The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) requires that a group health plan must offer each qualified person who would otherwise lose coverage, the opportunity to elect continuation of the same coverage he/she had while an active employee or dependent. The following information discusses COBRA’s requirements.

Who is a qualified person?

The following individuals are qualified for coverage if they were covered under the plan at the time of one of the following qualifying events:

An employee and his/her dependents who would lose coverage due to reduction in scheduled work hours or termination of employment (including retirement, layoff and strike) for reasons other than gross misconduct.
An employee’s former spouse/partner (and/or children) who would lose coverage due to divorce or legal separation.
An employee’s surviving spouse/partner (and/or children) who would lose coverage due to an employee’s death.
An employee’s spouse/partner (and/or children) who would lose coverage due to an employee’s entitlement to Medicare.
An employee’s child who would lose coverage due to no longer meeting the definition of dependent under the plan (i.e. attainment of maximum age). A full time student, who meets the age requirements set by the plan and is certified by the carrier, can disregard this notice.

Please note: With the exception of number 1 above, it is possible that you as the employee would need to notify the Benefits Department of such a change in family status. This would require you to fill out necessary paperwork to make a change. Please contact the Benefits Department at (412) 624-8160 for details and deadlines.

How long can I continue?

The following are the maximum continuation periods for the qualifying events noted above:

For individuals who lose coverage due to termination of employment, retirement, layoff, strike or reduction in work hours, the maximum continuation period is 18 months from the qualifying event date.

Exception: Individuals who were disabled prior to or within the first 60 days of COBRA coverage may be eligible to continue for a maximum of 29 months (contact COBRA directly about Disability Extension)

For qualified dependents who would otherwise lose coverage due to divorce, legal separation, employee’s death, loss of dependent status or employee’s loss of group coverage due to Medicare entitlement, the maximum continuation is 36 months from the qualifying event date.

How do I elect COBRA coverage?

In order to continue coverage for yourself and/or your qualified dependents, including spouse/partner, you must complete a continuation election form (which you will receive from Highmark Services-COBRA, not the University of Pittsburgh) within 60 days of the date of the notice or 60 days from the date of termination of coverage, whichever is later. If you mail your election form after this deadline, continuation will be denied.

Your coverage will remain with the same insurance carriers. Highmark Services Company, nor the University of Pittsburgh processes claims for COBRA subscribers. Questions regarding claims should be directed to your insurance carrier.

COBRA rates are as follows:

MEDICAL

UPMC HEALTH PLAN FOR THE UNIVERSITY OF PITTSBURGH

	Preferred Provider Organization (PPO)
Individual	$229.77
Parent/Child	$446.69
Parent/Children	$487.31
Two Adults	$446.69
Family	$487.31

VISION

DAVIS VISION MANAGED CARE VISION PLAN

	Davis Vision
Individual	$4.20
Parent/Child	$8.43
Parent/Children	$10.10
Two Adults	$8.43
Family	$10.10

DENTAL

UNITED CONCORDIA

	ConcordiaPLUS Basic	ConcordiaPLUS Premier
Individual	$10.12	$12.58
Parent/Child	$19.56	$25.74
Parent/Children	$28.42	$38.14
Two Adults	$19.56	$25.74
Family	$28.42	$38.14

NOTE: A two percent administrative charge is applied to each premium rate.

FURTHER INFORMATION:
For questions about billing cycles and payment due dates, please contact the COBRA administrator directly at 1-800-457-3397.