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COBRA

Continuing your health care coverage Through COBRA

Under a federal law called the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your spouse and dependent children may elect to pay for continued health care coverage if certain qualifying events occur.

Health care coverage includes your medical Beverage and Brewery Local 67 Health and Welfare Plan, prescription drug; dental and vision care plans. Your COBRA rights are described in this section.

Continued Coverage in Qualifying Events
You may purchase continued health care coverage for you and your dependents for up to 18 months if you lose coverage due to:

• Insufficient hours worked during the eligibility determination period
• Your employment ends for any reason other than your gross misconduct or:
• Retirement. Individuals who are entitled to (enrolled in) Medicare are not eligible for continued health care coverage.

In Case of Disability
You (or your covered dependents) may be eligible for a total of 29 months of continued coverage if you (or your dependent) receive a determination from your physician stating that you (or your dependents) were disabled at the time your employment ended. You must notify the Fund in writing within the initial 18?month coverage period. Your spoken notice is not binding until confirmed in writing.

Continued coverage for dependents
Your covered dependents may continue their health care coverage for up to 36 months if they lose coverage as a result of your:

• Death (36 months from the end of the one (1) year extension)
• Divorce or legal separation (36 months from the qualifying even date)
• Entitlement to Medicare (36 months from the qualifying event date); or
• Dependent child ceasing to be a dependent as defined by the plan (36 months from dependents 19th or 23rd birth date)

If you become covered by Medicare while you are an active member and you later experience a qualifying event (i.e., terminate your employment), you are not eligible for COBRA continuation of coverage. However, your dependents may be eligible for continued coverage until the later of 36 months from the date you first become covered by Medicare or the maximum coverage period for the qualifying event (18 months in the case of loss of eligibility for benefits).

Multiple Qualifying Events
Should your dependents experience more than one qualifying event, they may be eligible for an additional period of coverage, not to exceed a total of 36 months from the date of the first qualifying event.

Applying for COBRA continuation of coverage
Both you and the Fund have responsibilities if qualifying events occur that make you or your covered dependents eligible for continued coverage. You or your covered dependents must notify the Fund within 60 days of the date of the qualifying event or the date coverage ceased under the plan, whichever is later, when one of these events occurs:

• You become divorced or legally separated; or
• Your dependent child is no longer considered an eligible dependent as defined by the plan.

The fund will notify you or your covered dependents of the right to elect continued coverage should the following events occur:

• Loss of eligibility for benefits
• Retirement
• Your entitlement to Medicare, or
• Your death

Election Period
You and your covered dependents will have a 60 day period in which to elect continued coverage, beginning on the later of

• The date your coverage terminates by reason of the qualifying event; or
• The date you or your covered dependents were notified of the right to elect continued coverage.

Type of Coverage
If you elect to exercise your right to continue medical benefits under COBRA, you may choose to continue:

• Dental coverage

Cost of Continued Coverage
You and your covered dependents will be required to pay 100% of the full cost of your continued coverage.

You will be asked to pay for coverage in monthly installments. Your first payment will be retroactive to the date of your qualifying event (or the expiration of the Beverage and Brewery Local 67 Health and Welfare Plan) and will be due no later than 45 days after the date you elected continued coverage. Subsequent payments will be due on the first of each month, with a 10 day grace period. If the cost or the benefits change in the future for active employees, these changes will also affect continued coverage under COBRA. You will be notified in advance of any changes in the cost of benefits.

Termination of Continued Coverage
Your right to purchase continued coverage may end before the expiration of the maximum coverage period if:

• You or your covered dependent(s) fail to make the required payment on time
• The Fund terminates health care plans for all members
• You or your covered dependent(s) first becomes covered under another group health (as an employee or otherwise) that does not contain a preexisting condition limitation with respect to you or your covered dependent(s)

Please note: Coverage under COBRA will be provided as required by law. If the law changes, your rights will also change.

Important Notice: This website provides only a brief explanation of the Health and Welfare Plan under the Beverage and Brewery Local 67 Health and Welfare Trust Fund. It is not a summary plan description. If there are any inconsistencies between this explanation and the Plan document, the Plan document shall control. Also, please refer to the Summary Plan Description for additional information about the benefits available and procedures of the Beverage and Brewery Local 67 Health and Welfare Trust Fund or contact the Welfare Fund Office.

Copyright 2007 Teamsters Local 67. All Rights Reserved
2120 Bladensburg Rd., NE
 Washington, DC 20018