D.C. Mun. Regs. tit. 22, r. 22-B8902

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 22-B8902 - COBRA

8902.1

The PBC shall adhere to the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). The PBC shall offer employees and their eligible dependents the opportunity to continue certain coverages when a qualifying event occurs, as defined by law, for a limited amount of time determined by the event.

8902.2

Policies that apply are as follows:

(a) Eligibility: All regular employees who are scheduled to work at least 22.50 hours or more per week and are covered by PBC's group health plan are eligible. Dependents of these employees are also covered.

(b) Reasons for Coverage: The PBC's group health care plans coverage may be continued up to eighteen (18) or thirty-six (36) months (and, in some cases, twenty-nine (29) months) on behalf of a self (employee) paid basis for the following qualifying events:

(1) For covered employees (up to 18 months at continued coverage);

(2) Termination of employment (other than for gross misconduct); or

(3) Reduction of hours worked.

(c) For spouses or dependent children (up to 36 months of continued coverage) for the following:

(1) The covered employee's termination of employment or reduction of hours worked;

(2) The covered employee's death;

(3) Divorce or legal separation of a spouse from a covered employee;

(4) A covered employee's entitlement to Medicare; and

(5) A child's loss of dependent status.

8902.3

Notification procedures which apply are as follows:

(a) Initial notification shall be forwarded to employees and dependents via first class mail upon eligibility for benefits and when an employee adds on a new dependent (spouse or child);

(b) Election notices shall be mailed certified (with a return receipt requested) to the employee, spouse and dependents when a qualifying event occurs. In the case of divorce, legal separation, or cessation of dependency, covered employees and qualified beneficiaries shall be responsible for notifying the plan administrator within sixty (60) days after the qualifying event;

(1) The employee shall have sixty (60) days from the termination date or the date of the letter, whichever is later, to make the election;

(2) Upon receipt of a signed election notice, the individual or individuals applying shall be processed for benefits. The first payment is due at the time of election, but must be made no later than due forty-five (45) days after receipt of the election notice. The amount of the first payment must include the premium from the date coverage ceased until the date payment is made;

(3) Subsequent payments shall be due by the 1st of the month for which the participant is covered. The participant has a thirty (30) day grace period to make payments;

(4) Open enrollment notification: COBRA participants shall be notified of open enrollments occurring during their period of coverage. This notification gives COBRA participants the opportunity to make changes to their coverage; and

(5) Notification of plan changes: A notification shall be sent to all COBRA participants when the plan offered to active employees is changed. This notice includes a description of change and rates.

8902.4

Termination of continuation: Coverage may be terminated for the following reasons:

(a) The eighteen (18), twenty-nine (29) or thirty-six (36) month period has been exhausted;

(b) PBC no longer provides group health coverage to any of its employees;

(c) The premium for continuation coverage is not paid on time;

(d) The former employee or dependent becomes covered under another group health plan; unless that plan contains any exclusions or limitations with respect to any pre-existing conditions;

(e) Medicare entitlement, and

(f) If coverage is extended up to twenty-nine (29) months due to disability and there has been a determination that the former employee is no longer disabled.

8902.5

Termination notices shall be mailed via first class mail within one hundred and eighty (180) days prior to expected termination date.

D.C. Mun. Regs. tit. 22, r. 22-B8902

Final Rulemaking published at 45 DCR 7353, 7406 (October 9, 1998)