(Subject to 6/9/06 binding arbitration award)
This dental plan provides benefits for most types of dental services. Your level of dental benefits is known as the GHI Preferred Dental Plan. This document is your Certificate of Insurance.
COBRA: Continuation Of Coverage
Continuation Coverage: important benefit
This section explains your rights under the Consolidated Omnibus Budget Reconciliation Act (COBRA), a federal continuation of coverage law for you, your spouse or domestic partner and your covered dependents. The law requires that most employers sponsoring group health plans offer employees and their families the opportunity for a temporary extension of dental care coverage called "continuation coverage" at group rates in certain instances where coverage under the program would otherwise end. The dental care benefits you may continue are the same benefits you would receive as an active employee enrolled in the GHI Preferred Dental Plan. There is also no change in benefits when your dependent enrolls in COBRA. This section summarizes your rights and obligations under the continuation coverage provisions of the law. If your spouse/domestic partner is also covered under the New York State Dental Insurance Program, they should take the time to read this carefully.
Who is eligible?
If you are an active employee enrolled in the GHI Preferred Dental Plan, you have a right to continue coverage if you lose your group dental care coverage because of a reduction in your hours of employment or the termination of employment.
Your spouse or domestic partner
The spouse or domestic partner of an active employee covered as the employee's dependent by the GHI Preferred Dental Plan, has the right to continue coverage under this plan if group dental care coverage is lost for any of the following reasons:
- Your death;
- Termination of your employment;
- Reduction in your hours of employment with New York State;
- Divorce or termination of the domestic partnership.
- Legal separation (spouse only) Your spouse does not automatically lose coverage if you are legally separated. However, if your spouse loses coverage under this plan, he or she may continue coverage under COBRA.
A dependent child of an employee covered by the GHI Preferred Dental Plan has the right to continue coverage if coverage under the dental plan is lost for any of the following reasons:
- The dependent ceases to be an eligible "dependent child"
under this Plan;
- The termination of your employment;
- A reduction in your hours of employment with New York State;
- Your divorce or termination of domestic partnership.
- Your legal separation (Note: a dependent child does not automatically lose
coverage because of parents' legal separation);
- Your death.
Under COBRA, the employee or a family member is responsible for notifying the Employee Benefits Division of the New York State Department of Civil Service of a divorce or termination of a domestic partnership, a legal separation, social security determination that a qualified beneficiary was disabled at the time of employee's termination or reduction in hours, or of a child's losing eligible dependent status under this Plan, within 60 days from the date of the qualifying event. Other people acting on your behalf may provide written notice to the Employee Benefits Division of a COBRA qualifying event.
If the enrollee or dependent does not notify the Employee Benefits Division in writing within that 60-day period, regardless of the reason, the dependent will not be entitled to choose continuation coverage.
When you notify the Employee Benefits Division of an event that allows you to choose COBRA coverage, the Division will advise you of your right to choose continuation coverage. If you do not receive this notice, call the Employee Benefits Division (1-800-833-4344). You must inform the Employee Benefits Division that you want continuation coverage within 60 days from the date you would lose coverage because of one of the events described previously or 60 days from the date you are notified of your eligibility for continuation coverage, whichever is later
A dependent who wishes to continue coverage as a COBRA enrollee must send a written request to the Employee Benefits Division within 60 days from the date coverage would otherwise end.
If you, your spouse/domestic partner or eligible dependent or someone acting on your behalf does not choose continuation coverage, your group dental insurance coverage will end.
How long you may keep COBRA coverage
You, the employee, will have the opportunity to maintain continuation coverage for 18 months. However, the continuation coverage period is extended to 29 months for you and your enrolled dependents if it is determined that you or your enrolled dependent is disabled (under Social Security Act provisions defining disabilities) either at the time of the initial qualifying event or during the first 60 days of COBRA coverage. To qualify for this extension to 29 months, you must notify the Employee Benefits Division within 60 days of the disability award from Social Security and before the end of the 18-month continuation period.
If, during the continuation coverage period, another event takes place that would entitle a dependent spouse/domestic partner or child to his or her own continuation coverage, the continuation coverage may be extended. However, in no case will any period of continuation coverage be more than 36 months from the original COBRA qualifying event.
Enrolled spouses/domestic partners and dependent children who lose eligibility due to a COBRA qualifying event have the opportunity to elect COBRA continuation coverage for up to 36 months.
When you no longer qualify for COBRA coverage
New York State law provides that your COBRA coverage may be canceled for any one of the following reasons:
- If New York State no longer provides group dental care coverage to
State employees; or
- If the premium for your COBRA coverage is not paid on time.
Your costs under COBRA
You will have to pay the entire premium for your continuation coverage plus a two (2) percent administrative fee. (If your coverage continues beyond 18 months due to a determination of disability under the Social Security Act, you will pay 150% of the premium cost for the 19th through the 29th month.) You will have 45 days starting with the date you choose continuation coverage to pay any premium. After this 45-day period, you will have a grace period of 30 days to pay any subsequent premiums.
Conversion rights after COBRA coverage ends
The COBRA law also requires that, at the end of the 18-month, 29-month or three-year continuation coverage period, you must be allowed to convert to a direct-pay conversion contract with GHI.
If you choose COBRA coverage, you must exhaust those benefits before converting to a direct-pay conversion contract. If you choose COBRA coverage and fail to make the required payments or cancel coverage for any reason, you will not be eligible to convert to an individual policy.
Whom to contact
If you have any questions about COBRA, please contact your Health Benefits Administrator.
Please note that the responsibility for determining your eligibility for continuation coverage under either COBRA or any state law rests solely with your employer, not with GHI. Therefore, please do not contact GHI about your eligibility for continuation coverage.
You may convert to one of GHI's direct payment dental plans once your continuation coverage under COBRA terminates, unless the continuation coverage ends for one of the following reasons:
- You fail to make a premium payment for continued coverage within the
specified time period; or
- You cancel continuation coverage at any time for any reason.
GHI will send conversion information to your home.
Whom to contact
If you have any questions about conversion privileges, be sure to contact GHI and/or your Agency Health Benefits Administrator.