September 6, 2010   TABLE OF CONTENTS   1.1.9 COBRA Continuation Coverage   A. Introduction The following paragraphs generally explain COBRA coverage, when it may become available to you and your family and what you need to do to protect the right to receive it. The St. Louis Graphic Arts Joint Health and Welfare Trust Fund provides continued health care coverage on a self-pay basis pursuant to the Consolidated Omnibus Budget Reconciliation Act of 1985, commonly known as COBRA. Eligible Employee s and their Dependents are offered the opportunity for a temporary extension of health coverage called “continuation coverage” in certain instances called "qualifying events," which would otherwise cause coverage to end. (Self payment under this Section 1.1.9 is permitted only for Medical Benefits, Prescription Drug Benefits, the Employee Assistance Program, the Wellness Program and Dental Benefits. See Section 2.2.5, on page 52, for information on conversion of life insurance to an individual policy). You do not have to show that you are insurable to qualify for continuation coverage. However, you must pay the cost of the continuation coverage. B. Things to Consider When Deciding Whether to Take COBRA Coverage Your decision whether or not to elect COBRA can have an effect on your rights regarding health benefits under federal law. First, under federal law, if you have had health coverage continuously for 12 (or in some cases 18) months and you have less than a 63-day gap in your health coverage when you become covered under another group health plan, that new group health plan cannot limit coverage of any pre-existing conditions you may have. Taking COBRA coverage may help you complete 12 (or 18) months of coverage under this Plan and may help you avoid a 63-day gap in coverage. Second, federal law generally requires that insurance companies offer individual health insurance policies with no pre-existing condition limitations to individuals who have exercised their right to take COBRA continuation coverage from a group health plan for the maximum period. If you do not take COBRA, you will lose this protection. Finally, it is important that you know that under the federal law, you have the special right to enroll in any other group health plan for which you may be eligible (such as a plan sponsored by your spouse’s employer) within 30 days after your regular coverage under this Plan terminates due to a qualifying event. You will not have to wait until that other plan’s next open enrollment period. If you elect COBRA continuation coverage under this Plan, you will have that same special right to enroll in another group health plan at the end of your COBRA coverage, but only if you keep the COBRA coverage for the maximum period it is available to you. C. What is COBRA Continuation Coverage? COBRA continuation coverage is self-payment continuation of Plan coverage when coverage would otherwise end because of a qualifying event. Specific qualifying events are listed below in the section entitled, “Who is Entitled To Elect COBRA.” After a qualifying event occurs and any required notice of that event is properly provided, COBRA continuation coverage will be offered to each person who is a “Qualified Beneficiary.” You, your spouse, and your dependent children could become Qualified Beneficiaries if coverage under the Plan is lost because of a qualifying event. (Certain newborns, newly adopted children and alternate recipients under QMCSOs may also be Qualified Beneficiaries. This is discussed in more detail below.) Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. D. Who is Entitled To Elect COBRA—Qualifying Events A Participant may elect Continuation Coverage at his own expense if his coverage under the Plan terminates because of a reduction in hours of employment or termination of employment (for reasons other than gross misconduct). The spouse of a Participant who was covered under the Plan on the day before the qualifying event may elect Continuation Coverage if his coverage under the Plan terminates for any of the following reasons: 1. Death of the Participant; 2. Termination of the Participant’s employment (for reasons other than gross misconduct) or reduction in the Participant’s hours of employment; 3. Divorce or legal separation from the Participant; or A Dependent child of a Participant who was covered under the Plan on the day before the qualifying event may elect Continuation Coverage if his coverage under the Plan terminates for any of the following reasons: 1. Death of the Participant; 2. Termination of the Participant’s employment (for reasons other than gross misconduct) or reduction the Participant's hours of employment; 3. The Participant’s divorce or legal separation; or 4. Cessation of the child’s status as an Eligible Dependent under the Plan. If coverage ends because an employer stops making contributions to the Welfare Fund, a Qualifying Event has not occurred. E. How to Elect COBRA The events described above which might result in eligibility for Continuation Coverage are referred to as “Qualifying Events.” The Participant, spouse or child who becomes entitled to Continuation Coverage as the result of a Qualifying Event is referred to as a “Qualified Beneficiary.” A child born to, adopted by or placed for adoption with a Participant who is a Qualified Beneficiary is also a Qualified Beneficiary. No other Dependent is a Qualified Beneficiary. To be eligible for Continuation Coverage under this section, the Qualified Beneficiary must inform the Fund Office of a divorce, legal separation or a child ceasing to be an Eligible Dependent under the Plan by written notice to the following address within 60 days of such Qualifying Event. Notices should be sent or hand-delivered to: St. Louis Graphic Arts Joint Health and Welfare Fund 14323 South Outer Forty Road, Suite S106 Chesterfield, Missouri 63017 Oral notice, including notice by telephone is not acceptable. Electronic (including e-mailed or faxed) notices are not acceptable. If mailed, the notice must be postmarked no later than the deadline described above. If hand-delivered, the notice must be received at the address specified above no later than the deadline described above. The notice must include the following information: The name and address of the Participant or former Participant who is or was covered under the Plan; The name(s) and address(es) of all Qualified Beneficiary(ies) who lost coverage due to the Qualifying Event; The Qualifying Event (divorce, legal separation or child’s loss of dependent status); The date the divorce, legal separation or child’s loss of dependent status happened; and The signature, name and contact information of the individual sending the notice. The Fund Office will notify the Qualified Beneficiary that he has the right to elect Continuation Coverage within 14 days after timely receipt of proper notification that a Qualifying Event has occurred (or the date that a Participant loses coverage for failure to acquire the required number of Contribution Hours). The Qualified Beneficiary must then make a written election of Continuation Coverage by returning the election form included with the notice. Such election must be postmarked to or received by the Fund Office within 60 days after the later of (a) the date the notice of the right to elect Continuation Coverage is provided or (b) the date coverage would otherwise terminate as a result of the Qualifying Event. Any Qualified Beneficiary who would lose coverage under this plan as a result of a Qualifying Event is entitled to independently elect continuation coverage under this plan. If any Qualified Beneficiary does not elect Continuation Coverage within the time limits described above, his terminated coverage will not be reinstated. If the Qualified Beneficiary elects Continuation Coverage, the Plan will provide him with Medical, Prescription Drug, Employee Assistance Program, Wellness and Dental Benefits, which, as of the time coverage is being provided, are identical to such coverage provided under the Plan to similarly situated active Covered Individuals. Continuation Coverage must commence the day following termination of the Participant’s (and/or Dependent’s) active coverage under the Plan and must be continuous. Example: A Participant whose coverage terminates July 31 because of a Qualifying Event must elect to Self-Pay starting August 1. He cannot skip August and start coverage September 1. Nor can he skip any later months after he starts to Self Pay without losing his right to Self-Pay. F. Duration of Continuation Coverage Continuation Coverage may be continued for a maximum of: 1. 18 months from the date of the Qualifying Event if coverage was lost because of termination of employment or reduction in hours. If a Qualified Beneficiary is continuing coverage as a result of this qualifying event and is determined by the Social Security Administration to have been disabled anytime during the first 60 days of continuation coverage (measured from the later of the date of the qualifying event or date coverage would have terminated in the absence of a COBRA election), then any or all of the qualified beneficiaries who have coverage as a result of the qualifying event, are entitled to 11 additional months of continuation coverage, for a maximum of 29 months. In order to qualify for the additional 11 months, the qualified beneficiary seeking the extension must provide the Fund Office with a copy of the Social Security determination before the end of the original 18-month maximum coverage period and within 60 days of the later of: the date of the disability determination the date of the qualifying event; or the date the qualified beneficiary would lose coverage under the Plan. If the disabled qualified beneficiary elects this 11-month extension, the Plan may charge up to 150% of the regular premium during the 11-month extension. If the qualified beneficiary is determined by the Social Security Administration to no longer be disabled, the qualified beneficiary must notify the plan within 30 days of that determination. Note: The 29-month limit on Self-Payment does not apply to Medical coverage for a Participant (and his Dependents) who qualifies as a Retired Participant as defined below. For non-retired disabled Participants the 18 (or 29) month maximum period of continuation coverage will be measured from the end of the continuation of eligibility provision described in Section 1.1.12. Note also, if the Participant was eligible for Medicare prior to this qualifying event, his Dependents’ maximum coverage period will end on the later of 36 months from the date he became eligible for Medicare or 18 months from the date of the Qualifying Event if the Qualifying Event is loss of hours or termination of employment. If, during the first 18 or 29 months of Continuation Coverage, a Dependent experiences another Qualifying Event, coverage may be extended, but in no case may the total amount of Continuation Coverage be more than 36 months. In order to qualify for extended coverage, the Dependent must notify the Fund Office in writing within 60 days of the date coverage would otherwise terminate due to that qualifying event. 2. 36 months* from the date of the original Qualifying Event if a spouse’s or child’s coverage was lost because of divorce or legal separation, the death of the Participant (unless paragraph 3 below applies) or a child ceasing to be an Eligible Dependent in accordance with Section 1.1.4. *The COBRA period cannot be extended more than 36 months beyond the date that the Participant began Self-Paying for Continuation Coverage. Example: Because of retirement an Employee started Self-Paying for himself and his Dependent wife and child on January 1, 2006. His child reaches the maximum age for eligibility as a Dependent in December 2006 and starts to Self-Pay; the child can Self-Pay only through December 2008 (36 months from January 1, 2006). 3. Indefinitely if coverage was lost because of termination of employment or the death of a Participant and the Participant or surviving spouse or child qualifies as a Retired Participant as defined in Section 1.1.10 on page 42, subject to the following limitations: a. This indefinite coverage applies only to Medical, Prescription Drug, EAP and Wellness benefits. Dental benefits are not subject to indefinite coverage and may only be continued for the applicable maximum periods stated in paragraphs 1 or 2 above. b. This indefinite coverage does not apply to (and Continuation Coverage is limited to the applicable 18, 29 or 36 months for) a spouse and/or Dependent child(ren) who elect Continuation Coverage if the Participant does not choose to continue his own coverage. c. This indefinite coverage does not extend the coverage of a surviving child beyond the date the child would have ceased to qualify as a Dependent in accordance with Section 1.1.4 had the Participant not died. In no event will Continuation Coverage be continued beyond the earliest of the following: 1. The date the Self-Pay contribution for Continuation Coverage is not paid by the end of the 45 or 30-day grace period described below; 2. The date, after the Continuation Coverage election date, on which the Qualified Beneficiary becomes covered under another group health plan which does not limit or exclude coverage for any preexisting health conditions of such Qualified Beneficiary. 3. The date, after the Continuation Coverage election date, on which the Qualified Beneficiary becomes entitled to Medicare; 4. For coverage that is extended due to disability, the first day of the first month that begins more than 30 days after the date that a disabled qualified beneficiary is finally determined by the Social Security Administration to be no longer disabled. If an employer stops making contributions to the Fund, and makes group health plan coverage available to (or starts contributing to another multiemployer plan that is a group health plan with respect to) a class of the employer’s employees formerly covered by the Fund, the plan maintained by the employer (or the other multiemployer plan), from that date forward, has the obligation to make COBRA continuation coverage available to any qualified beneficiary who was receiving coverage under the Fund on the day before the cessation of contributions and who is, or whose qualifying event occurred in connection with, a covered employee whose last employment prior to the qualifying event was with the employer. Example 1: Assume Employer ABC terminates its obligation to contribute to the Welfare Fund on August 31, 2006; is required to contribute for hours worked in August 2006; and is required to pay the contributions for hours worked in August 2006 by September 20, 2006. Eligibility of a Covered Employee who is actively employed by Employer ABC on or after September 1, 2006, will terminate immediately after September 30, 2006. With respect to the active employees who were previously covered by the Welfare Fund through September 30, 2006, on October 1, 2006, Employer ABC covers these employees in the Employer’s group health plan. Employee Jones had a qualifying event (reduction in hours) while employed by Employer ABC in March 2006, and has been on COBRA with the Welfare Fund through September 30, 2006. Effective October 1, 2006, Employee Jones COBRA continuation coverage will be transferred to Employer ABC’s group medical plan. Example 2: Same facts as Example 1. Employee Miller also had a qualifying event in March 2006 (reduction in hours due to disability) while employed by Employer ABC, and pursuant to Plan Section 1.1.12 received free continued coverage by the Plan through January 2007 because he qualified for weekly disability income benefits. Beginning in February 2007, if Miller elects COBRA continuation coverage, his coverage will be provided by Employer ABC’s plan with the COBRA period starting on February 1, 2007. G. Payment for Continuation Coverage Qualified Beneficiaries who elect Continuation Coverage must pay directly to the Fund such amounts as the Trustees shall from time to time require in accordance with regulations governing the amounts, frequency and manner of such payment. Contact the Fund Office to obtain this information. The Trustees will determine annually the Self-Pay contribution rates applicable to Continuation Coverage. Self-Pay contribution rates for Medicare retirees are reduced to reflect the fact that the Fund is secondary to Medicare. This rate cannot exceed 102% of the cost of benefits (150% for qualified beneficiaries receiving the 11-month disability extension of coverage). A grace period of 45 days from the election date will be allowed for the initial payment of the Self-Pay contribution for Continuation Coverage and a grace period of 30 days from the beginning of each month of coverage will be allowed for payment of each subsequent Continuation Coverage Self-Pay contribution. If the first Self-Pay contribution is not postmarked or received by the end of the 45-day grace period, Continuation Coverage will not take effect and the right to Continuation Coverage is forfeited. If any subsequent Self-Pay contribution is not postmarked or received by the end of the 30-day grace period, an additional 10-day grace period will be allowed. If the Self-Pay contribution is postmarked or received during the additional 10-day grace period coverage will be continued. If the Self-Pay contribution is not postmarked or received during the additional 10-day grace period, Continuation Coverage will be terminated as of the end of the period for which the last timely Self-Pay contribution was received and will not be reinstated. The additional 10-day grace period does not apply to retirees. Self-Pay contributions are required in full each month, however if a timely payment is made in an amount that is not significantly less than the amount required, the Qualified Beneficiary will be notified and will have 30 days to pay the deficient amount due. This 30-day period will be measured from the original due date or the date of the notice, whichever is later. H. Special Second Election Period for Certain Trade-Displaced Individuals Who Did Not Elect COBRA Coverage Special COBRA rights apply to Employees who lost health coverage as a result of a termination or reduction of hours and who qualify for a “trade readjustment allowance” or “alternative trade adjustment assistance” under a federal law called the Trade Act of 1974. These Employees are entitled to a second opportunity to elect COBRA coverage for themselves and certain family members (if they did not already elect COBRA coverage) during a special second election period. This special second election period lasts for 60 days or less. It is the 60-day period beginning of the first day of the month in which an eligible Employee begins receiving a trade readjustment allowance (or would be eligible to begin receiving the allowance but for the requirement to exhaust unemployment benefits) or begins receiving alternative trade adjustment assistance, but only if the election is made within the six months immediately after the eligible Employee’s group health plan coverage ended. If you qualify or may qualify for assistance under the Trade Act of 1974, contact the Fund Office for additional information. YOU MUST CONTACT THE FUND OFFICE PROMPTLY AFTER QUALIFYING FOR ASSISTANCE UNDER THE TRADE ACT OF 1974 OR YOU WILL LOSE YOUR SPECIAL COBRA RIGHTS. I. Keep Your Plan Informed of Address Changes Since additional information about your rights under COBRA will be sent to you or your Dependents if there is a qualifying event, it is important that the Fund Office have your current address and that of any dependents not living with you. So, if your spouse or any Dependent child has an address different from yours or if your family status changes, please notify the Fund Office. You should also keep a copy, for your records, of any notices you send to the Fund Office. J. If You Have Questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. 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 the EBSA website at www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) K. Contact for COBRA Questions If you have any questions regarding this Plan’s COBRA continuation coverage, you should call or write the Fund Office: St. Louis Graphic Arts Joint Health and Welfare Fund 14323 South Outer Forty Road, Suite S106 Chesterfield, Missouri 63017 Telephone: (314) 878-1579   TABLE OF CONTENTS   St. Louis Graphic Arts Joint Health & Welfare Fund 14323 South Outer Forty Rd. - Suite S106 Chesterfield, Missouri 63017 Fund Office: (314) 878-1579 twesthues@slgahw.org Fax: (314) 275-2640   If you have any comments about this web site, please contact us at twesthues@slgahw.org.   Site Concept and Design ©2002 jWeb. Maintenance and Hosting provided by jWeb.