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Continuation of coverage (COBRA) for retirees

Guide to Continuation of Coverage (Retiree)

What does my dependent do if he/she loses coverage?

1. Dependent Survivor Coverage

Dependent coverage terminates when a member’s eligibility ends for any reason other than death, or on the date when the dependent no longer meets the definition of eligible dependent, whichever occurs first. In cases of the member’s death, the Welfare Fund extends dependent coverage three (3) months following the month in which the member died.

2. COBRA

The election of City (Medical/Hospital) COBRA does not enroll you in UFT Welfare Fund COBRA. A separate UFT Welfare Fund COBRA application is required.

COBRA provides continuation of Fund coverage when coverage would otherwise end because of a life event known as a "qualifying event." Specific qualifying events are listed below. COBRA continuation coverage must be offered to each person who is a "qualified beneficiary" (QB). A qualified beneficiary is someone who will lose coverage under the Fund because of a qualifying event. Depending on the type of qualifying event spouses of members/domestic partners, and dependent children of members may be qualified beneficiaries under the Fund’s plan of benefits. Qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.

The following language is required by the Federal Patient Protection and Affordable Care Act: The Fund cannot represent whether or not “stand-alone” prescription drug, dental, vision and other supplemental benefits it provides are available through health insurance exchanges.

You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.

When am I eligible for COBRA?

Spouses/domestic partners1 of covered members have the right to continue coverage if coverage is lost for any of the following qualifying events:

  1. death of the member; or
  2. divorce or legal separation from the member; or
  3. termination of the domestic partnership with the member.

1 The law does not require that COBRA continuation coverage be extended to domestic partners. However, the Fund Board of Trustees has determined that such COBRA continuation coverage will be offered to registered domestic partners of Fund members.

Dependents of members have the right to continue coverage if coverage is lost for any of the following qualifying events:

  1. death of the parent-member; or
  2. the dependent ceases to be a “dependent child” under the Fund’s rule of eligibility.

Qualified Beneficiary (QB): Individuals entitled to COBRA coverage on their own are called qualified beneficiaries (QB). Individuals who may be qualified beneficiaries are the spouse/domestic partner of the covered member and the dependent child(ren) of a covered member. In order to be a QB, an individual must be covered under the UFT Welfare Fund on the day before the event that causes the loss of coverage. The Health Insurance Portability and Accountability Act (HIPAA) amended this requirement to allow a child who is born to or adopted by the covered employee, while on COBRA, to become a Qualified Beneficiary.

Notes: Individuals covered under another employer sponsored group health plan prior to their COBRA start date are still eligible to purchase UFT Welfare Fund COBRA. However, individuals who become covered under another employer sponsored group health plan while on UFT Welfare Fund COBRA may not be eligible to continue the UFT Welfare Fund COBRA (except for the period that the new health plan excludes pre-existing conditions).

The Fund offers Medicare eligible enrollees and/or their Medicare eligible dependent(s) continuation benefits similar to COBRA if a COBRA event should occur.

What are the periods of continued coverage?

Continuation of coverage is available for a maximum duration of thirty-six (36) months for the member’s eligible dependents as a result of:

  1. death of member; or
  2. divorce; or
  3. legal separation; or
  4. termination of a domestic partnership; or
  5. dependents that cease to be a “dependent child” under the Fund’s rules of eligibility.

COBRA premiums for thirty-six (36) month periods are calculated at 102% of the employer’s cost for coverage to the plan at the group rate.

Continuation of coverage can never exceed thirty-six (36) months in total, regardless of the number of events that relate to a loss of coverage. Coverage during the continuation period will terminate if the COBRA participant fails to make timely payments or if the COBRA participant becomes covered under another employer sponsored group health plan while on the UFT Welfare Fund COBRA (unless the new plan contains a pre-existing condition exclusion).

What are my notification responsibilities?

Under the law, the member, retiree or eligible dependent has the responsibility to notify either their payroll secretary or the Department of Education’s Health & Welfare Office (In-Service), or City of NY Health Benefits Program (Retirees) and the Welfare Fund within sixty (60) days of an address change, death, divorce, legal separation, termination of domestic partnership or a child losing dependent status.

When a qualifying event (such as a member's death) your eligible dependents will be notified by the Department of Education’s Health & Welfare Office (In-Service), or City of NY Health Benefits Program (Retirees) of your option to choose continuation coverage.

To protect your family’s rights, let the UFT Welfare Fund know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the UFT Welfare Fund.

How do I elect City COBRA coverage?

To elect City COBRA continuation of health coverage, the COBRA eligible person must complete a "COBRA - Continuation of Coverage Application" (Form EB7). This application is available through the payroll secretary, the Department of Education’s Health & Welfare Office (In-Service), or City of NY Health Benefits Program (Retirees).

City COBRA applications, rates and general information are also available from the Health Benefits Program section of the NYC Office of Labor Relations website.

What should I do if I am interested in electing the UFT Welfare Fund COBRA?

To elect UFT Welfare Fund COBRA you must:

  • Contact the Fund office directly at 212-539-0560 for necessary forms, available options and costs.

    or

  • Make a copy of your City COBRA application and send it directly to the Welfare Fund Office. If you do not elect City COBRA but you would like to purchase Welfare Fund COBRA, please contact the Fund office.

If you do not elect City COBRA but you would like to purchase Welfare Fund COBRA, contact the Fund office directly.

Upon notification, a Welfare Fund COBRA application will be mailed to you so that you may enroll in the UFT Welfare Fund COBRA benefit plan.

Eligible persons choosing to elect COBRA coverage must do so within sixty (60) days of the qualifying event or of the date on which they receive notification of their rights, whichever is later.

Are there other coverage options besides COBRA Continuation Coverage?

Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.

The following language is required by the Federal Patient Protection and Affordable Care Act: The Fund cannot represent whether or not “stand-alone” prescription drug, dental, vision and other supplemental benefits it provides are available through health insurance exchanges.

When are my premium payments due?

The initial premium is due within forty-five (45) days of your COBRA election. Thereafter, premiums are due on the first of the month with a thirty (30) day grace period. Since there cannot be a gap in the coverage period, coverage and premiums are retroactive to the COBRA qualifying event date. Subsequent premium payments are applied to the earliest unpaid month(s).

When can I change my benefits selected under COBRA?

COBRA participants are entitled to change the selection of COBRA benefits during the City’s Fall Open Enrollment Period as designated for In-Service or Retirees.

Who can I call if I have any questions about COBRA?

If you have questions about your COBRA continuation coverage, you should contact the Fund or you may contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefits Security Administration (EBSA). Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA's website.

Extension of Coverage for Unmarried Children 29 Years of Age or Under

New York State Insurance Law requires unmarried children to be covered under the member’s insured health plan, such as your basic medical plan with NYC, if they choose, by paying the premium cost of the coverage until the unmarried child reaches his/her 30th birthday. Although not required, the UFT Welfare Fund extends this opportunity to continue the Supplemental benefits, on a self-pay basis.

Welfare Fund forms hotline: 212-539-0539