Care Plan, you will become a qualified beneficiary and have the right to choose continuation coverage for yourself if you lose group health coverage under those plans for any of the following qualifying events: The death of your spouse; A termination of your spouse s employment (for reasons other than gross misconduct); Reduction in your spouse s hours of employment; or Divorce or legal separation from your spouse. In the case of a dependent child of an employee, if that child is covered by the Embarq Medical Plan, the Embarq Prescription Drug Program, the Embarq Dental Plan, or the Embarq Vision Care Plan, he or she will become a qualified beneficiary and will have the right to continuation coverage if group health coverage under the Embarq Medical Plan, the Embarq Prescription Drug Program, the Embarq Dental Plan, or the Embarq Vision Care Plan is lost for any of the following qualifying events: The death of the parent-employee; A termination of the parent-employee s employment (for reasons other than gross misconduct); Reduction in the parent-employee s hours of employment with the participating company; The employee s divorce or legal separation; or The dependent child ceases to be a dependent child under the Embarq Medical Plan, the Embarq Prescription Drug Program, the Embarq Dental Plan, or the Embarq Vision Care Plan. Newly Eligible Child A child who is born to or placed for adoption with the covered employee during a period of COBRA coverage will be eligible to become a qualified beneficiary. In accordance with the terms of the Embarq Medical Plan, the Embarq Prescription Drug Program, the Embarq Dental Plan, and the Embarq Vision Care Plan, and the requirements of federal law, these qualified beneficiaries can be added to COBRA coverage upon proper notification to the Plan Administrator of the birth or adoption. This notice must be provided within 31 days of birth, adoption or placement for adoption. The notice must be in writing and must include the name of the new qualified beneficiary, date of birth or adoption of new qualified beneficiary, and birth certificate or adoption decree.

7 5 W H E N C O V E R A G E E N D S If you fail to notify the Company within the 31 days, you will not be offered the option to elect COBRA coverage for the newly acquired child. Newly acquired dependent child(ren) (other than children born to, adopted by, or placed for adoption with the employee) will not be considered qualified beneficiaries, but may be added to the employee s continuation coverage, if enrolled in a timely fashion, subject to the Plan s rules for adding a new dependent. Qualified Medical Child Support Order A child of the covered employee who is receiving benefits under the Plan pursuant to a qualified medical child support order (QMCSO) received by the Company during the covered employee s period of employment with the Company is entitled to the same rights to elect COBRA as an eligible dependent child of the covered employee. Family Medical Leave Act If you take a leave of absence that qualified under the Family and Medical Leave Act (FMLA) and do not return to work at the end of the leave, you (and your spouse and dependent children, if any) will have the right to elect COBRA if: you were covered by group health coverage under the Plan on the day before the FMLA leave began (or became covered by group health coverage under the Plan during the FMLA leave); and you lose group health coverage under the Plan because you do not return to work at the end of the leave. COBRA coverage will begin on the earliest of the following to occur: when you definitively inform the Company that you are not returning at the end of the leave; or the end of the leave, assuming you do not return to work. In addition, if a proceeding in bankruptcy is filed under Title 11 of the United States Code (relating to bankruptcy) is filed with respect to Embarq, and that bankruptcy results in the loss of coverage for any retired employee covered under the Plan, the retired employee, his or her spouse, surviving spouse and any qualifying dependent children will be qualifying beneficiaries that may be entitled to purchase coverage under any continuation plan. Notification Requirements If the qualifying event is the end of employment or a reduction of hours of employment, the Plan will offer COBRA to the qualified beneficiaries. You do not need to notify the Company of any of these qualifying events. For a qualifying event, which is a divorce, legal separation, death or child losing dependent status under the Embarq Medical Plan, the Embarq Prescription Drug Program, the Embarq Dental Plan or the Embarq Vision Care Plan, you or a family member have the responsibility to inform the Plan Administrator within 60 days of the date of the event. If you or your family member do not provide such notification within the required 60-day period in the manner discussed below, your spouse or dependent(s) will not be offered the option to elect COBRA continuation coverage.

8 W H E N C O V E R A G E E N D S 6 In addition, if any claims are mistakenly paid for expenses incurred after the date coverage would normally be lost because of the qualifying event, you will be required to reimburse the Plan for any claims mistakenly paid. For purposes of establishing sufficient notification to maintain additional coverage options discussed above, any notice that you provide must be in writing (oral notice is not acceptable) and delivered to the Employee Resource Center at: Employee Resource Center Attn: COBRA Dept. Mailstop: KSOPKR West 110 th Street Overland Park, KS Your notice must be post-marked no later than the last day of the required notice period. The notice must state the name of the plan (e.g., Embarq Medical Plan, Embarq Prescription Drug Program, the Embarq Dental Plan or the Embarq Vision Care Plan), the name and address of the employee covered under the Plan and the names and addresses of all of the other qualified beneficiaries that are covered under the plan. You also should state the event that occurred giving rise to the change in dependent status (such as a divorce, legal separation or loss of dependent status). If the qualifying event is a divorce, you must include a copy of the divorce decree. If the event is related to a determination of disability, the plan needs written notification of the date that you or your family member became disabled and the date that the Social Security Administration made its disability determination. Similar rights may apply to certain retirees, spouses, and dependent children if your employer commences a bankruptcy proceeding and these individuals lose coverage. How To Elect COBRA Coverage When the Plan Administrator is notified that one of these qualifying events has occurred, the Plan Administrator will in turn notify you that you have the right to choose continuation coverage. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. A covered employee or spouse also may elect COBRA continuation coverage on behalf on behalf of all qualified beneficiaries, and a parent or legal guardian may elect COBRA continuation coverage on behalf of a minor child. The employee s spouse may elect continuation coverage even if the employee does not. Also, if there is a choice among types of coverage, each qualified beneficiary who is eligible for COBRA continuation coverage is entitled to make a separate election among the types of coverage. Thus, a spouse or dependent child may elect different coverage than the employee elects. Under the law, you have at least 60 days from the latter of the date of the COBRA notice or the date you would lose coverage because of one of the events described above to inform the Plan Administrator that you want continuation coverage. If you do not choose continuation coverage or make any required COBRA premium payments on a timely basis, your group health coverage will end. If you choose continuation coverage, the law requires that you be given coverage, which, as of the time coverage is being provided, is identical to the coverage provided under the plan to similarly situated employees or family members. However, if any changes are made to coverage for similarly situated employees or family members, your coverage will be modified as well. Similarly situated refers to a current employee or dependent child(ren) who has not had a qualifying event. Qualified beneficiaries on COBRA have the same enrollment and election change rights as active employees.

9 7 W H E N C O V E R A G E E N D S Medicare And Other Coverage Qualified beneficiaries who are entitled to elect COBRA may do so even if they have other group health coverage or are entitled to Medicare benefits on or before the date on which COBRA is elected. However, as discussed in more detail below, a qualified beneficiary s COBRA coverage will terminate automatically if after electing COBRA, he or she becomes entitled to Medicare benefits or becomes covered under other group health plan coverage (but only after any applicable preexisting condition exclusions of that other plan have been exhausted or satisfied). When you complete the election from, you must notify the Company if any qualified beneficiary has become entitled to Medicare (Part A, Part B or both) and, if so, provide the date of Medicare entitlement. Health Care Reimbursement Account COBRA coverage under the Health Care Reimbursement Account (HCRA) will be offered only to employees and qualified beneficiaries losing coverage who have under-spent accounts. There is an under-spent account if the annual limit elected under the HCRA by the covered employee, reduced by reimbursements of expenses incurred up to the time of the qualifying event, is equal to or more than the amount of premiums for HCRA COBRA coverage that will be charged for the remainder of the plan year. COBRA coverage for the HCRA, if elected, will consist of the HCRA coverage in force at the time of the qualifying event (i.e., the elected annual limit reduced by expenses reimbursed up to the time of the qualifying event). The use-or-lose rule will continue to apply. All qualified beneficiaries who were covered under the HCRA may be covered for HCRA COBRA coverage, if continued coverage is elected. Cost Of Coverage Each qualified beneficiary is required to pay the entire cost of COBRA coverage. The amount a qualified beneficiary may be required to pay may not exceed 102 percent (or, in the case of an extension of COBRA coverage due to disability, 150 percent) of the cost to the group health plan (including both employer and employee contributions) for coverage of a similarly situated plan participant or beneficiary who is not receiving COBRA coverage. The American Recovery and Reinvestment Act of 2009 (ARRA) reduces the COBRA premium in some cases. The premium reduction is available to certain individuals who experience a qualifying event that is an involuntary termination of employment during the period beginning with September 1, 2008 and ending with December 31, If you qualify for the premium reduction, you need only to pay 35% of the COBRA premium otherwise due to the plan. This premium reduction is available for up to nine months. If your COBRA continuation coverage lasts for more than nine months, you will have to pay the full amount to continue your COBRA continuation coverage. See the section entitled Summary of the COBRA Premium Reduction Provisions under ARRA for more details, restrictions, and obligations. This premium reduction does not apply to the Health Care Spending Account. The amount of your COBRA premiums may change from time to time during your period of COBRA coverage and will most likely increase over time. You will be notified of COBRA premium changes.

10 W H E N C O V E R A G E E N D S 8 Your first premium is due within 45 days after you elect COBRA coverage. If you do not make your first payment for COBRA coverage within the 45 days after the date of your timely election, you will lose all COBRA rights under the Plan. Thereafter, payments are due by the first day of each month to which the payments apply (payments must be postmarked on or before the end of the 30-day grace period). If you fail to make a monthly payment before the end of the grace period for that month, you will lose all rights to COBRA coverage under the Plan. All COBRA premiums must be paid by check or money order. Your first payment and all monthly payments for COBRA coverage must be mailed to: Employee Resource Center Attn: COBRA Dept. Mailstop: KSOPKR West 110 th Street Overland Park, KS If mailed, your payment is considered to have been made on the date that it is postmarked. You will not be considered to have made any payment by mailing a check if your check is returned due to insufficient funds or otherwise. Your first payment must cover the cost of COBRA coverage from the time your coverage under the Plan would have otherwise terminated up through the end of the month before the month in which you make your first payment. You are responsible for making sure that the amount of your first payment is correct. You may contact the Employee Resource Center at ERC (4372) to confirm the correct amount of your first payment or to discuss payment issues related to the ARRA premium reduction. COBRA coverage is not effective until you elect it and make the required payment. Claims for reimbursement will not be processed and paid until you have elected COBRA and made the first payment for it. Length Of Coverage If you lose Plan coverage because of termination of employment or reduction in hours, the law requires that you be given the opportunity to maintain COBRA coverage for a maximum of 18 months. For all other qualifying events, the law requires that you be given the opportunity to maintain COBRA coverage for a maximum of 36 months. When Plan coverage is lost because of termination of employment or reduction in hours, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA coverage for qualified beneficiaries (other than the employee) who lose coverage as a result of the qualifying event can last until up to a maximum of 36 months after the date of Medicare entitlement. This COBRA coverage period is available only if the covered employee becomes entitled to Medicare within 18 months BEFORE termination or reduction of hours. The maximum COBRA coverage period for the Health Care Reimbursement Account ends on the last day of the Plan Year in which the qualifying event occurred. COBRA coverage for the Health Care Reimbursement Account cannot be extended under any circumstances. There are two ways in which this 18-month period of COBRA continuation coverage can be extended.

11 9 W H E N C O V E R A G E E N D S Disability Extension of 18-month Period of Continuation Coverage If the qualifying event that resulted in your COBRA election was the covered employee s termination of employment or reduction of hours, an extension of coverage may be available if a qualified beneficiary is disabled. If you or anyone in your family covered under the Embarq Medical Plan (including Embarq Prescription Drug Program), the Embarq Dental Plan or the Embarq Vision Care Plan, is determined by the Social Security Administration to be disabled and you notify the Plan Administrator in a timely fashion, you and all of the qualified beneficiaries your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage for a total maximum of 29 months. The disability would have to have started at some time before the 61 st day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. The affected individual must also notify the Plan Administrator within 30 days of any final determination that the individual is no longer disabled. To continue coverage for the additional 11 months, you or a representative acting on your behalf must notify the Employee Resource Center in writing of the Social Security Administration s determination within 60 days after the latest of: The date of the Social Security Administration s disability determination; The date of the covered employee s termination of employment or reduction of hours; and The date on which the qualified beneficiary loses (or would lose) coverage under the terms of the Plan as a result of the covered employee s termination of employment or reduction of hours. You must also provide this notice within 18 months after the covered employee s termination or reduction of hours in order to be entitled to a disability extension. The notice must be provided in writing and must include the following information: The name(s) and address(es) of all qualified beneficiaries who are receiving COBRA due to the initial qualifying event; The name and address of the disabled qualified beneficiary; The date that the qualified beneficiary become disabled; The date that the Social Security Administration made its determination of disability; A statement as to whether or not the Social Security Administration has subsequently determined that the qualified beneficiary is no longer disabled; and The signature, name and contract information of the individual sending the notice. Your notice must include a copy of the Social Security Administration s determination of disability. You must mail or hand-deliver this notice to the Employee Resource Center. If the above procedures are not followed or if the notice is not provided within the 60-day notice period, there will be no disability extension of COBRA coverage.

12 W H E N C O V E R A G E E N D S 10 Second Qualifying Event Extension of 18-month Period of Continuation Coverage If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, the spouse and dependent children in your family, who are qualified beneficiaries, can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the Plan. This extension may be available to the spouse and any dependent children receiving continuation coverage if the employee or former employee dies, gets divorced or legally separated, or if the dependent child stops being eligible under the Plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. This extension is only available if you or a representative acting on your behalf notify the Employee Resource Center in writing of the second qualifying event within 60 days after the date on which the qualified beneficiary would have lost coverage under the terms of the Plan as a result of the second qualifying event (if it had occurred while the qualified beneficiary was still covered under the Plan as an active participant). The notice must include the following information: The name(s) and address(es) of all qualified beneficiaries who are receiving COBRA due to the initial qualifying event; The second qualifying event; The date of the second qualifying event; and The signature, name and contact information of the individual sending the notice. In addition, you must provide documentation supporting the occurrence of the second qualifying event, if the Plan requests it. Acceptable documentation includes a copy of the divorce decree, death certificate or dependent child(ren) s birth certificates, driver s license, marriage license or letter from a university or institution indicating a change in student status. You must mail this notice to the Employee Resource Center at the address listed earlier in this section. If the above procedures are not followed or if the notice is not provided within the 60-day notice period, there will be no extension of COBRA coverage due to a second qualifying event. Summary Of The COBRA Premium Reduction Provisions Under ARRA Pursuant to the American Recovery and Reinvestment Act of 2009 ( ARRA ) an Assistance Eligible Individual ( AEI ) has the right to pay reduced COBRA premiums for periods of coverage beginning on or after February 17, 2009 for up to 9 months. For purposes of this section, you will be considered an AEI if you: Are eligible for continuation coverage at any time during the period from September 1, 2008 through December 31, 2009 and elect the coverage; Have a continuation coverage election opportunity related to an involuntary termination of employment that occurred at some time from September 1, 2008 through December 31, 2009; Are NOT eligible for Medicare; and Are NOT eligible for coverage under any other group health plan, such as a plan sponsored by a successor or new employer or a spouse s employer. (Generally, this does not include coverage for only dental, vision, counseling, or referral services; coverage under a health flexible spending arrangement; or treatment that is furnished in an on-site medical facility maintained by the employer).

13 11 W H E N C O V E R A G E E N D S Individuals who experienced a qualifying event as the result of an involuntary termination of employment at any time from September 1, 2008 through February 16, 2009 and were offered, but did not elect, continuation coverage OR who elected continuation coverage and subsequently discontinued it may have the right to an additional 60-day election period. *IMPORTANT* If, after you elect COBRA and while you are paying the reduced premium, you become eligible for any other group health plan coverage or Medicare you must notify the plan in writing. If you do not, you may be subject to a tax penalty. Electing the premium reduction disqualifies you for the Health Coverage Tax Credit. If you are eligible for the Health Coverage Tax Credit, which could be more valuable than the premium reduction, you will have received a notification from the IRS. The amount of the premium reduction is recaptured for certain high income individuals. If the amount you earn for the year is more than $125,000 (or $250,000 for married couples filing a joint federal income tax return) all or part of the premium reduction may be recaptured by an increase in your income tax liability for the year. If you think that your income may exceed the amounts above, you may wish to consider waiving your right to the premium reduction. For more information, consult your tax preparer or visit the IRS webpage on ARRA at If you are denied treatment as an Assistance Eligible Individual you may have the right to have the denial reviewed. For more information regarding reviews or for general information about the ARRA Premium Reduction, go to: or call EBSA (3272). Early Termination Of COBRA The law also provides that continuation coverage may be cut short for any of the following reasons: Embarq and all participating companies no longer provide group health coverage to any of its employees; The required premium for COBRA continuation coverage is not paid on time; After COBRA continuation coverage is elected, the qualified beneficiary becomes covered under another group health plan that does not contain any exclusion or limitation with respect to any pre-existing condition he or she may have (in the case of the Embarq Medical Plan, the Embarq Prescription Drug Program, the Embarq Dental Plan and the Embarq Vision Care Plan); After COBRA continuation coverage is elected, the qualified beneficiary becomes entitled to Medicare (in the case of the Embarq Medical Plan, the Embarq Prescription Drug Program, the Embarq Dental Plan and the Embarq Vision Care Plan); The qualified beneficiary extends coverage for up to 29 months due to disability and there has been a final determination that the individual is no longer disabled. Coverage will end no sooner than the first month that is more than 30 days from the date Social Security determines that the individual is no longer disabled. If the Plan Administrator determines that continuation coverage of a qualified beneficiary must terminate earlier than the end of the maximum period of continuation coverage applicable to such qualifying event, the Plan Administrator shall provide notice to such qualifying beneficiary as soon as practicable following the Plan Administrator s decision. The notice shall provide: (i) the reason that continuation coverage has terminated earlier than the end of the maximum period of continuation coverage applicable to such qualifying event; (ii) the date of termination of continuation coverage; and

14 W H E N C O V E R A G E E N D S 12 (iii) any rights the qualified beneficiary may have under the Plan or under applicable law to elect an alternative group or individual coverage. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) restricts the extent to which group health plans may impose pre-existing condition limitations. These rules are generally effective for plan years beginning after June 30, HIPAA coordinates COBRA s other coverage cut-off rule with these new limits as follows. If you become covered by another group health plan and that plan contains a pre-existing condition limitation that affects you, your COBRA coverage cannot be terminated. However, if the other plan s pre-existing condition rule does not apply to you by reason of HIPAA s restrictions on pre-existing condition clauses, the Embarq Medical Plan may terminate your COBRA coverage. At the end of the 18-month, 29-month or 36-month continuation coverage period, you may be allowed to enroll in an individual conversion health plan provided by a fully-insured health maintenance organization (HMO) offered under the Embarq Medical Plan. There is no right to convert coverage to an individual plan under the EMBARQ Indemnity, EMBARQ Choice, EMBARQ Select, EMBARQ HPN, or the EMBARQ self-insured HMO medical options of the Embarq Medical Plan. Trade Act Credit The Trade Act of 2002 created a new tax credit for certain individuals who become eligible for trade adjustment assistance ( eligible individuals ). Under the new tax provisions, eligible individuals can either take a tax credit or get an advance payment of 65 percent of premiums paid for qualified health insurance, including COBRA continuation coverage. These individuals are also entitled to a second opportunity to elect COBRA coverage for themselves and certain family members (if they did not already elect COBRA coverage). This election must be made within the 60-day period that begins on the first day of the month in which the individual becomes eligible for assistance under the Trade Reform Act of However, this election may not be made more than six months after the date the individual s group health plan coverage ends. ARRA made several amendments to these provisions, including an increase in the amount of the credit to 80% of premiums for coverage before January 1, 2011 and temporary extensions of the maximum period of COBRA continuation coverage for PBGC recipients (covered employees who have a nonforfeitable right to a benefit any portion of which is to be paid by the PBGC) and TAA-eligible individuals. If you have questions about these new tax provisions, including your possible eligibility status, you may call the Health Coverage Tax Credit Customer Contact Center, at TTD/TTY callers may call toll-free, at More information about the Trade Act is also available at Certificates Of Coverage Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you and your spouse and dependent child(ren) who lose group health coverage must receive certification of your coverage under the Plan. You may need this certification in the event you later become covered by a new plan under a different employer, or under an individual policy. You, your spouse, your domestic partner, and/or dependent child(ren) will receive a coverage certificate when your Plan coverage terminates, again when COBRA coverage terminates (if applicable and if you

15 13 W H E N C O V E R A G E E N D S elected COBRA), and again upon your request (if the request is made within 24 months following either termination of coverage). You should keep a copy of the coverage certificate(s) you receive, as you may need to prove you had prior coverage when you join a new health plan. For example, if you obtain new employment and your new employer s plan has a pre-existing condition limitation (which delays coverage for conditions treated before you were eligible for the new plan), the employer may be required to reduce the duration of the limitation by one day for each day you had prior coverage (subject to certain requirements). If you are purchasing individual coverage, you may need to present the coverage certificate to your insurer at that time as well. Keep Your Plan Informed Of Changes In order to protect your family s rights, you should keep the Plan Administrator informed of any changes in the addresses of family members. If your marital status has changed, you or your spouse has changed your address, or you experience a change in family status, please notify the Employee Resource Center. You should also keep a copy, for your records, of any notices you send to the Plan Administrator or the Employee Resource Center. Questions About Your COBRA Rights? If you have any questions about COBRA, please contact the Employee Resource Center. Employee Resource Center Attn: COBRA Dept. Mailstop: KSOPKR West 110 th Street Overland Park, KS For more information about your rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), 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 the EBSA website at (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA s website.)