COBRA for Dental and Vision
(For conversion of other coverage, go to that benefit or contact the Trust)
Federal law requires most employers sponsoring group health
plans to offer employees and their families the opportunity to elect a temporary extension of health coverage (called
"continuation coverage") in certain instances where coverage under the group health plans would otherwise end. The
Trust maintains several health plans in two groups, dental and vision, that are subject to this notice: currently the vision plans are the EyeMed Vision Care and the Vision Service Plan; the dental plan is the UBT Dental Plan. For simplicity, each is referred to in this notice as the "Plan."
You do not have to show that you are insurable to elect
continuation coverage; however, you will have to pay all the premium for your continuation coverage. At the end of the maximum
coverage period (described below), your coverage will end unless an individual conversion health plan is otherwise available.
This notice is intended to summarize, as best possible, your
rights and obligations under the law. The Plan offers no greater
COBRA rights than what the COBRA statute requires, and this
notice should be construed accordingly. In areas where the notice
is not clear, these points are interpreted by Federal agencies
and the courts (and Congress often changes the law). Therefore,
this summary is subject to change without notice as
interpretations or changes of the law occur.
BOTH YOU (the employee) AND YOUR SPOUSE SHOULD READ THIS NOTICE CAREFULLY AND KEEP IT WITH YOUR RECORDS.
If you are a State of Ohio employee and an eligible member of
a covered bargaining unit covered by the Plan, you have a right
to elect continuation coverage if you lose coverage under the
plan because of any one of the two following "qualifying
- Termination (for reasons other than your gross misconduct) of
your employment or
- Reduction in the hours of your employment.
If you are the spouse of an employee covered by the Plan, you
have the right to elect continuation coverage if you lose
coverage under the plan because of any one of the four following
- Death of your spouse
- termination of your spouse's employment (for reasons
other than gross misconduct) or reduction your spouse's hours
of employment with the State
- Divorce or legal separation from your spouse or
- Your spouse becomes entitled to Medicare benefits.
In the case of a dependent child of a State of Ohio employee
and an eligible member of a covered bargaining unit covered by
the Plan, he or she has the right to elect continuation coverage
if group coverage under the Plan is lost because of any one of
the five following "qualifying events:"
- Death of the employee parent
- A termination of employee parent's employment (for
reasons other than gross misconduct) or reduction your
spouse's hours of employment with the State
- Parent's divorce or legal separation
- Employee parent becomes entitled to Medicare benefits or
- The dependent ceases to be a "dependent child"
under the Plan.
Notices and Election
The Plan provides that your spouse's coverage terminated
(thus is lost) as of the last day of the month in which a divorce
or legal separation occurs. A dependent child's coverage
terminates the last day of the month in which he or she ceases to
be an eligible dependent under the Plan (for example, after
attainment of a certain age). Under the COBRA statute, you (the
employee) or a family member has the responsibility to notify the
Plan Administrator upon a divorce, legal separation or a child
losing dependent status. You or a family member must give notice
no later than 60 days after the last day of the months of the
divorce, legal separation or a child losing dependent status. If
you or a family member fail to notify the Plan Administrator
during the 60-day notice period, any family member who loses
coverage will NOT be offered the option to elect continuation
coverage. Further, if you or a family member fail to notify the
Plan Administrator, and contrary to all Plan terms, any claims
are paid for expenses incurred after the last day of the month of
the divorce, legal separation or a child losing dependent status,
then you and your family members will be required to reimburse
the Plan for any claims so paid.
If the Plan Administrator is timely notified of a divorce,
legal separation or a child losing dependent status that has
caused a loss of coverage, the Plan Administrator will notify the
affected family member of the right to elect continuation
coverage. You (the employee) and/or your family member will also
be notified of the right to elect continuation coverage
automatically (i.e., without any action required by you or a
family member) upon the following events that result in loss of
coverage: the employee's termination of employment (other
than for gross misconduct), reduction in hours, death, or the
employee becoming entitled to Medicare.
You (the employee) or your family member must elect
continuation coverage within 60 days after Plan coverage ends,
or, if later, 60 days after the Plan Administrator sends you or
your family member notice of the right to elect continuation
coverage. If you or your family member do not elect continuation
coverage within this 60-day election period, you will lose your
right to elect continuation coverage.
A covered employee or the spouse of the covered employee may
elect continuation coverage for all family members. The covered
employee, and his or her spouse and dependent children, however,
each have an independent right to elect continuation coverage.
Thus, a spouse or dependent child may elect continuation coverage
even if the covered employee does not elect it.
Type of Coverage: Premium
If COBRA coverage is elected, the Trust must provide coverage
that is identical to the coverage provided under the Plan to
similarly situated employees or family members. If the coverage
for similarly situated employees or family members is modified,
COBRA coverage will be modified the same way.
If you are covered by the Dental Plan and Vision Plan, you may
elect COBRA coverage under one Plan or both Plans. If you are
covered only by the Dental Plan, you may elect COBRA coverage
under the Dental Plan. If you are covered only by the Vision
Plan, you may elect COBRA coverage under the Vision Plan.
You (the employee) or a family member must pay the premium
payments for the initial premium months" by the 45th day
after electing continuation coverage. The initial premium months
are the months that end on or before the 45th day after the date
of the COBRA election. All other premiums are due on the 1st of
the month for which the premium is paid, subject to a 30-day
The premiums are calculated
each spring for the upcoming plan year (July 1 to June 30).
Here are the current COBRA rates.
||36 Months. If you
(spouse or dependent child) lose group health coverage because of
the employee's death, legal separation, or the employee's
becoming entitled to Medicare, or because you lose your status as
a dependent under the Plan, the maximum coverage period (for
spouse and dependent child) is three years from the date of the
||18 Months. If you
(employee, spouse or dependent child) lose group health coverage
because of the employee's termination of employment other
than for gross misconduct) or reduction in hours, the maximum
continuation coverage period (for the employee, spouse or
dependent child) s 18 months from the date of termination or
reduction in hours. There are three exceptions
- If an
employee or family member is disabled at any time during the
first 60 days of continuation coverage (running from the date or
termination of employment or reduction in hours), the
continuation coverage period for all qualified beneficiaries
under the qualifying event is 29 months from the date of the date
or termination of employment or reduction in hours. The Social
Security Administration must formally determine under Title II
(Old Age, Survivors and Disability Insurance) or Title XVI
(Supplemental Security Income) of the Social Security Act that
the disability exists and when it began. For the 29-month
continuation coverage period to apply, notice of the
determination of disability under the Social Security Act must be
provided by the disabled individual to the Trust within the
18-month coverage period and within 60 days after the date of the
- If a second
qualifying even occurs (for example, the employee dies or becomes
divorced) within the 18-month or 29-month coverage period, the
maximum coverage period becomes three years from the date of the
initial termination or reduction in hours.
- If the
qualifying even occurs within 18 months after the employee
becomes entitled to Medicare, the maximum coverage period (for
the spouse and dependent child) ends three years from the date
the employee became entitled to Medicare.
Newborn Children of, or Children Placed
for Adoption with, the Covered Employee after the Qualifying
If, during the period of continuation coverage, a child is
born to the covered employee, adopted by the covered employee or
placed for adoption with the covered employee, the child is
considered a qualified beneficiary. The covered employee or other
guardian has the right to elect continuation coverage for the
child, provided the child satisfies the otherwise applicable plan
eligibility requirements (for example, age). The covered employee
or family member must notify the Plan Administrator within 30
days of the birth, adoption or placement to enroll the child on
COBRA. (The 30-day period is the Plan's normal enrollment
window for newborn children, adopted children or children placed
for adoption.) If the covered employee or family member fails to
so notify the Plan Administrator in a timely fashion, the covered
employee will NOT be offered the option to elect COBRA coverage
for the child.
Termination Before the End of the
Maximum Coverage Period
Continuation coverage of the employee, spouse or dependent
child will automatically terminate (even before the end of the
maximum coverage period) when any one of the following five
- The Trust no longer provides group health coverage to any
- The premium for COBRA coverage is not timely paid
- You (employee, spouse or dependent child) become covered
under another group health plan (as an employee or otherwise)
that has no exclusion or limitation with respect to any
preexisting condition that you have. If the other plan has
applicable exclusions or limitations, your COBRA coverage will
terminate after the exclusion or limitation no longer applies
(for example, after the 12-month preexisting condition waiting
period expires). This rule applies only to the qualified
beneficiary who becomes covered by another group health plan.
(Note that under Federal Law (the Health Insurance Portability
and Accountability Act of 1996/HIPAA), an exclusion or limitation
of the other group health plan might not apply at all to the
qualified beneficiary, depending on the length of his or her
creditable health plan coverage prior to enrolling in the other
group health plan.)
- You (employee, spouse or dependent child) become entitled to
Medicare benefits (applies only to the person who becomes
entitled to Medicare)
- If you (employee, spouse, or dependent child) became entitled
to a 29-month maximum coverage period due to a disability of a
qualified beneficiary, but then there is a final determination
under Title II or XVI of the Social Security Act that the
qualified beneficiary is no longer disabled (however,
continuation coverage will not end until the month that begins
more than 30 days after the determination).
If you (the employee) or a family member have any questions
about this notice or COBRA, please contact
the Trust. Also, please contact the Plan Administrator if you
wish to receive the most recent plan documentation.
If your marital status changes, or a dependent ceases to be a
dependent eligible for coverage under the Plan terms, or your or
your spouse's address changes, you must notify both the Trust
and the State (via your Payroll/Personnel officer).
Plan Administrator: Union Benefits Trust is the Plan
Administrator. All notices and other communications regarding the
Plan and regarding COBRA should be directed to the following
individual who is acting on behalf of the Plan Administrator:
Call Customer Service Coordinator at 614-508-2255, or
800-228-5088. Mailing address is 390 Worthington Road, Suite B,
Westerville, Ohio 43082-8332.