- In order for COBRA coverage to become available, a qualified beneficiary must have a loss of coverage due to a "qualifying event." Please review the information below to learn more about COBRA eligibility, time periods, rates, qualifying events, costs, and other conditions.
COBRA Continuation of Coverage
- Loyola has contracted with Benefit Express (“the COBRA Administrator”) to perform many of the administrative tasks required by federal law. This Initial Notice of COBRA Rights indicates when employees should contact the COBRA Administrator, rather than Loyola, for information or assistance. To contact the COBRA Administrator, address all inquiries to:
P.O. Box 189
Arlington Heights, IL 60006
- The Loyola University Chicago Health Insurance Plan
- The Loyola University Chicago Dental Insurance Plan
- The Loyola University Chicago Health Care Flexible Spending Account Plan
- Vision Service Plan
Loyola Advantage PPO (BCBS)
Vision Service Plan
- Traditional Dental Plan—Delta Dental
Managed Care Dental Plan—First Commonwealth DMO
Health Care Flexible Spending Account Plan
|Length of Continuation of Coverage||Qualifying Events|
|18 Months||Termination of employment for the covered employee/participant or a reduction in work hours|
|29 Months||Social Security Disability: 18 months of continuation of coverage can be extended an additional 11 months, to a maximum of 29 months, if the Social Security Administration determines a qualified participant/beneficiary was disabled|
|36 Months||If the original event causing loss of coverage, such as the death of the spouse, divorce, legal separation, medicare entitlement, or a dependent child's eligibility ends under the employer's Group Health Plan(s)|
- For a child born to, adopted by, or placed for adoption with a participant during continuation coverage, these periods are measured from the date of the event that triggered the continuation coverage in effect at the time of birth, adoption, or placement. In no event is the coverage period for such a child based on the date of birth, adoption, or placement.
- If a 36-month maximum COBRA coverage period applies, it cannot be extended under any circumstances.
If you are a participant, you will be entitled to elect COBRA if you have a loss of coverage under the Plan because one of the following events occurs:
- Your hours of employment with Loyola are reduced to a level that renders you ineligible for benefits
- Your employment with Loyola ends for any reason other than your gross misconduct
- Your spouse dies
- Your spouse’s hours of employment with Loyola are reduced
- Your spouse’s employment with Loyola ends for any reason other than his or her gross misconduct
- You become divorced or legally separated from your spouse, but only if notice of the divorce or legal separation is given, as specified later in this Notice in the section entitled “In Some Cases Qualified Beneficiaries Are Required to Give Notice”
The participant that is your parent dies
The participant that is your parent has a reduction in hours of employment with Loyola
The participant that is your parent terminates employment with Loyola for any reason other than his or her gross misconduct
The participant that is your parent becomes divorced or legally separated, but only if notice of the divorce or legal separation is given as specified later in this Notice in the section entitled “In Some Cases Qualified Beneficiaries Are Required to Give Notice”
You stop being eligible for coverage under the Plan as a “dependent child” of the participant, but only if notice of the event making you ineligible is given as specified later in this notice in the section entitled “In Some Cases Qualified Beneficiaries Are Required to Give Notice”
- The participant’s maximum COBRA coverage period would end on March 15, 2007.
- The participant’s spouse and dependent children would have a maximum COBRA coverage period that ends on July 1, 2008.
- Social Security Administration Determination of a Qualified Beneficiary’s Disability
- The 18-month maximum COBRA coverage period (or the period of coverage resulting from Medicare entitlement as described in the preceding paragraph) may be extended to a total of 29 months from the date of termination of employment or reduction in hours if a qualified beneficiary receives a Social Security Administration determination that the qualified beneficiary is disabled. This extension will apply only if the Social Security Administration determines that the employee (or another individual who is entitled to COBRA coverage because of the same qualifying event) was disabled at any time during the first 60 days of COBRA coverage, the employee notifies the COBRA Administrator in a timely fashion, and the employee remains disabled throughout the extension period. For this extension to be available, the COBRA Administrator must be notified in writing of the Social Security Administration determination.
- A second qualifying event for a participant’s spouse may consist of the participant’s death, legal separation, or divorce, but only if the event would have caused the spouse to lose coverage under the Plan had the first qualifying event not occurred.
- A second qualifying event for a participant’s dependent child may consist of the participant’s death, legal separation, or divorce, or the dependent child’s ceasing to meet the dependent eligibility requirements under the Plan, but only if the event would have caused the dependent child to lose coverage under the Plan had the first qualifying event not occurred.
- For this extension to be available, written notice of the event must be properly given to the COBRA Administrator.
- If a qualified beneficiary elects COBRA under the Health Care FSA, the COBRA coverage will apply to all of the qualified beneficiaries who lost Health Care FSA coverage due to the same qualifying event as the electing qualified beneficiary, unless the election form specifies otherwise.
- Each qualified beneficiary has separate election rights, and each could elect separate COBRA coverage under the Health Care FSA to cover that beneficiary only, with a separate Health Care FSA annual limit and a separate premium.
- If a qualifying event is a participant’s divorce or legal separation, or a dependent child’s losing eligibility for coverage under the Plan, COBRA will not be offered (or available) unless written notice of these events is provided to Loyola University Chicago
- The notice must be given within 60 days of the event (the divorce or legal separation, or the event causing the dependent child’s ineligibility) or the date the Plan says coverage will end because of the event.
- If notice is not provided within the 60-day period, COBRA coverage will not be available as a result of that event. Also, any claims paid by the Plan after the date coverage should have ended must be refunded to the Plan.
- If COBRA coverage election is not made before the end of the 60-day election period as described above, beneficiaries will lose the right to obtain COBRA coverage and health coverage under the Plan will end.
Beginning an FMLA leave is not an event which qualifies for continuation coverage (beginning a non-FMLA leave may be a COBRA qualifying event, however).
If one of the qualifying events listed earlier in this notice occurs during an FMLA leave, however, and, under the terms of the Plan, it normally would result in loss of coverage, then the normal rules described above concerning COBRA coverage would apply. In addition, if a participant who takes an FMLA leave does not return at the end of that leave, the last day of that leave may be treated as a reduction in hours for purposes of determining whether COBRA rights apply.
- The initial COBRA premium is due no later than the 45th day after the election date. That initial payment must cover the premium for the period of COBRA coverage from the date on which Plan coverage would have ended if COBRA had not been elected through the last day of the month that ends before the due date for the initial payment.
COBRA coverage will terminate automatically on the first date Loyola ceases to provide any group health coverage to any employee.
Cessation of Disability
- COBRA coverage will terminate automatically if, after becoming entitled to a 29-month maximum coverage period due to an employee's own or another qualified beneficiary’s disability, during the extension, there is a final Social Security Administration determination that the disabled individual ceased to be disabled.
- Within 30 days after receipt of the Social Security Administration determination, the COBRA Administrator must be notified in writing of that determination according to the notice procedures. Termination of COBRA coverage will be effective on the first day of the first month that is more than 30 days after the date of the Social Security Administration determination, regardless of whether or not an employee gives the required notice.
COBRA coverage will terminate automatically if, after electing COBRA, an employee first becomes entitled to any Medicare benefits (Part A, Part B or both).
- Employees must notify the COBRA Administrator promptly after Medicare becomes effective.
- Regardless of whether or not this notice is provided, termination of COBRA coverage will be effective on the date of Medicare entitlement.
820 North Michigan Avenue, 8th floor
Chicago, Illinois 60611
Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.
P.O. Box 189
Arlington Heights, IL 60006
In order to protect your family’s rights, you should keep Loyola, as well as the COBRA Administrator (after electing COBRA continuation coverage), 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 Loyola or the COBRA Administrator