COBRA stands for the Consolidated Omnibus Budget Reconciliation Act of 1985. COBRA is a federal law that gives certain eligible participants the right to continue health care coverage at group rates for a set period of time. If a spouse or a covered family member should become ineligible for Plan coverage because of what COBRA refers to as a “Qualifying Event” (described below), he or she may be able to continue coverage for up to 36 months. COBRA Continuation Coverage generally is the same health coverage the Dependents had the day before beginning COBRA Continuation Coverage.
Note that a Same-Sex Domestic Partner who loses coverage under the Plan does not qualify for COBRA Continuation Coverage under the federal government’s COBRA regulations. However, the Plan allows the Same-Sex Domestic Partner to continue coverage in the same manner as a spouse, as long as the opportunity is elected in a timely manner and the required Contributions are made; or if the Same-Sex Domestic Partner relationship ends, in the same manner as a divorced or legally separated spouse by making self-payments (in the same amount as the COBRA payment) for coverage for up to 36 months.
Note: If you are enrolled in a Medicare Advantage plan, this section does not apply to you.
A spouse and/or dependent children can elect and pay for COBRA coverage for up to 36 months if they are no longer eligible for coverage under the Plan.
This section addresses claims and appeals for services under the TCN or PPO plan options and the prescription drug benefit. If you have a claim or appeal involving an HMO, Medicare Advantage, or other plan option, you should consult that Carrier’s booklet for the proper procedures for resolving claims and appeals.