Continuation Coverage Rights Under COBRA (Including COVID‐19 Modifications)

Introduction

This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the medical plans (the ʺPlansʺ) administered by the Professional Musicians, Local 47, and Employer Health & Welfare Trust Fund (the ʺFundʺ). This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it and how this right has been modified to deal with the COVID‐19 outbreak.

The right to COBRA continuation coverage was first created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to the Participant and other members of her/his family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description (ʺSPDʺ: also posted on the Fundʹs website) or contact the Plan Administrator.

What is COBRA continuation coverage?

COBRA continuation coverage is a continuation of coverage under one of the Fundʹs Plans when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are reviewed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” Participants of the Fund, their spouses, and their dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Fundʹs COBRA Policy, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage. There is also an administrative fee that added on to the premiums charged by the Fund for administering your COBRA continuation coverage.

When is a ʺQualifying Eventʺ under COBRA?

Generally, a Participant becomes a ʺqualified beneficiaryʺ if you lose your qualification to enroll in coverage because of the following events:

• The Participantʹs amount of employment is reduced (for any reason other than your gross misconduct):

• The Participant has exhausted their ʺCarry‐Over Bankʺ (as described in the SPD), and;

• As a result, the Participant no longer qualifies for coverage under the Fundʹs rules for enrolling in group coverage.

If you’re the spouse of a currently enrolled or qualified beneficiary, you’ll also become a qualified beneficiary if you lose your coverage with the Fund because of the following qualifying events:

• The Participant dies;

• The Participantʹs amount employment is reduced (for any reason other than gross misconduct), and, as a result, the Participant loses the ability to qualify for enrollment in the Fundʹs benefit Plans;

• The Participant becomes entitled to Medicare benefits (under Part A, Part B, or both); or

• The Participant become divorced or legally separated from their spouse.

A Participantʹs dependent children will also become qualified beneficiaries if they lose coverage with the Fund because of the following qualifying events:

• The parent‐employee dies;

• The parent‐employee’s amount of employment is reduced (for any reason other than your gross misconduct), and, as a result, you lose the ability to qualify for enrollment in the Fundʹs benefit Plans ;

• The parent‐employee becomes entitled to Medicare benefits (Part A, Part B, or both);

• The parents become divorced or legally separated; or

• The child stops being eligible for coverage under the Plan as a “dependent child.”

When is COBRA continuation coverage available?

The Fund will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The Plan Administrator determines the following qualifying events for purpose of notification to the enrolled beneficiary:

• Reduction of employment;

• Failure of the Participant to qualify for enrollment at annual Open Enrollment Window (generally December of each Calendar Year);

• The Participant becoming entitled to Medicare benefits (under Part A, Part B, or both).

For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to:

PROFESSIONAL MUSICIANS, LOCAL 47 AND
EMPLOYERSʹ HEALTH & WELFARE TRUST FUND
C/O PACIFIC FEDERAL
1000 N. Central Ave. #400
Glendale, CA 91202

How is COBRA continuation coverage provided?

Once the Fundʹs Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. This means that the Fund will send each qualified beneficiary a notice about their independent right to elect COBRA continuation coverage. This notice will advise you of the plans you may enroll in, the premium costs associated with the plans and the administrative fee charged by the Fund for processing COBRA Parents may elect COBRA continuation coverage on behalf of their children.

COBRA continuation coverage generally lasts for 18 months after your initial enrollment. As discussed below, these coverage time frames may fluctuate due to the COVID‐19 outbreak. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.

Disability extension of 18‐month period of COBRA continuation coverage

If you or anyone in your family covered under the Plan is determined by Social Security to be disabled during the 18 months of COBRA coverage and you notify the Fund Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18‐month period of COBRA continuation coverage. Again, these notice and coverage periods may change due to the COVID‐19 outbreak.

Second qualifying event extension of 18‐month period of continuation coverage

If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Fund Administrator is properly and timely notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the participant dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. Again, these time frames and deadlines may fluctuate due to the COVID‐19 outbreak.

What Changes To COBRA Continuation Coverage Have Been Mad Due To COVID‐19?

Under recent guidance issued by the United States Department of Labor (ʺDOLʺ), all deadlines that relate to notice of a COBRA qualifying event and/or enrolling as a COBRA qualified beneficiary have been extended by sixty (60) days. This means that if/when you receive a notice of a COBRA qualifying event, you automatically have an additional sixty (60) days – from the date of the Notice – on top of the usual forty‐five (45) days, to enroll as a COBRA qualified beneficiary.

For example, if you were to receive a notice of a COBRA qualifying event on April 1, the usual deadline for enrolling as a COBRA qualified beneficiary would be approximately May 15th. Under the new DOL guidance, you have an additional sixty (60) days to enroll, making positive COBRA enrollment due on or before approximately July 13th.

Note that premiums are retroactive as well. Thus, if a qualified beneficiary waits the entire one hundred and five (105) days now allowed for COBRA enrollment under DOL guidance, the qualified beneficiary will be responsible for all applicable premium payments, retro‐active to initial date of COBRA coverage. Since the DOL guidance also provides for potential delays in the issuance of a COBRA premium billing statements, the premium payment necessary to maintain coverage may be significant.

The DOL guidance is in effect until the federal government issues a declaration that the ʺOutbreak Periodʺ for California has been concluded. We will amend this Notice accordingly when such a declaration is issued.

Do you have questions?

Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov.

Keep your Plan informed of address changes:

To protect your family’s rights, let the Plan Administrator know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.

Plan contact information:

PROFESSIONAL MUSICIANS, LOCAL 47 AND
EMPLOYERSʹ HEALTH & WELFARE TRUST FUND
C/O PACIFIC FEDERAL
1000 N. Central Ave. #400
Glendale, CA 91202
818‐243‐0222