When Coverage Ends | Continuation of Coverage

When coverage ends

Certain Qualifying Events Explained

After your employees enroll in our health and dental plans, we will send them information explaining their continuation rights and options. An individual is entitled to continuation coverage if he or she is a qualified beneficiary who experiences a qualifying event.

A qualified beneficiary can be an employee, spouse, or dependent(s) who is covered under the employer’s group plan on the day before a qualifying event takes place. The only exception to this rule is a child who is born to, or placed for adoption with, a qualified beneficiary who was previously the covered employee during the COBRA continuation period also becomes a qualified beneficiary.

Note: If your policy covers domestic partners, the Trust extends continuation coverage to domestic partners and their biological or legally adopted children who were covered under the group plan on the day before a qualifying event took place.

A qualifying event is any of the following which causes a qualified beneficiary to lose his or her coverage under the employer’s group plan:

  • Death of the covered employee.
  • Termination of the covered employee’s employment.
  • Reduction in the covered employee’s hours.
  • Divorce or annulment of the covered employee’s marriage.
  • Covered employee’s eligibility for Medicare benefits.
  • Loss of a dependent child’s eligibility for coverage under the plan.

When coverage ends

For most people, group continuation coverage ends on the earliest of the following dates:

  • The end of the period for which the last premium was paid on time.
  • The date on which the applicable period of continuation coverage ends.
  • The date on which the covered individual becomes covered under another group health plan which does not contain any exclusion or limitation regarding a preexisting condition of the individual.

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