Medical Plan

Continuing Your Coverage Under COBRA – Very Important Notice for you and your spouse (if covered) or your Domestic Partner (if covered)

On April 7, 1986, the Consolidated Omnibus Budget Reconciliation Act (“COBRA”) was enacted (Public Law 99-272, Title X) requiring that most employers sponsoring group health plans offer employees and their families the opportunity for a temporary extension of health coverage (called “continuation coverage”) at group rates in certain instances where coverage under the plan would otherwise end.

You are receiving this notice because you are covered under a group health plan. This notice contains important information about your right to COBRA continuation coverage. This notice generally explains COBRA continuation coverage, when it may become available to you and your eligible family members, and what you need to do to protect the right to receive it.

Both you and your spouse or your Domestic Partner, if your spouse or Domestic Partner is currently covered under any of the group health plans sponsored by the University, should take the time to read this section of the summary plan description carefully and keep this summary plan description with your records.

If you are an employee of the University, the spouse or a Dependent of the employee and you are covered under a group health plan sponsored by the University, you have an independent right to elect continuation coverage. An eligible Dependent includes a child who is born or placed for adoption with you or your Domestic Partner during the period of continuation coverage under COBRA.

Qualified beneficiaries can elect continuation of coverage for any of the reasons outlined below (called “qualifying events”). Different qualifying events apply to different covered groups as follows:

Qualifying Event	You	Spouse or Domestic Partner	Dependent Children	Notification
Your employment with the University ends (except for gross misconduct, in which case COBRA benefits are not available)	X	X	X	Within 44 days after the date coverage would end because of the event (usually, that date is the end of the month in which the event occurs), the Benefits Office will notify you and your covered Dependent(s) of the right to continue coverage under COBRA. You and your covered Dependent(s) will have 60 days after notification to make an election and pay the premium. If you do not elect and pay for continuation coverage on a timely basis, your group health plan coverage will terminate.
You are no longer a Benefits-Eligible Employee	X	X	X
You become eligible for Medicare		X	X
You die		X	X
You divorce, legally separate or terminate your Domestic Partnership		X	X	You or your Covered Dependents(s) have 60 days after a divorce, legal separation, termination of a Domestic Partnership or when your child loses Dependent status to notify the Benefits Office of the qualifying event. If you or your covered Dependents provide timely notice of these qualifying events, such notice will preserve the COBRA election rights for all Dependents that lost coverage as a result of the qualifying event. Failure to provide such notice in a timely manner may result in loss of the right to elect COBRA continuation coverage. Upon notice of the qualifying event, within 44 days, the Benefits Office will notify you and your covered Dependents, as applicable, of benefit election rights under COBRA. After receiving a notice of benefit election rights, you or your covered Dependents, as applicable, will then each have 60 days to make an election and pay the premium. If you or your Covered Dependents do not elect and pay for continuation coverage on a timely basis, your group health plan coverage will terminate.
Your child loses Dependent status or disability status			X

The benefits provided under COBRA will be the same as those provided to active employees. However, the University no longer shares the cost with you. The premiums you pay include the full health care cost, plus a 2% administrative fee. The claims administrator will bill you.

The situations and time limits during which you can continue coverage are shown in the chart below.

Who Can Continue Coverage

In What
Situations

For
How Long

You and your eligible
Dependents

A reduction in your work hours resulting in a loss of coverage.

Your termination (except for gross misconduct).

18 months

Your eligible
Dependents

Your death.

Divorce, legal separation or termination of Domestic Partner registration.

Eligibility for Medicare.

36 months

Your Dependent
child(ren)

Child(ren) reach age 23.

Child(ren) are no longer eligible.

36 months

If you lost coverage because your employment was terminated or your hours were reduced, your and your Dependents’ continuation coverage ends after 18 months. If during those 18 months another event takes place that entitles you to continuation coverage, your continuation coverage may be extended up to another 18 months, but in no case can it last more than 36 months.

You do not pay your premiums by the required due date.

You or your Dependent(s) become covered under another group plan (except if that plan has a pre-existing condition rule).

The Dependent enrolls in Medicare.

The University discontinues medical care coverage for active employees.

Once you cancel your continued coverage, you cannot re-enroll in the University medical plans.

If you, your spouse or your eligible Dependents are disabled (as determined by Social Security) at any time during the first 60 days of continuation coverage, the disabled person may be able to continue coverage for up to a total of 29 months from the date of the qualifying event.

To qualify, you must notify the Benefits Office within 60 days of the date Social Security makes its disability determination, and that determination must be made within the first 18 months of continuation coverage. If the disability ends, you (or your disabled Dependent) must notify the Benefits Office within 30 days of the determination. Continued coverage will end on the first day of the month that is 31 or more days after the Social Security determination that the disability has ended.

Certain Individuals who, under limited circumstances, become eligible to take advantage of trade adjustment assistance pursuant to the Trade Act may receive a second 60-day COBRA election period. If you are receiving trade adjustment assistance or if you are eligible for trade adjustment assistance, please contact the Benefits Office for more information.

Your COBRA rights are subject to change. Coverage will be provided only as required by law. This notice is only a general summary of the law, federal and state continuation coverage law and the applicable plan provisions will control over this summary in the event of a conflict. If the law changes, your rights will change accordingly.

If you have questions about the plan or your COBRA continuation coverage rights, contact the Benefits Office at:

The University of Chicago
Benefits Office
956 East 58^th Street
Chicago, IL 60637
773-702-9634

For more information about your rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s Web site.)

To protect your family’s rights, you should keep the Benefits Office informed of any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Benefits Office.

While this Summary Plan Description summarizes the major provisions of this plan, it does not provide you with every plan detail. The plan documents, which govern this plan, provide full details. If there are any discrepancies between this Summary Plan Description and the legal plan documents, the legal plan documents control.