When Coverage Ends/
Continuation of Benefits through COBRA

All health care insurance plans terminate on the last day of the month in which employment ends (i.e. resignation, relieved during probationary period, layoff, or discharge for unsatisfactory performance or misconduct).

  • *Health Plans
  • *Dental Plans
  • *Vision Plans
  • *FSA Medical Reimbursement Account
  • FSA - Dependent Care Spending Account
  • Life Insurance
  • Accidental Death & Dismemberment
  • Short/Long Term Disability

*These plans may be continued in accordance with the federal guildelines of the Consolidated Omnibus Budge Reconciliation Act (COBRA).  Refer to the next secion on COBRA for additional information, or contact the Benefits office at 566-3446 for detailed information and premium cost.

Dependent Coverage Termination

Dependent coverage terminates at the end of the month when the dependent is no longer eligible.  Please refer to the Dependent Eligibility Section for further information.

Dependents who have lost their eligibility may elect to continue their health, dental and/or vision insurance coverage under the provisions of COBRA.  Refer to the next section on COBRA or contact the Benefits Office for further information.

Certification of Creditable Coverage

When an employee or dependent terminates coverage for any reason, he/she will be sent a Certification of Creditable Coverage which outlines the type of health insurance plan, any deductibles, and the length of time the employee was enrolled in the plan at SJC.  If the employee is leaving SJC and going to another employer, the certification can be presented to meet any pre-existing conditions clause a new employer may have with its plan.

Consolidated Omnibus Budget Reconciliation (COBRA)

In accordance with COBRA regulations effective January 1, 1987, COBRA requires employers who employ 20 or more employees to offer group health care continuation under certain qualifying events.

Covered Employee

An employee who is (or was) covered under the College's group health, dental and/or vision plan at the time of the qualifying event.

Qualified Beneficiary

Employee's legal spouse/domestic partner and/or dependent children provided each is insured under the plan on the day before a qualifying event occurred.

Qualifying Event Qualified Beneficiaries Continued Coverage
Covered employee's termination (for reasons other than gross misconduct) or reduction in hours of employment classification (from regular to temporary or on-call). Covered Employee
Spouse
Dependent Child
18 months (29 months if qualified beneficiary is disabled)
Death of a covered employee Spouse
Dependent Child
36 months
Covered employee's divorce or legal separation from spouse Spouse
Dependent Child
36 months
Covered employee's entitlement to Medicare Spouse
Dependent Child
36 months
Dependent child's ineligibility for benefits under plan Dependent Child 36 months
Bankruptcy of retiree's covered employer Covered retiree
Widows and Widowers
Until death
Until death
Employee Notification of Qualifying Event

When a qualifying event occurs, the employee or qualifying beneficiary must notify the College's Benefits Office to effect their COBRA rights.  San Juan College must be notified within 60 days of the qualifying event or the date the qualified beneficiary would lose coverage as a result of the qualifying event, whichever is later.

The group health plan does not have to offer the qualified beneficiary the opportunity to elect COBRA coverage if the covered employee or qualified beneficiary fails to comply with these notification requirements.

Employer's Responsibility

When the College's Benefits Office is notified within 60 days of the qualifying event, the College must notify qualified beneficiaries of their COBRA rights within fourteen (14) days of receiving notice of any qualifying event.

When COBRA Continuation Coverage Begins

Individuals have 60 days from the date of notification in which to make an election to continue coverage.  If coverage is elected, the effective date for COBRA is retroactive to the date the SJC group coverage ended.

Cost

The cost is 102% of the total cost (employer cost) of coverage.  The premium can be increased to 150% of the total cost for coverage that extends beyond 18 months in the case of a disabled individual receiving COBRA coverage as a result of a termination or reduction in hours.

COBRA Rates

Payment

You have 45 days from the time you elect coverage to remit payment to the insurance company.

Thereafter, payment is due on the first of the month for which you wish to be insured.

There is a 30-day grace period for receipt of premium.

COBRA coverage may be terminated prior to the end of the maximum period if:

  1. The employer ceases to provide a group health plan to any employee,
  2. The premium for your continuation coverage is not paid on time,
  3. You become entitled to Medicare,
  4. You become covered under another group health plan.  (COBRA coverage will not terminate, however, if a qualified beneficiary becomes covered under another group health plan that excludes or limits a pre-existing condition of that beneficiary.)
  5. You extended coverage for up to 29 months due to your disability and there has been a final determination that you are no longer disabled.