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Frequently Asked Questions (FAQs)
COBRAProvide a common example of a situation, which might occur, causing me to lose my eligibility for benefits under the Trust.How long are my COBRA benefits available? I am an employee and make COBRA payments. Are my dependents covered for Plan benefits? If I continue coverage under COBRA, can I change my choice of medical Plans? What if I shift from active coverage to retiree coverage? How is the COBRA self-payment calculated? How often do I make a COBRA self-payment? What is "basic" coverage? How much will the COBRA self-payment cost? When will I again be eligible for the COBRA self-payment of $50.00 per month? Will the Trustees always offer the COBRA self-payment of $50.00 for the first three months? Who can pay the cost of my COBRA continuation coverage? When would my medical coverage start, if I wasn't covered under the Active Plan when I begin receiving my pension and am eligible for the RHP? When do the rates for RHP coverage change? When will I be notified? How do I contact Kaiser, PacifiCare, or Anthem Blue Cross if I want to purchase an individual policy? What happens to my medical coverage if I move/retire out of state (leave California)? What is the maximum bank of hours and how long can a participant remain with Active coverage? Explain how I run out my Active medical coverage as a Retiree and then begin RHP participation? QUESTION: Provide a common example of a situation, which might occur, causing me to lose my eligibility for benefits under the Trust. ANSWER: Your eligibility terminates because you are no longer working the required hours to maintain
eligibility under the Plan. This event would qualify you to continue coverage under COBRA by
making a self-payment.
QUESTION: How long are my COBRA benefits available? ANSWER: A qualified participant is entitled to 18 months, or up to 36 months under Cal-COBRA if enrolled in Kaiser or PacifiCare, of continued coverage if the qualifying event is
termination of employment or a reduction of employment hours. This may be extended 11 months
if you are considered disabled under the Social Security Act. Any other qualifying event increases
the available coverage term for qualified beneficiaries to 36 months (maximum). Refer to the
"Qualifying Events" section below.
QUESTION: I am an employee and make COBRA payments. Are my dependents covered for Plan benefits? ANSWER: Yes, provided they are eligible dependents, as defined by the Plan. Refer to section; "Eligibility
and General Plan Provisions" subtitle "Eligible Dependents" for a complete description of eligible
dependents. Also, children born or adopted during the period of continuation coverage are
considered dependents, the same as those of active eligible employees. (However, this applies only
if the covered employee elects COBRA coverage during the election period and enrolls the new
child upon birth or adoption.)
QUESTION: If I continue coverage under COBRA, can I change my choice of medical Plans? ANSWER: Yes, you can change your choice of medical Plans (from among the plans being offered) during
the annual open enrollment period. Refer to section, "Rolling Twelve-Month Open Enrollment
Procedures" for details on the open enrollment.
QUESTION: What if I shift from active coverage to retiree coverage? ANSWER: A shift from active to retiree coverage is an open enrollment right, and you have the same rights
that an active employee receiving coverage through employment is entitled to. On this basis,
COBRA serves as a bridge to retiree coverage.
QUESTION: How is the COBRA self-payment calculated? ANSWER: Under the COBRA law, the Trustees are permitted to base the self-payment on a formula, which is
the Plan cost plus 2% for administration. For example, if you are covered under either Kaiser or
PacifiCare, your monthly COBRA payment for continuation coverage is based on the applicable
HMO premium cost, and prescription drug cost, plus 2% for administration. Note, for a disabled
qualified participant, the premium for months 19 through 29 may be no more than 150% of the
applicable non-COBRA premium.
QUESTION: How often do I make a COBRA self-payment? ANSWER: Payments must be paid monthly.
QUESTION: What is "basic" coverage? ANSWER: Basic coverage includes medical (either Kaiser, PacifiCare or Self-Funded Indemnity Plan). These
medical plans include the prescription drug plan benefits are as described in this SPD.
QUESTION: How much will the COBRA self-payment cost? ANSWER: The Board of Trustees have instituted a temporary pilot program, whereby the Health Fund will
subsidize a portion of your COBRA payments for the first three (3) consecutive months of
continuation coverage. Certain participants and beneficiaries are not eligible for the subsidized COBRA. Refer to Amendments 15b and 26 for more information. The self-payment will be
$50.00 per month for the first three consecutive months of continuation of your "Basic Coverage"
of hospital/medical and prescription drug benefits. Benefits for dental and vision can be added for
an additional cost. Thereafter, on the fourth month of continuation coverage, the self-payment will
increase to the full amount allowed under COBRA. Life Insurance benefits are not continued by
COBRA
QUESTION: When will I again be eligible for the COBRA self-payment of $50.00 per month? ANSWER: After you have reestablished your Hours Bank Reserve to a maximum of 600 hours. The Hours
Bank Reserve is explained under the section, "Eligibility & General Plan Provisions" subtitle
"Continuation of Eligibility - Hours Bank Reserve".
QUESTION: Will the Trustees always offer the COBRA self-payment of $50.00 for the first three months? ANSWER: Not necessarily. The Trust subsidy of COBRA self-payments is not guaranteed, and may be
discontinued or reduced at any time with 30 days notice to participants.
QUESTION: Who can pay the cost of my COBRA continuation coverage? ANSWER: Of course, you can pay the monthly premium. However, it is also permitted for a third party to pay
the premium, such as a hospital or a new employer.
QUESTION: When would my medical coverage start, if I wasn't covered under the Active Plan when I begin receiving my pension and am eligible for the RHP? ANSWER: Upon the Fund Office's receipt of the required Retiree Enrollment materials, you may be enrolled the 1st of the following month.
QUESTION: When do the rates for RHP coverage change? When will I be notified? ANSWER: Yearly in October. You will be notified in August.
QUESTION: How do I contact Kaiser, PacifiCare, or Anthem Blue Cross if I want to purchase an individual policy? ANSWER: See the links page for links to each of the carriers, then contact them directly.
QUESTION: What happens to my medical coverage if I move/retire out of state (leave California)? ANSWER: If you move out of the State of California, you can participate in Premium Reimbursement. If you are enrolled in Medicare Parts A & B, you may enroll in Medicare Supplement.
QUESTION: What is the maximum bank of hours and how long can a participant remain with Active coverage? ANSWER: A.600 hours; providing a maximum of 6 months coverage under the Active plan.
QUESTION: Explain how I run out my Active medical coverage as a Retiree and then begin RHP participation? ANSWER: The Fund Office will take monthly health hour deductions from your reserve bank. Prior to your bank hours running out, you will be notified of your RHP status.
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