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Legal Notices Benefits for 2023

COBRA

For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibi lity

for coverage as a dependent child), you must notify the Plan Administrator within 60 days [ or enter longer period permitted

under the terms of the Plan ] after the qualifying event occurs. You must provide this notice to the plan administrator

How is COBRA continuation coverage provided?

Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offeredto 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, or a second qualifying event during the initial period of coverage,

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 Plan is determined by Social Security to be disabled and you notify the Plan

Administrator 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.

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 thePlan 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 Plan 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

Plan had the first qualifying event not occurred.

This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.

2023 Employee Benefit Guide

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