• The last day of the month in which you were engaged in active employment, unless you are transferring
to another participating group
• The last day of the month in which you become ineligible for coverage (for example, your working hours are reduced from full-time to part-time)
• The day after your death
• The date the coverage ends for all subscribers or
• The last day of the month in which your premiums were paid in full. (You must pay the entire premium, including the tobacco-use surcharge, if it applies.)
Coverage for your spouse and/or children will end:
• The date your coverage ends
• The date coverage for spouses and children is no longer offered or
• The last day of the month in which your spouse or child’s eligibility for coverage ends.
If your coverage or your spouse or child’s coverage ends, you may be eligible for continuation of coverage as
a retiree, as a survivor or under COBRA. If you are dropping a spouse or child from your coverage, you
must complete a Notice of Election (NOE) form within 31 days of the date the spouse or child is no lon- ger eligible for coverage.
COBRA
COBRA is short for Consolidated Omnibus Budget Reconciliation Act. It requires that continuation of
group health, vision, dental and/or Medical Spending Account coverage be offered to you and/or your covered spouse and/or children if you are no longer eligible for coverage due to a qualifying event. Qualify-
ing events include:
• The covered employee’s working hours are reduced from full-time to part-time
Gener al Inf or ma tion gross misconduct)
• A covered spouse loses eligibility due to a legal separation or divorce • A child no longer qualifies for coverage.
Please note: An individual who loses coverage as a result of a Dependent Eligibility Audit is not eligible for COBRA.
For a covered spouse and/or children to continue coverage under CO-
BRA, the subscriber or covered family member must notify his benefits
office within 60 days after the qualifying event or the date coverage
would have been lost due to the qualifying event, whichever is later.
Otherwise, the individual will lose his rights to COBRA coverage. To begin coverage under COBRA, a COBRA NOE and premiums must
be submitted. The premiums must be paid within 45 days of the date cov-
erage was elected. Your first premium payment must include premiums for the month following the date you lost coverage, the month you elected coverage and the first full month of COBRA coverage.
For example: You lost coverage on June 30, elected coverage on August 15 and paid the initial premium on September 17. You would be required to pay three premiums: one for the month following the date you lost coverage (July); one for the month in which you elected coverage (August); and one for the month in which you made your first payment (September).
COBRA coverage becomes effective when the first premium is paid and remains in effect only as long as the premiums are up-to-date. A premium is considered paid on the date of the postmark or the date it is hand- delivered, not by the date on the check.
EIP is the benefits administrator for COBRA subscribers of state agencies, higher education institutions and
public school districts. COBRA subscribers from local subdivisions keep the same benefits administrator.
How COBRA Coverage May End
COBRA coverage will end before the maximum benefit period is over if:
1. A subscriber fails to pay the full COBRA premium on time
2. A qualified beneficiary gains coverage under another group health plan that does not impose a pre-exist-
ing condition exclusion
3. A qualified beneficiary becomes entitled to Medicare
4. EIP no longer provides group health coverage
5. During a disability extension, the Social Security Administration determines the qualified beneficiary is no longer disabled
6. An event occurs that would cause EIP to end the coverage of any subscriber, such as the subscriber com-
mits fraud.
The qualified beneficiary, his personal representative or his guardian is responsible for notifying EIP when he is no longer eligible for COBRA. COBRA coverage will be canceled automatically by EIP in situations numbered 1, 3 and 6. The qualified beneficiary is responsible for submitting a Notice to Terminate COBRA Continuation Coverage, along with supporting documents, in situations numbered 2 and 5.
How Medicare Affects COBRA Coverage
If you or your eligible spouse or child is covered by COBRA and becomes eligible for Medicare Part A, Part
B or both, please notify the Employee Insurance Program.
A copy of the Initial COBRA Notice begins on page 246. For more information about COBRA, including the length of your
coverage, check your CO-
BRA notice or contact your benefits administrator.
Gener
al Inf
or
ma
tion
A subscriber or eligible spouse or child who is covered by Medicare and then becomes eligible for COBRA can enroll in COBRA for secondary coverage. Medicare will be his primary coverage.
If you need more information about COBRA, contact your benefits office or EIP.
When COBRA Benefits Run Out
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) guarantees that persons who have
exhausted COBRA benefits and are not eligible for coverage under another group health plan have access to health insurance coverage without being subject to a pre-existing condition exclusion period. However, certain conditions must be met. In South Carolina, the South Carolina Health Insurance Pool provides this guarantee of health insurance coverage. For information, call 803-788-0500, ext. 46401 (Greater Columbia area) or 800-868-2500, ext. 46401 (toll-free outside the Columbia area).