Continuing Coverage Under the Plan (other than continuing coverage as a Retiree)
In certain situations, coverage may be extended for an employee and covered eligible dependents with the employee being responsible for all applicable premiums. For information on continuing coverage as a retiree, refer to the Retiree Eligibility section. The following chart summarizes the circumstances in which coverage may be continued under the Plan.
If... | Coverage May Be Extended... |
|---|---|
An employee is no longer receiving pay from his employer and has been approved for a leave of absence without pay... | ...For up to 12 months for both the employee and his covered dependents. The employee can contact his Human Resources office for more details. |
An employee is placed on involuntary furlough without pay... | ...Until the employee returns from furlough to full-time employment. The employee can contact his Human Resources office for more details. |
An active employee is called to active military duty... | ...For up to 24 months under COBRA. |
An employee dies while not yet eligible to retire, dependents may be eligible to extend coverage... | ...For up to 36 months under COBRA for any covered dependents. See below for exceptions. |
An employee dies while eligible to retire and his spouse and children are covered as dependents | ...For the rest of the covered spouse's lifetime and until the end of the month for any covered dependent child who reaches age 26. See Surviving Spouse Eligibility and Surviving Spouse Enrollment in this section. |
An employee dies while eligible to retire and his children are covered as dependents... | ...For up to 36 months under COBRA for any covered dependent children. |
Exceptions for a surviving spouse of an employee who dies while not yet eligible to retire:
If a covered surviving spouse is on Medicare at the time of the employee's death, he will be eligible to continue coverage for up to 36 months under COBRA. Medicare will be the primary payer.
If a covered surviving spouse enrolls in Medicare at any time after COBRA continuation has begun, coverage will terminate.
Active Military Duty
If an employee is called to active military duty and elects not to continue coverage under the Plan while on active duty, the employee may re-enroll for coverage upon return from active duty. The employee must apply for coverage within 31 days from the date he returns from active duty. If the employee returns within the same calendar year and applies for coverage within the 31-day period, the employee and any covered dependents will not be required to satisfy a new calendar year deductible.
Frequently Asked Questions
COBRA, or the Consolidated Omnibus Budget Reconciliation Act of 1986, is a federal law that allows people covered under an employer's health plan to continue their coverage for a limited time after experiencing a qualifying event.
A qualified beneficiary includes employees, their spouses, or their dependent children who were covered before a qualifying event. This can also include children born or adopted during the COBRA continuation period.
A qualifying event is an occurrence that would cause the loss of coverage for a qualified beneficiary under the plan. Under COBRA, qualifying events include job termination (not due to gross misconduct), reduction in work hours, the death of the enrollee, divorce or legal separation, Medicare entitlement, and loss of dependent eligibility.
If the qualifying event is divorce, legal separation, or ineligibility of a dependent child, the employee or qualified beneficiary must notify the employee's employer unit no later than 60 days after the qualifying event occurs; otherwise, continuation coverage may not be made available. Any other enrollee or his qualified beneficiary must notify BCBSMS no later than 60 days after the qualifying event occurs; otherwise, continuation coverage may not be made available.