COBRA Notification Information

General Information

COBRA legislation requires employers to continue group health and dental coverage for a maximum of 18 months to employees and their covered dependents who would lose their group insurance coverage at the time of termination of appointment/employment. If you elect this option, the benefits will be continued until:

• The expiration of 18 months following termination of your appointment;
• You [or your dependent(s)] become covered under any group plan;
• You [or your dependent(s)] become entitled to Medicare benefits;
• You fail to pay the monthly charge for this coverage on time;
• The health plan is no longer in force; whichever occurs first.

Additional Points:

1. If you or your dependent(s) become disabled prior to the end of the 18-month period, and are determined disabled under Title II or Title XVI of the Social Security Act, you must notify the Office of Graduate Medical Education within the first 18 months of COBRA coverage of your receiving the Social Security disability determination to continue coverage up to 29 months, and you must be determined to be disabled during the first 60 days of COBRA continuation coverage.
2. Effective January 1, 2003, under the California COBRA program (Cal-COBRA) employees covered by insurance plans written in the state of California will have the option of continuing medical coverage for an additional 18 months. At the conclusion of your initial 18 months of coverage, Blue Cross will communicate with you regarding Cal-COBRA.
3. If you are age 60 or older at termination, you may be eligible for an additional extension of COBRA coverage. Contact the Office of Graduate Medical Education for information.

Eligibility

As an active appointee during your residency/fellowship you are covered under one or more of our available insurance plan(s) - Blue Cross PPO, Blue Cross HMO (California Care), Standard Dental, Vision Services Plan (VSP), Standard Life, and Standard Long Term Disability. You may elect to continue your current benefits. You may choose to drop a dependent, but you may not enroll a dependent who was not previously covered, nor are you permitted to change from one carrier to another unless you are insured under the Blue Cross HMO plan and are leaving California.

Cost

While you are appointed full-time as an active appointee the University subsidizes your insurance premium cost. Under COBRA continuation the University will no longer subsidize your premium cost and you must pay 102% of the rate established for the active plan. These premiums or underwriters may change during a policy renewal. If you are actively covered under COBRA you will be notified at the time of any rate and/or benefit changes and you will have the right to participate in future open enrollments. Current costs are noted below:

Key:

EO - Single Coverage (Only one person)

SD - Double Coverage (Two persons)

M - Family Coverage (More than two persons)

Life and Term Disability

If you have chosen to purchase disability coverage through the local Housestaff Union, the San Diego Housestaff Association (SDHSA), departing housestaff who desire to convert that coverage should contact the SDHSA as soon as possible at 619-884-0840.

If you wish to apply for Standard Life and/or Long Term Disability Insurance conversion coverage, please complete the attached Standard Life Insurance Group Conversion Packet Request form and/or the Standard Group Conversion Request for Long Term Disability Insurance and forward it to the Standard Insurance Company. Application must be made within 31 days of the date your Group coverage terminates.

Health, Dental, and Vision Insurance

In order for you to establish eligibility for coverage, you must complete and send the enclosed "Notice of Right to Elect Continued Coverage" form to HR Simplified within sixty (60) days of your receipt of this letter, or sixty (60) days from the date your coverage ends, whichever is later. Their address is:

H R Simplified
8441 Wayzata Blvd. Suite 300
Minneapolis, MN 55426

H R Simplified is the financial administrator for our house staff COBRA account. They are not, however, going to be insuring you. You will be insured either by Blue Cross Prudent Buyer, Blue Cross CaliforniaCare (HMO), Standard or VSP.

If you wish to elect continued coverage for health, dental, or vision, YOU MUST review and complete the following forms:

• Notice of Right to Elect Continued Health Coverage Form - (Required) Mail to H R Simplified
• Summary of COBRA Insurance Continuation Form - (Required) Mail to Graduate Medical Education
• To continue your current health plan: Blue Cross COBRA Enrollment Form - [170 kb] - Mail to Graduate Medical Education
• To continue your current dental plan: COBRA Standard Dental Enrollment Form - Mail to Graduate Medical Education
• To continue your current vision plan: Vision Services Plan Enrollment Form - Mail to Graduate Medical Education

Payments

Your first payment must be received by H R Simplified 45 days from the date you sign the "Notice of Right to Elect Continued Health Coverage" form, and it must include premium from the time you lost group coverage under the UCSD Medical Center sponsored plan to the present.

Do not wait for H R Simplified to bill you for the coverage you desire. You must pay within 45 days as noted above or you will lose eligibility and will not be insured.

Subsequently, your payments are due to H R Simplified on the first of each month. You will have a grace period of 30 days in which to submit payment before your coverage is terminated. To assure continuity of coverage and to avoid the possibility of service or claim complications, you may wish to remit payment with the enclosed form.

Send the completed enrollment forms to the Office of Graduate Medical Education.

Send your payment with Notice of Election form to HR Simplified.

If you have any questions after you review the rest of this memo please contact the Office of Graduate Medical Education, 619-543-7820.