COBRA

Consolidated Omnibus Budget Reconciliation Act (COBRA)

This notice is intended to give you a summary of your rights and obligations with respect to COBRA continuation of coverage under State College of Florida health plans. You (and if you have family coverage, your spouse) should take the time to read this notice carefully.

The right to elect COBRA continuation coverage

The occurrence of certain qualifying events, make you (and if you have family coverage, your covered dependents) qualified beneficiaries who have the right to elect COBRA Continuation Coverage. Qualifying events are described below:

Employee

You have the right to elect COBRA Continuation Coverage if you lose your group health coverage under the Plan because of:

reduction of hours of employment; or
the termination of your employment for reasons other than gross misconduct

Spouse

If you are covered under one of the health plans, you have the right to elect COBRA Continuation Coverage if you lose group health coverage for any of the following reasons:

your spouse's death; or
the termination of your spouse's employment for reasons other than gross misconduct; or
a reduction in your spouse's hours of employment; or
you become divorced or legally separated from your spouse; or
your spouse becomes entitled to Medicare benefits

Child

If you have a dependent covered under one of the health plans, that child has the right to elect COBRA Continuation Coverage if he/she loses group health coverage for any of the following reasons:

the death of the employee; or
the termination of the employee's employment for reasons other than gross misconduct; or
a reduction of the employee's hours of employment; or
employee's divorce or legal separation; or
employee becomes entitled to Medicare benefits; or
the dependent child ceases to be a "dependent child" for purposes of eligibility for group health coverage

Important

You, or a family member, have the responsibility to inform the Plan Administrator within 30 days of a divorce, legal separation, or a child's loss of dependent status.

Once the Plan Administrator is notified that one of the qualifying events has occurred, the Plan Administrator will, in turn, notify the qualified beneficiaries of their right to elect COBRA Continuation Coverage.

Cost Of COBRA Continuation Coverage

Individuals electing COBRA Continuation Coverage will be required to pay all of the cost of their coverage. The first payment is due within 45 days of the date COBRA Continuation Coverage is received. There is a 30-day grace period in which to pay monthly premiums.
If the first premium payment or any subsequent monthly payment is not received on time, you will lose COBRA Continuation Coverage. Your coverage will be terminated retroactively back to the first day of the month in which your premium was not paid.

Early Termination of COBRA Continuation Coverage

COBRA Continuation Coverage WILL BE CUT SHORT for any of the following reasons:

COBRA Continuation Coverage premiums are not paid on time; or
The qualified beneficiary becomes covered (after the date he/she elects COBRA Continuation Coverage) under another group health plan that does not contain any exclusion or limitation with respect to any preexisting conditions he/she may have OR the other plan's exclusion does not apply because of the HIPAA creditable service rules; or
The qualified beneficiary becomes entitled to Medicare after the date he/she elects COBRA Continuation Coverage; or
If coverage was extended to 29 months due to Social Security Disability, a final determination that the individual is no longer disabled; or
State College of Florida no longer provides group health coverage to any of its employees

Other Important Information

You do not have to show that you are insurable to elect COBRA Continuation Coverage. However, COBRA Continuation Coverage is provided subject to your eligibility for coverage; the Plan Administrator reserves the right to terminate your COBRA Continuation Coverage retroactively if you are determined to be ineligible.
Once COBRA Continuation Coverage ends for any person, it cannot be reinstated. However, that person may obtain an individual conversion health care policy without evidence of insurability, if provided for under the terms of the Plan.

Questions about COBRA Continuation Coverage, and notification of any changes in status or changes in address, should be directed to the Plan Administrator at the address below:

Address:
Ceridian COBRA Services Center
3201 34^th Street South
St. Petersburg, Florida 33711-3828
Fax: 727-865-3648
Telephone: 1-800-877-7994

Electing COBRA Continuation Coverage

Under the law, you or your family member have at least 60 DAYS from the date the coverage provided under your plan would end because of one of the qualifying events TO ELECT COBRA Continuation Coverage.
If you elect COBRA Continuation Coverage, the coverage provided would be identical to that provided to similarly situated employees or family members. This means that if coverage for similarly situated employees or family members is modified, your coverage will be modified.
If you do not elect COBRA Continuation Coverage on a timely basis, your group health coverage will end.

How long COBRA continuation lasts

The maximum required period for COBRA Continuation Coverage begins on the date of the qualifying event and ends on the last day of the period determined under the following table:

Qualifying Event	Maximum Period of COBRA Continuation Coverage
Termination of employment OR reduction of hours of employment	Up to 18 months
Determination of Social Security disability within 60 days after termination or reduction in hours of employment	Up to 29 months Will apply only if: employee or qualified dependent is determined disabled by the Social Security Administration at any time during the first 60 days following a qualifying event; AND the employee or qualified dependent provides the plan administrator with written certification of the disability within 60 days of the Social Security Administration's determination AND before the end of the initial 18-month COBRA period
Death, Divorce, Medicare Entitlement, Child's loss of Dependent Status	Up to 36 months

Note

The 18-month or 29-month maximum coverage period will be expanded to 36 months if a second qualifying event caused by the employee's death, divorce or legal separation, Medicare entitlement, or by a child's loss of dependent status occurs during the original 18 or 29 months maximum coverage period. The second qualifying event cannot give rise to a maximum coverage that ends more than 36 months after the date of the first qualifying event.
If while covered under COBRA, a qualified beneficiary gives birth to or adopts a child, that child may be enrolled for COBRA Continuation Coverage in the same manner that a newly acquired dependent may be enrolled by an active employee. Once enrolled, the child will be covered as a qualified beneficiary; the child's COBRA coverage rights will be independent from the COBRA coverage rights of his/her parents.