The right to COBRA coverage was created by federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to your spouse and dependent children, if they are covered under your group health plan, under specific circumstances when they would otherwise lose their coverage.

COBRA Continuation Privileges for Staff Members and/or Dependents

Concerning your Health Plan, Vision, Dental, Prescription Drug Plans, and/or Health Care Flexible Spending Account

You and/or any individual dependent(s) currently enrolled on your benefits may elect to continue each or all of your health plan coverages in the university's group for as long as 18 months, if the qualifying event is due to termination or reduction in hours (e.g., retirement). An election of 36 months can occur if the qualifying event is due to the death of the employee, loss of dependent child status, employee's Medicare enrollment while on COBRA, or divorce.

Extensions

The 18-month continuation period can be extended, if during the 18 months of continuation coverage, a second event takes place (divorce, death, Medicare entitlement, or a dependent child ceasing to be a dependent). The 18 months or continuation coverage will be extended to 36 months from the date of the original qualifying event. Upon the occurrence of a second event, it is your or your spouse's or dependent's responsibility to notify the Benefits Office within 30 days of the event and within the original 18-month COBRA period. COBRA coverage does not last beyond 36 months from the original qualifying event, no matter how many events occur.

The 18 months may also be extended to 29 months for all individuals covered under COBRA coverage from the date of the qualifying event, if it is determined that you and your spouse or dependent child(ren), if any, were disabled (as determined under the Social Security Act) during the first 60 days of COBRA coverage. In order to receive the extension you must notify the Benefits Office within 60 days of the disability determination and before the end of the original 18-month period.

Health Care Flexible Spending Accounts

If you are participating in the Health Care FSA, the account will reimburse you for eligible claims up to the total annual amount you will contribute during the calendar year. If you have a balance in your account after your coverage has ended and do not have sufficient claims incurred prior to the coverage end date to exceed that balance but have future claims, you must continue after-tax contributions to receive reimbursement of future claims.

Coverage Continuation Procedure

In order to continue coverage, you must complete and return the Election Form to the Payroll Office within 60 days of the COBRA notification or coverage end date, whichever is later. Keep a copy for your records. You and each of your enrolled family members are entitled to make at separate decision to continue coverage. Please be certain to clearly indicate which family member(s) are electing COBRA continuation coverage when completing the Election Form. If your spouse and/or any dependent does not live with you, you must advise the Benefits Office immediately of his, her or their address(es) so that we can provide them with this Notice and an Election Form.

Premium Payments

Irrespective of the qualifying event, the full monthly premium must be made to continue COBRA coverage. Your first payment, including payments from the first day of COBRA coverage through the current month, must be received within 45 days of your election and sent to the Payroll Office address. Return the completed form and payment to:

University of Michigan – Payroll
Box 223081
Pittsburgh, PA 15251-2081

COBRA coverage will be effective retroactive to the date university coverage ended, not the date the Election Form is received. Premiums must be paid retroactive to the date university coverage ended. Please enclose the retroactive payment along with your first premium payment. If your first payment, or any subsequent payment, is not received on time, you will lose your option to continue coverage. Payments must be for the full amount of the required premium. Coverage is provided only when the full premium for the applicable period is received. Subsequent payments must be made by the 1st of each month, for that month's coverage. Payment can be made in cash (exact amount only), personal check, money order, or certified check. Checks should be made payable to "The University of Michigan." There is a 30-day grace period for late payments received within 30 days of the due date. Payment is received on the 31st day following the due date is deemed late and will result in permanent termination of coverage. Premiums paid will not be refunded. Coverage will be terminated when payment is overdue. Coverage will not be reinstated.

If you lost your eligibility because of a reduction in appointment and you still receive a paycheck from the university (not temporary hourly or scholarship/fellowship), you can remit payment directly or your premium payments can also be deducted from another staff member's University of Michigan payroll check. For example, if your spouse works for the university and you desire health plan coverage that is not available through your spouse, your spouse can authorize the Payroll Department to deduct your monthly premium from his or her paycheck. This requires the completion of a Payroll Deduction Authorization Form signed by you and the staff member. The staff member must notify the Payroll Office in writing in order to cancel the payroll deduction once it has begun. If a payroll deduction is authorized and paid for from a staff member's check, the 2% administration fee, included in the dollar amounts on the COBRA letter you will receive, will be waived.

Open Enrollment

Each October during Open Enrollment you will be given the option to change to a different health plan, with the change effective Jan. 1 of the following year.

COBRA Termination

COBRA coverage will terminate early in these situations:

• You do not make the monthly payments on a timely basis, or your check is returned for insufficient funds. (Note: The university reserves the right to require future payment of COBRA premiums by cash, money orders or certified check due to a bounced check), OR
• You become covered under another group health plan that does not exclude or limit coverage for any pre-existing condition you may have, OR
• The university no longer provides the coverage to any staff members, OR
• You become covered under or entitled to Medicare after the effective date of COBRA continuation coverage, OR
• If coverage was extended to 29 months due to disability, determination that a disabled person is no longer disabled.

Moving Out of a Managed Care Service Area

If you are in a managed care plan (excluding GradCare; see below) and you are moving outside the service area for 6 consecutive months or more, you can change coverage by completing and submitting a Moving Out of a Managed Care Service Area form to SSC Benefits Transactions within 30 days of the move. Your submitted election will be effective when your COBRA coverage becomes active, if this form is received with your COBRA election paperwork. Otherwise, it will be effective the 1st day of the month following receipt of the form.

GradCare

If you are enrolled in GradCare under COBRA and move outside the service area, your coverage will be restricted to urgent care and Emergency Room care only. GradCare off-site registration forms do not apply to those covered under COBRA.

Convert to a Direct Subscriber Contract

At the end of your coverage in the university's group health plan, you may convert to direct subscriber contract for base health coverage if such a conversion plan is available. If you wish to convert, it is your responsibility to apply directly to the health plan company within 31 days after your COBRA continuation coverage ends.

Premiums and coverage are subject to change. Premiums will usually change once a year, most often in December for January's coverage. We will attempt to notify you by U.S. Mail when premiums change, but it is your responsibility to send in the proper amount. It is your responsibility to notify the office of any changes in address or a change in family status for the addition or deletion of dependents within 30 days.

Return from a Leave of Absence or Layoff (RIF)

Upon return to work from a leave of absence or layoff to an eligible appointment, your benefits will be reinstated automatically. Contact the Benefits Office immediately if you have elected COBRA continuation coverage during the leave or layoff in order to resume university contributions toward benefits.

Reappointment — Not Due to a Return from a Leave or Layoff (RIF)

If, in the future, you receive an appointment eligible for benefits, you will have 60 days from the date of appointment to enroll in benefits. Enrollment is not automatic. You must complete the appropriate applications to enroll in benefits. Contact the Benefits Office immediately if you have elected COBRA continuation coverage and later receive an eligible appointment in order to resume university contributions toward benefits.

Dental Coverage

Please note that a dependent child continuing dental coverage on his/her own contract does NOT provide an extension of orthodontic benefits. Orthodontic benefits cease for a dependent child once he/she reaches 19 year of age.

Group Life Insurance

The death benefit is in force for 31 days from the date of ineligibility or during the period through which you have paid premiums, whichever occurs later. During this period of coverage you have "Conversion Privileges" whereby you may change your Group Life Insurance, without a medical examination, to an individual policy customarily being issued by MetLife. This excludes term insurance or a policy containing disability benefits. You must have had the coverage for at least five years in order to qualify for the conversion. Conversion Privilege does not apply to dependent and spouse coverages.

Long-Term Disability Plan

Long-Term Disability coverage is not transferable outside the university. Coverage terminates when your eligible appointment ends.

Disabled Dependent Status

Please call the SSC Contact Center for more information if you are a disabled dependent. Disabled dependents are eligible for extended coverage beyond age 26.

Call the SSC Contact Center at (734) 615-2000 locally, or (866) 647-7657 toll free, Monday through Friday from 8 a.m. to 5 p.m.

COBRA Benefits Plan Rates

COBRA Forms and Documents

• Notice of COBRA Qualifying Event
• Notice of COBRA Second Qualifying Event
• Notice of Disability
• COBRA Notification of Other Coverage, Medicare Entitlement, or Cessation of Disability
• Frequently asked questions about COBRA
• Important information about paying for your COBRA coverage
• Continuation coverage rights under COBRA
• Health Insurance Marketplace and other options