Compilation of Rules and Regulations of the State of Georgia › Department 111 - RULES OF DEPARTMENT OF COMMUNITY HEALTH › Chapter 111-4 - STATE HEALTH BENEFIT PLAN › Subject 111-4-1 - STATE HEALTH BENEFIT PLAN › Rule 111-4-1-.08 - Extended Coverage Under Federal Law (COBRA)

Current through Rules and Regulations filed through June 27, 2024
(1)
Extended Beneficiary.
Persons who lose coverage under the Plan and who meet requirements as specified
				in these regulations or as specified by federal law are eligible to continue
				Coverage in the enrolled Option, without evidence of insurability. An Extended
				Beneficiary shall have the same opportunities for enrolling eligible Dependents
				and changing Coverage election as Active Employees. The SHBP will be
				administered in compliance with federal law or regulation under the
				Consolidated Omnibus Budget Reconciliation Act (COBRA).
(a)
Terminated Employee.
An
				enrolled Employee who terminates employment or is separated from his employment
				for any reason other than for gross misconduct, or whose Approved Leave Without
				Pay Coverage period expires shall be eligible to continue Coverage under the
				Plan for a period not longer than eighteen (18) calendar months following the
				termination of Coverage as an Employee.
(b)
Reduction of Required Hours.
An enrolled Employee who continues SHBP eligibility under the definition of
				Employee, except for working the required number of hours, shall be eligible to
				continue Coverage under the Plan for a period not longer than eighteen (18)
				calendar months following the end of the month in which the reduction of hours
				occurred. If the reduced hours take effect on a day other than the first work
				day of the month, the eighteen (18) calendar month period would begin on the
				first of the month following termination of Coverage through payroll
				Deductions.
(c)
Laid-off
				Employee.
An Enrolled Employee who is determined to be a laid-off
				Employee shall be eligible to continue Coverage under the Plan for a period not
				longer than eighteen (18) months. The extended period begins on the first of
				the month following termination of Coverage through payroll
				Deductions.
(d)
Spouse of
				Deceased Employee.
The spouse of a deceased enrolled Employee who is not
				eligible as a Surviving Spouse, an Employee, or an Annuitant shall be eligible
				to continue Coverage for the Spouse and any Covered, eligible dependents under
				the Plan for a period not longer than thirty-six (36) calendar months. The
				extended period of Coverage begins on the first of the month following
				termination of Coverage through the deceased Employee's payroll Deductions, or
				if the Employee is on an Approved Leave Without Pay, the later of the end of
				the month or the end of one month following the month in which the Employee
				died when Premium was paid in advance.
(e)
Surviving Dependent Child.
An eligible Dependent child of a deceased enrolled Employee who is not eligible
				as a Dependent of another Employee, a Surviving Beneficiary under Section
				111-4-1-.04(10),
				and Employee, or an Annuitant shall be eligible to continue individual Coverage
				under the Plan for a period not longer than thirty-six (36) calendar months
				following the end of the month in which death occurred. Any months for which
				Coverage was granted under Section
				111-4-1-.04 will be included in the
				maximum allowance under this provision. The Extended Coverage period begins on
				the first of the month following termination of the deceased Employee's
				Coverage through payroll Deductions.
(f)
Dependent Child.
An eligible
				Dependent child of an enrolled Employee who is not eligible as an Employee or
				an Annuitant shall be eligible to continue Coverage under the Plan for a period
				not longer than thirty-six (36) calendar months following the end of the month
				in which the child is no longer an eligible Dependent under the Plan.
(g)
Legally Separated or Divorced
				Spouse.
A legally separated or divorced Spouse of an enrolled Employee
				who is not eligible as a Surviving Spouse, an Employee, or an Annuitant shall
				be eligible to continue Coverage for a period not longer than thirty-six (36)
				calendar months for the Spouse and any Covered dependents, who are no longer
				Covered Dependents of the Employee, under the SHBP. The Extended Coverage
				period begins on the first of the month following the month in which the legal
				separation documents were approved by a court of competent jurisdiction or the
				divorce was final.
(h)
Disability under Social Security.
An additional eleven (11)
				calendar months of Coverage may be provided to an Extended Beneficiary who
				meets the definition of disability under Title II or XVI of the Social Security
				Act prior to or within sixty (60) calendar days of the Qualifying Event. The
				eleven (11) additional months of Coverage applies to all Beneficiaries eligible
				under the contract. Eligibility for the additional eleven (11) months is based
				on the Beneficiary notifying the Administrator of the determination of
				disability no later than sixty (60) calendar days following the date of the
				determination. Such notices must be given within the initial eighteen (18)
				month continuation period. Additionally, the Extended Beneficiary must notify
				the Administrator within thirty (30) calendar days of the date of any final
				determination that the Beneficiary is no longer disabled. The Administrator is
				authorized to charge one hundred fifty percent (150%) of the applicable Premium
				as outlined in this section.
(i)
Multiple qualifying events.
If additional Qualifying Events occur
				which provide for a thirty-six (36) calendar month maximum period during the
				period when an Extended Beneficiary is covered, the maximum period of Coverage
				may be extended to a maximum of thirty-six (36) calendar months for Spouse or
				Dependent Child.
(j)
Beginning of the maximum period.
The maximum period of Extended
				Coverage as a result of one or more Qualifying Events shall begin on the day
				following termination of Coverage as a result of the first Qualifying
				Event.
(k)
Limitation for
				Individuals Added to Coverage of Extended
Beneficiary.
Individuals enrolled under an Extended Beneficiary's Coverage shall not be
				eligible to become an Extended Beneficiary as a result of the
				enrollment.
(l)
Payment for
				Extended Beneficiary Coverages.
The applicable Premium for any Coverage
				election shall include the total Employer and Employee cost plus two percent
				(2%) of the total Premium cost as established by the Board for Active Employees
				with eligibility under this section, except that the Extended Beneficiary shall
				pay this Premium on a monthly basis. An additional forty eight percent (48%) of
				the total Premium for the Coverage election under the Plan shall be required
				for the eleven (11) months extension as a result of disability under the Social
				Security Act. One (1) advance monthly premium plus any retroactive premiums for
				unpaid periods of Coverage will, however, be requested as a part of the
				application. Failure to pay the full Premium within the allotted time shall
				result in suspension of benefit payments and/or termination of Coverage and
				forfeit all eligibility for continued Coverage.
(m)
Notice Requirements.
At the
				time of implementation of the Extended Beneficiary provisions, the
				Administrator shall distribute to the Employing Entities, having Active
				Employees, a notice of reasons for the extended eligibility. The Employing
				Entities shall distribute this notice to each eligible Employee. The
				Administrator shall incorporate the Extended Beneficiary eligibility provisions
				in the Employee Summary Plan Description.
1.
				The Employing Entity must notify the Administrator of the Employee's
				termination, death, layoff, or reduce hours within thirty (30) calendar days
				following the event.
2. The
				enrolled Employee or eligible Beneficiary must notify the Administrator of a
				Qualifying Event in case of divorce, legal separation, or the Dependent child's
				loss of eligibility within sixty (60) calendar days of the later of the
				Qualifying Event or termination of Coverage as a result of the Qualifying
				Event. Failure to notify the Administrator within the sixty (60) calendar days
				will forfeit eligibility to enroll as an Extended Beneficiary.
3. The Administrator shall notify the
				Extended Beneficiary at the known address. The Administrator shall provide
				notice of the continuation rights within fourteen (14) calendar days following
				notification from the Employing Entity of the enrolled Employee's death,
				termination of employment, or reduction of hours. Notice to the Employee's
				Spouse other than upon the Employee's termination or reduction of hours shall
				be deemed to be notification to all other Beneficiaries under the
				contract.
4. The Administrator
				shall notify the Extended Beneficiary of the continuation rights at the address
				specified by the Employee or Extended Beneficiary within fourteen (14) calendar
				days following notification from the Employee of a divorce, legal separation,
				or the Dependent child's Coverage ineligibility as a Dependent.
5. The Administrator shall notify each newly
				covered Spouse of the Plans Extended Beneficiary continuation rights within
				fourteen (14) calendar days of the Spouse's effective date.
6. If the Administrator fails to notify the
				Extended Beneficiary of the continuation rights within the required time limits
				as a result of failure of the Employing Entity to notify the Administrator, any
				penalty required of the Administrator shall be billed to the Employing Entity
				who failed to notify the Administrator.
(n)
Extended Beneficiary's Election
				Period.
The Extended Beneficiary may elect to continue Coverage during
				the later of sixty (60) calendar days following the Administrator's
				notification to the Extended Beneficiary or the sixty (60) calendar days
				following Coverage termination. Coverage will be continued from the Coverage
				termination date through the months for which payment is received, provided
				payment is received no later than forty-five (45) calendar days following the
				Beneficiary's election to continue Coverage.
(o)
Extended Beneficiary's Independent
				Election.
Each Beneficiary eligible for Extended Coverage shall be
				afforded the opportunity to make an independent election to continue Coverage
				in the enrolled Option, provided the Beneficiary is not enrolled under the SHBP
				as an Employee, Spouse, Dependent, or Annuitant. If a Beneficiary, either the
				Employee or Spouse of a enrolled Employee makes an election to provide Coverage
				for the other Extended Beneficiary, the election shall be binding on that other
				Beneficiary. An election on behalf of a minor child can be made by the child's
				parent or legal guardian. An election on behalf of an eligible Beneficiary who
				is incapacitated can be made by the legal representative of the Beneficiary.
				Except for any child who is born to or placed with an Extended Beneficiary,
				Dependents enrolled in the Plan during a period of Extended Coverage under
				federal law do not themselves become Extended Beneficiaries and may not make
				separate Coverage elections or participate in Open Enrollment.
(p)
Required Documentation.
The
				Administrator may require a monthly certification on the Premium billing by the
				Extended Beneficiary that the conditions as outlined in Section
				111-4-1-.09(11)
				have not occurred.
(q)
Recovery of Paid Benefits.
The Administrator shall have the right
				to recover all benefit payments made on behalf of any Extended Beneficiary as a
				result of and after the occurrence of any of the conditions outlined in Section
				111-4-1-.09(11).