COBRA

Under certain circumstance coverage for you,  your spouse, or dependent children can be temporarily continued after it would normally end. Your right to this continued coverage was effective July 1, 1987 under the Consolidated Omnibus Budget Reconciliation Act of 1986, commonly called COBRA.

The continuation coverage gives you the right to purchase your benefits. You will be required to pay the full cost of the premiums for the coverage you continue plus 2%.

Continuation of Coverage at Termination or Reduction of Hours

If you lose your coverage because of a reduction in your hours of employment, retirement or termination, you have the right to continue your benefits for a period of 18 months. The exception to this is termination for reasons of gross misconduct. This right to purchase continuation of coverage applies to your spouse and covered dependent children.

Other Continuation for Your Dependents

If you have dependent coverage at the time of your divorce or retirement, your dependents, a spouse, or dependent children may apply to continue coverage for up to 36 months.

If your dependent child becomes ineligible for coverage, he or she may purchase continued coverage for up to 36 months. Also, if your dependent child was a full time student her or she may continue coverage for up to 36 months.

It is your responsibility or your family members' responsibility to notify the Fund Office of a divorce or a child losing dependent status. We must receive this information within 60 days of the event.

What Are the COBRA Benefits

You have options when continuing your coverage. You may purchase a package which includes dental, vision, prescription and major medical reimbursement. COBRA notices for basic health care (hospitalization, medical, surgical) should come from the School District Benefits Office.

Reduction in COBRA Coverage

The continuation of coverage for you or your dependents may be stopped if you don't pay the required premium or if the Fund were to terminate for all active participants any benefit you are purchasing.

Coverage for Disabled

Under certain conditions a disabled person his spouse and dependent children may qualify for an additional 11 months of coverage. To be eligible for this coverage the covered person must:

1. be determined by the Social Security Administration to have been totally and permanently disabled before the end of the first 60 days of COBRA coverage;
2. notify the Fund of the Social Security disability determination before the expiration of the 18 months of COBRA and within 60 days of receiving the determination. There will be an additional premium charge of up to 50% during the extra eleven months.

Pre-Existing Conditions

If you, your spouse, or dependent children become eligible for benefits through another group health plan which has pre-existing condition limitations or exclusions, your COBRA coverage may be continued.

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The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).  COBRA continuation coverage can become available to you and to other members of your family who are covered under the Plans when you would otherwise lose your group health coverage. 

This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it.  This notice gives only a summary of your COBRA continuation coverage rights.

The Plan Administrator is the Board of Trustees of the PFT Health & Welfare Fund.  The Plan Administrator is responsible for administering COBRA continuation coverage. 

COBRA Continuation Coverage

COBRA continuation coverage is a continuation of plan coverage when coverage would otherwise end because of a life event known as a “qualifying event.”  Specific qualifying events are listed later in this notice.  After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.”  A qualified beneficiary is someone who will lose coverage under the Plans because of a qualifying event.  Depending on the type of qualifying event, employees, spouses of employees, and dependent children of employees may be qualified beneficiaries.  Under the Plans, qualified beneficiaries who elect COBRA continuation coverage will be required to pay a monthly premium based on the cost of the coverage to the Fund, plus a small administrative fee. 

If you are an employee, you will become a qualified beneficiary if you will lose your coverage under the Plans because either one of the following qualifying events occur:

    1.    Your hours of employment are reduced, or

     2.    Your employment ends for any reason other than your gross misconduct.

If you are the spouse of an employee, you will become a qualified beneficiary if you will lose your coverage under the Plans because any of the following qualifying events occur:

                   (1)     Your spouse dies;

                             (2)    Your spouse’s hours of employment are reduced;

                             (3)    Your spouse’s employment ends for any reason other than his or her gross misconduct;

                             (4)    Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or

                             (5)    You become divorced from your spouse.

Your dependent children will become qualified beneficiaries if they will lose coverage under the Plans because any of the following qualifying events occur.

    (1)    The parent-employee dies;

    (2)    The parent-employee’s hours of employment are reduced;

    (3)     The parent-employee’s employment ends for any reason other his or her gross misconduct;

    (4)     The parent-employee becomes entitled to Medicare benefits (under Part A, Part B, or both);

    (5)           The parents become divorced; or

    (6)            The child stops being eligible for coverage as a “dependent child.”

The Plans will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred.  When the qualifying event is the end of employment or the reduction of hours of employment, death of the employee, or enrollment in Medicare (Part A, Part B, or both) the employer must notify the Plan Administrator of the qualifying event within 30 days of the qualifying event. 

For the other qualifying events (divorce of the employee and spouse, or an individual’s loss of eligibility for coverage as a dependent child), you must notify the Plan Administrator.  The Fund requires that you notify the Plan Administrator within 60 days after the qualifying event occurs.  You must send this notice to the Plan Administrator at 1816 Chestnut Street, Philadelphia, Pennsylvania 19103.   If you fail to notify the plan in a timely manner, the Fund may not be required to provide you with COBRA continuation coverage.  In addition, if you fail to notify the Fund that you are no longer eligible for benefits because of a divorce or because you no longer qualify as a dependent, the Fund’s Trustees may pursue any and all lawful remedies to recover monies paid on your behalf after the date you were no longer eligible for benefits.

Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each qualified beneficiary.  Each qualified beneficiary will have an independent right to elect COBRA continuation coverage.  Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.  For each qualified beneficiary who elects COBRA continuation coverage, COBRA continuation coverage will begin on the date that coverage under the Plans would otherwise have been lost.

COBRA continuation coverage is a temporary continuation of coverage.  When the qualifying event is the death of the employee, the employee’s becoming entitled to Medicare benefits (under Part A, part B, or both), the employee’s divorce, or an individual’s loss of eligibility as a dependent child, COBRA continuation coverage lasts for up to 36 months.  

When the qualifying event is the end of employment or reduction of the employee’s hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement.  For example, if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates, COBRA continuation coverage for his/her spouse and children can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus 8 months).

When the qualifying event is the end of employment or a reduction of the employee’s hours of employment, COBRA continuation coverage lasts for up to 18 months.  There are two ways in which this 18-month period of COBRA continuation coverage can be extended.

Disability Extension of 18-month Period of Continuation Coverage

If you or anyone in your family covered under the Plans is determined by the Social Security Administration to be disabled at any time during the first 60 days of COBRA continuation coverage and you notify the Plan Administrator in a timely fashion, you and your entire family can receive up to an additional 11 months of COBRA continuation coverage, for a total maximum of 29 months.  You must make sure that the Plan Administrator is notified of the Social Security Administration’s determination within 60 days of the date of the determination and before the end of the 18-month period of COBRA continuation coverage.  This notice should be sent to the Plan Administrator at 1816 Chestnut Street, Philadelphia, Pennsylvania 19103.

Second Qualifying Event Extension of 18-month Period of Continuation Coverage

If your family experiences another qualifying event while receiving COBRA continuation coverage, the spouse and dependent children in your family can get additional months of COBRA continuation coverage, up to a maximum of 36 months.  This extension is available to the spouse and dependent children if the former employee dies, gets divorced, or becomes entitled to Medicare benefits (under Part A, Part B, or both).  The extension is also available to a dependent child when that child stops being eligible under the Plans as a dependent child.  In all of these cases, you must make sure that the Plan Administrator is notified of the second qualifying event within 60 days of the second qualifying event.  This notice must be sent to the Plan Administrator at 1816 Chestnut Street, Philadelphia, Pennsylvania 19103.

Special Election Period

If you are certified as eligible for benefits under the Trade Act of 2002 by the U.S. Department of Labor (DOL), you may be eligible for both an individual Health Insurance Tax Credit and additional COBRA rights.  For example, if you did not elect COBRA during your election period, but are later certified by DOL for Trade Act benefits, you may be entitled to an additional 60-day COBRA election period beginning on the first day of the month in which you were certified.  However, in no event would this benefit allow you to elect COBRA later than six months after your coverage ended under the Plans.  If you are eligible for Trade Act benefits, you must contact the Plan Administrator immediately after your certification of these benefits or you will lose your special COBRA rights.  Please contact the Plan Administrator for additional details.

If You Have Questions       

If you have questions about your COBRA continuation coverage, you should contact Arthur Steinberg at 1816 Chestnut Street, Philadelphia, Pennsylvania 19103 or at 215-561-2722, 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 at

Keep Your Plan Informed of Address Changes

In order to protect your family’s rights, you should keep the Plan Administrator informed of any changes in the addresses of family members.  You should also keep a copy, for your records, of any notices you send to the Plan Administrator.