CONTINUATION OF HEALTH COVERAGE UPON GROUP INELIGIBILITY
NEISD will offer continued health coverage to employees and their eligible dependents who no longer meet the District eligibility requirements. This coverage is offered under the conditions set forth by the Consolidated Omnibus Budget Reconciliation Act of 1985, more commonly called COBRA, and as amended by the Omnibus Budget Reconciliation Act of 1989.
The "qualifying events" under which an employee and/or dependent will be eligible to continue coverage are:
- A reduction in hours;
- An employee's death;
- Voluntary or involuntary termination of employment (other than for gross misconduct);
- Divorce or legal separation;
- The employee's or eligible dependent's entitlement for Medicare benefits; or
- A dependent child ceasing to be a dependent under the applicable plan provisions.
The coverage would apply to an individual (known as a "qualified beneficiary") who, on the day before the qualifying event, was:
- The covered spouse of the employee;
- A covered dependent child of the covered employee; or
- The covered employee, in the event of termination.
A "qualified beneficiary" has at least sixty (60) days from the date of the termination or other qualifying event in which to elect continuing coverage, and no less than sixty (60) days after receiving notice of the right to continue coverage. In the case of a divorce or a dependent child losing dependent status, the covered employee or qualified beneficiary has the responsibility of notifying the Employee Benefits office in writing within thirty (30) days of the status change.
The continued coverage will be identical to the health coverage provided to the active employee and their dependents. Coverage would begin on the date of ineligibility due to the qualifying event and ends on the earliest of the following:
- Eighteen (18) months for employee whose employment has terminated or whose hours have been reduced;
- Thirty-six (36) months for widows, divorced spouses, dependent children, and spouses of covered employees who become entitled to Medicare benefits;
- The date on which the employer ceases to provide a group health plan to any employee (the replacing carrier must cover the individual-on continuation);
- The date on which coverage ceases under the plan because of failure, on the part of the beneficiary, to make timely payment of premium required;
- The date (after the date of election), on which the qualified beneficiary becomes entitled to benefits under Medicare;
- COBRA continuation coverage WILL NOT cease if a qualified beneficiary becomes covered under another group health plan that contains an exclusion with regards to pre-existing conditions (effective 12/31/89);
- Qualified beneficiaries determined to be disabled under the Social Security Act at the time a qualifying event occurs can extend COBRA continuation coverage for eleven (11) additional months provided notification requirements are met.
The qualified beneficiary has a forty-five (45) day period from the date he or she elects continuation to pay the first premium. The premium will be the full premium (without district contribution) plus 2%, and will be paid directly to North East Independent School District.
For more information please contact the Employee Benefits office at 407-0491 or 407-0492.