The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires that a group health plan offer each qualified person, who would otherwise lose coverage, the opportunity to elect continuation of the same coverage he/she had while an active employee or dependent. If you elect to continue your coverage under COBRA, you are required to pay the entire cost for the continued coverage plus an additional 2 percent administrative fee allowed by COBRA. (For disabled persons and others eligible for the 11-month extension, rates can be charged up to 150 percent of the total cost during the extension.)
Definitions and Procedures
The following individuals qualify for coverage if they were covered under the plan at the time of one of the following events:
- An employee and his/her dependents who would lose coverage due to reduction in scheduled work hours or termination of employment (including retirement, layoff, and strike) for reasons other than gross misconduct.
- An employee’s former spouse/partner (and/or children) who would lose coverage due to divorce or legal separation.
- An employee’s surviving spouse/partner (and/or children) who would lose coverage due to the employee’s death.
- An employee’s spouse/partner (and/or children) who would lose coverage due to the employee’s entitlement to Medicare.
- An employee’s child who would lose coverage due to no longer meeting the definition of dependent under the plan (i.e. attainment of maximum age).
With the exception of the first item above, it is possible that you as the employee would need to notify the Benefits Department of such a change in family status. This would require you to fill out necessary paperwork to make a change. Please contact the Benefits Department at 412-624-8160 for details and deadlines.
How long can I continue?
The following are the maximum continuation periods for the qualifying events noted above:
- For individuals who lose coverage due to termination of employment, retirement, layoff, strike, or reduction in work hours, the maximum continuation period is 18 months from the qualifying event date.
- Exception: Individuals who were disabled prior to or within the first 60 days of COBRA coverage may be eligible to continue for a maximum of 29 months (contact COBRA directly about Disability Extension)
- For qualified dependents who would otherwise lose coverage due to divorce, legal separation, employee’s death, loss of dependent status or employee’s loss of group coverage due to Medicare entitlement, the maximum continuation is 36 months from the qualifying event date.
How do I elect COBRA coverage?
In order to continue coverage for yourself and/or your qualified dependents, including spouse/partner, you must complete a continuation election form (which you will receive from UPMC Benefit Management Services, not the University of Pittsburgh) within 60 days of the date of the notice or 60 days from the date of termination of coverage, whichever is later. If you mail your election form after this deadline, continuation will be denied.
Your coverage will remain with the same insurance carriers. Questions regarding coverage should be directed to your insurance carrier. Claims will continue to be processed by your insurance carrier.
COBRA monthly premium rates for the University of Pittsburgh plans for faculty and staff are as follows:
Medical - UPMC Health Plan, Plan Year 7/1/15 - 6/30/16
|Type||Panther Gold||Panther Advocate||Panther Plus||Panther Basic|
Vision - Davis Vision (Subsidiary of Highmark BlueCross/BlueShield)
|Type||Davis Vision Fashion Excellence Plan||Davis Vision Designer Gold Plan|
|Individual/Spouse/Partner or Child||$12.45||$17.41|
Dental - United Concordia (Subsidiary of Highmark BlueCross/BlueShield)
|Type||Concordia Plus Managed Care||Concordia Flex I Standard||Concordia Flex II Standard|
|Individual + One Adult or one Child||$36.23||$34.37||$52.71|
NOTE: A two percent administrative charge is applied to each premium rate.
For questions about billing cycles and payment due dates, please contact COBRA directly at 1-888-499-6885.