Section 10.3 - Continuation Coverage. Under COBRA, employees and their spouses and dependent children have the opportunity for a temporary extension of group medical, dental, and or vision coverage (called “continuation coverage”) at group rates in certain instances where coverage would otherwise end. This notice is intended to inform you, in a summary fashion, of your rights and obligations under the continuation coverage provisions of the law. Each person (employee, spouse, or dependent child) to whom this notice is addressed should take the time to read it carefully.

If you are an employee of the City of Oakwood (the “City”) and are covered under the City’s group medical, dental, and/or vision plans (called the “plan”), you are a “qualified beneficiary” and have a right to choose continuation coverage if you lose your group 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) (both called “qualifying events”).

If you are the spouse of an employee covered by the plan, you are a “qualified beneficiary” and have the right to choose continuation coverage for yourself if you lose group coverage under the plan for any of the following four reasons (“qualifying events”):

  1. The death of your spouse;
  2. A termination of your spouse’s employment (for reasons other than gross misconduct) or a reduction in your spouse’s hours of employment;
  3. A divorce or legal separation from your spouse, if you or your spouse tells the plan about the divorce or separation within 60 days after the official determination; or
  4. Your spouse becoming entitled to Medicare.

In the case of a dependent child of an employee covered by the plan, he or she is a “qualified beneficiary” and has the right to continuation coverage if group coverage under the plan is lost for any of the following five reasons (“qualifying events”):

  1. The death of an employee parent;
  2. The termination of an employee parent’s employment (for reasons other than gross misconduct) or a reduction in an employee parent’s hours of employment with the City;
  3. The employee parent’s divorce or legal separation, if the employee, spouse, or child tells the plan about the divorce or separation within 60 days after the official determination;
  4. The employee parent becoming entitled to Medicare; or
  5. The dependent ceasing to be a “dependent child” under the plan, if the employee, spouse, or child tells the plan about the event within 60 days of when he or she ceases to be eligible.

Separate right to elect. Each employee or family member who is eligible to choose continuation coverage in accordance with the above rules has a separate right to elect that coverage, even if other family members do not elect that coverage. However, an election form filed by one family member will apply to other family members if they do not

35