General Information and Forms
On April 7, 1986, a Federal law was enacted (Public Law 99-272, Title X) requiring employers who sponsor group health plans to offer employees and their families the opportunity for a temporary extension of health coverage (called "continuation coverage") at group rates in certain instances where coverage under the plan would otherwise end.
As an employee of Wayne State University covered by the university medical and dental plan, you have a right to choose this continuation coverage if you lose your group health coverage because of a reduction in your hours of employment or the termination of your employment (for reasons other than gross misconduct on your part).
Spouse of Employee
As the spouse of an employee covered by the university medical and dental plan, you have the right to choose continuation coverage for yourself if you lose this group health coverage for any of the following reasons:
- the death of the employee; or
- a termination of your spouse's employment (for reasons other than gross misconduct) or reduction in your spouse's hours of employment; or
- divorce or legal separation from your spouse; or
- your spouse becomes eligible for Medicare; or
- you become eligible for Social Security disability.
Dependent Child of an Employee
The dependent child of an employee covered by the university medical and dental plan, he or she has the right to continuation coverage
if the group health coverage is lost for any of the following reasons:
- the death of a parent; or
- the termination of a parent's employment (for reasons other than gross misconduct) or reduction in parent's hours of employment; or
- parents' divorce or legal separation; or
- a parent becomes eligible for Medicare; or
- the dependent ceases to be a "dependent child" under the university medical and dental plan policy; or
- your parent becomes eligible for social security disability.
How to Continue Coverage
Under the law, the employee or a family member has the responsibility to inform Benefits Administration of a divorce, legal separation, or a child losing dependent status under a university medical and dental plan.
When Benefits Administration is notified that one of these events has occurred, we will in turn notify you that you have the right to choose continuation coverage. Under the law, you have at least 60 days from the date you would lose coverage because of one of the events described above to inform the Benefits Administration Office that you want continuation coverage.
If you choose continuation coverage, Wayne State University is required to give you coverage which, as of the time coverage is being provided, is identical to the coverage provided under the plan to all university employees or family members. The law requires that you be afforded the opportunity to maintain continuation coverage for 3 years unless you have lost group health coverage because of a termination of employment or reduction in hours. In that case, the required continuation coverage is 18 months unless the reason for your termination is your disability and then coverage may continue for 29 months. However, the law also provides that your continuation coverage may be cut short for any of the following reasons:
- Wayne State University no longer provides group health coverage to any of its employees; or
- The premium for your continuation coverage is not paid; or
- You become an employee covered under another group health plan; or
- You become eligible for Medicare; or
- You were divorced from a covered employee and subsequently are covered under your new spouse's health plan.
You do not have to show that you are insurable to choose continuation coverage. However, under the law, you will have to pay all of the premiums plus 2% for your continuation coverage.
End of Coverage
If you do not choose continuation coverage, your group health insurance coverage will end the first of the month following the month in which you lose eligibility through termination of employment, reduction in work hours, divorce, death, medicare eligibility or loss of dependency.
Flexible Spending Account
This law has applied to the University medical and dental plan since September 1, 1986. This law also applies to Flexible Spending Accounts. If you participate in the Medical Care Spending Account Benefit, a federal law know as "COBRA" gives you the right to continue coverage if your employment with Wayne State University is terminated for any reason other than gross misconduct.
Generally, continuation coverage will extend your plan coverage for 18 months. However, COBRA rules must be coordinated with the 12-month period of coverage rules for Flexible Spending Accounts.
This means that if the entire 12-month period required for Flexible Spending Accounts falls during the 18-month COBRA period, you can elect to participate during one additional plan year following your termination. If not, you may only participate through the end of the current plan year.
Dependent Care FSA's are not subject to COBRA.