City Of New York Employee Benefits Program Continuation Of Coverage Application (Page 6 of 8) in pdf

The Consolidated Omnibus Budget Reconciliation Act (Public Law 99-2721, Title X), also known as

COBRA, was enacted April 7, 1986. This law requires that, effective July 1, 1987, in addition to offering

normal conversion opportunities, the City and the union welfare funds must offer employees and their

families the opportunity for a temporary extension of group health and welfare fund coverage (called

“continuation of coverage”) at 102% of the group rates, in certain situations in which benefits under either

City basic or the applicable welfare fund would be reduced or terminated. This notice is intended to inform

you of your rights and obligations under the continuation coverage provisions of this law as well as your

normal conversion option.

As a result of collective bargaining agreements, Medicare-eligible enrollees and/or their Medicare-

eligible dependents will be offered continuation benefits similar to COBRA if a COBRA event should occur.

(See Medicare-Eligible Section.)

Employees

All City group health benefits including the optional benefits riders are available under COBRA

continuation coverage. Welfare fund benefits eligible for continuation under COBRA are dental, vision,

prescription drugs and other related medical benefits. Welfare funds offer core benefits (prescription drugs

and major medical plans) and non-core benefits (dental and vision) which may be purchased separately or

combined with City core benefits.

If you are a non-Medicare-eligible employee covered by the City program, you have the right, in

certain situations, to continue benefits if you lose your coverage because of a reduction in your hours of

employment; or upon the termination of your employment (for reasons other than gross misconduct on your

part); or if you take an unpaid leave of absence. If you are Medicare-eligible, you may be entitled to

continuation of coverage as is described in the Medicare-eligible section below.

Retirees

You and your dependents are eligible to receive City-paid health care coverage if you have, at the

time of retirement:

Ten (10) years of credited service as a member of a retirement or pension system maintained by

the City (if you were an employee of the City on or before December 27, 2001, then at the time of your

retirement you must have at least five (5) years of credited service as a member of a retirement or pension

system maintained by the City). This requirement does not apply if you retire because of accidental disability;

and

You have been employed by the City immediately prior to retirement as a member of

such

system, and have worked regularly for at least 20 hours per week; and

You receive a pension check from a retirement system maintained by the City.

If you do not meet these eligibility requirements, you and your dependents (if not Medicare-eligible)

may continue under COBRA the benefits you received as an active employee, for a period of 18 months at

102% of the City’s cost. If your welfare fund benefits are reduced at retirement, you are eligible to continue

those benefits that were reduced under the welfare fund as a COBRA enrollee for a period of 18 months at

102% of the cost to the union welfare fund. You should contact your union welfare fund for the premium

amounts and benefits available.

Spouse/Domestic Partners and Dependents

If you are the non-Medicare-eligible spouse/domestic partner of an eligible employee or a retiree,

you have the right to continue coverage under any of the available NYC health benefits plans and the

applicable welfare funds if your health insurance or welfare fund benefits are reduced or terminated for any

of the following reasons:

The death of your spouse/domestic partner;

City Of New York Employee Benefits Program Continuation Of Coverage Application Page 6

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