Rights & Protections
COBRA Continuation of Coverage
In this section you’ll find information on:
- Continuation of coverage during certain absences
- How you may be able to pay for continuing coverage under the law known as “COBRA” in certain circumstances when your coverage would otherwise end
COBRA (the Consolidated Omnibus Budget Reconciliation Act) is a federal law that requires the Fund to provide you and your eligible dependents with the opportunity to continue your health coverage at your expense when your Employer-paid health coverage ends as the result of a “qualifying event.” When you purchase COBRA coverage, you can choose between medical and prescription drug coverage only (“core coverage”) or medical and prescription drug coverage plus dental and vision, which is referred to as “full coverage.” Life insurance, AD&D insurance, and the employee short-term disability income benefit (time loss benefit) are not COBRA benefits, but you may convert your life insurance coverage to an individual policy as described under “Conversion Privileges” on page 56 of the Summary Plan Description/Plan Document.
To find information on continuation of coverage during certain services and how you may be ale to pay for continuing coverage under COBRA in certain circumstances when you coverage would otherwise end, refer to “Continuation of Coverage” starting on page 9 of the Summary Plan Description/Plan Document.
Family & Medical Leave Act
Your coverage may be continued during an approved family care or medical leave of absence, as provided under applicable federal or state law.
You may be eligible for up to 12 weeks of unpaid leave of absence under the federal Family and Medical Leave Act (“FMLA”) or the California Family Rights Act (“CFRA”) to take care of family needs such as: (1) birth and care of a newborn child, newly adopted child, or a child placed for foster care; or (2) care of an ill parent, spouse, child, or your own serious health condition that makes you unable to perform your job. Generally, to be eligible for FMLA/CFRA leave you must have been employed for at least 12 months at a worksite where your employer has at least 50 employees (or a total of 50 employees within 75 miles of your worksite) and have worked at least 1,250 hours during the 12-month period immediately before the start of your leave of absence. Whether you qualify for FMLA/CFRA leave will be determined by your employer and labor agreement.
If you qualify for leave under the FMLA or CFRA, your (and your dependents’) eligibility for coverage continues throughout your leave, provided your employer continues to pay monthly contributions for your coverage (as it is required to do for those who qualify). Coverage will continue until:
- The exhaustion of your 12-week FMLA/CFRA entitlement;
- The date your employer can show that you would have been laid off and the employment relationship terminated; or
- The date you do not return to work, or you inform your participating employer that you will not return to work.
Because the Family and Medical Leave laws do not apply to all employers or all employees, you may or may not qualify for this leave. Disputes over entitlement to FMLA leave must be resolved between you, your union, and your employer.
Once you have exhausted your FMLA leave, you may be eligible for COBRA continuation coverage.
If, because of a labor dispute, you lose coverage because you have stopped working for an employer who is contributing towards the cost of your coverage under a Collective Bargaining Agreement, you may continue your coverage by exercising your COBRA right and paying the required contributions yourself.
If you were covered under the Plan and leave employment for active duty or training, your employer is required to continue to pay for your coverage for up to 31 days. If your military leave continues beyond 31 days, you may continue your coverage under the federal Uniformed Services Employment and Reemployment Rights Act (“USERRA”) by paying a monthly premium equal to 102% of the cost of your coverage. Such self-payments may be made for up to 24 months. As long as you continue making monthly payments, your USERRA coverage will end on the earlier of:
- The date the 24-month USERRA coverage period is exhausted, beginning on the date your military leave started; or
- The day after the date your military leave ends, and you have not applied for or returned to work.
You and your covered dependents must elect this coverage; it is not automatic, and the duration of the military leave combined with all of your previous periods of military leave under the same Employer must generally not exceed five years. You can elect USERRA coverage after you have informed the Administrative Office that you are taking military leave. If your USERRA leave ends, you may be able to continue benefits under COBRA Continuation Coverage. For more information on USERRA rights, contact your Employer.
No Surprises Act
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
If you are prevented from working enough hours to maintain your coverage because you are disabled, the medical, prescription drug, dental, and accidental death and dismemberment coverage provided under your Plan for you and your dependents will be extended for up to three months if you become totally and continuously disabled such that you are unable to work. The three-month extension period begins on the first day of the month following the last month for which your Employer contributed on your behalf. For this purpose, Totally Disabled means the complete inability due to disease or bodily injury to perform your regular and customary work. In no event will you be considered totally disabled if you are engaged in any gainful occupation.
Refer to “Continuation of Coverage if Totally Disabled” on page 9 of the Summary Plan Description/Plan Document.
Women’s Health & Cancer Rights Act
The Women’s Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that provides protections to patients who choose to have breast reconstruction in connection with a mastectomy.