COBRA Information

If you are the spouse of an employee of the City of Newton and are covered by one of our health plans, you may have the right to elect this health plan continuation coverage for yourself if you lose your group coverage because of any of the following reasons;

1. A termination of your spouse’s employment (for reasons other than gross misconduct) or reduction of your spouse’s hours of employment with the City of Newton to less than 20.
2. The death of your spouse – if your spouse is not vested in the City’s Retirement Plan.
3. If you are divorced and you or your spouse remarries.

If you are the dependent child of an employee of the City of Newton covered by one of our health plans, you may have the right to elect continuation coverage for yourself if you lose group coverage under one of our health plans for any of the following reasons;

1. A termination of the employee’s employment (for reasons other than gross misconduct) or reduction in the employee’s hours of employment with the City of Newton to less than 20;
2. The death of the employee if the employee is not vested in the City’s Retirement Plan;
3. Employee divorces and remarries;
4. The employee of the City of Newton becomes entitled to Medicare; or
5. You cease to be a “dependent child” under one of our health plans.

Under the law, the employee, spouse or other family member has the responsibility to notify the City of Newton Human Resources Department, of a divorced person losing coverage because their spouse remarries, or a child losing dependent status under one of our health plans.  This notification must be made within 60 days from whichever date is later, the date of the event or the date on which health plan coverage would be lost under the terms of the insurance contract because of the event.  All such notices must be in writing.  If this notification is not completed according to the above procedures and within the required 60-day notification period, then rights to continuation coverage will be forfeited.

Once the City of Newton Human Resources Department is notified that a qualifying event has occurred, they will in turn notify covered individuals (also known as qualified beneficiaries) of their rights to elect continuation coverage.  Each qualified beneficiary has independent COBRA election rights and will have 60 days to elect continuation coverage.  The 60 day election window is measured from the later of the date health plan coverage is lost due to the event or from the date of COBRA notification. 

This is the maximum period allowed to elect COBRA, as the plan does not provide an extension of the election period beyond what is required by law.  If a qualified beneficiary does not elect continuation coverage within this election period, then rights to continue health insurance will end.

If a qualified beneficiary elects continuation coverage, they will be required to pay the entire cost for the health insurance, plus a 2% administrative fee.  The City of Newton is required to provide the qualified beneficiary with coverage that is identical to the coverage provided under the plan to similarly situated employees and/or covered dependents.  Should coverage change or be modified for similarly situated active employees, then the change and/or modification will be made to your coverage as well.

If the event causing the loss of coverage is a termination of employment (other than for reasons of gross misconduct) or a reduction in work hours to less than 20 per week, then each qualified beneficiary will have the opportunity to continue coverage for 18 months from the date of the qualifying event.

Social Security Disability – The 18 months of continuation coverage can be extended for an additional 11 months of coverage to a maximum of 29 months, for all qualified beneficiaries if the Social Security Administration determines a qualified beneficiary was disabled according to Title II or XVI of the Social Security Act on the date of the qualifying event or at any time during the first 60 days of continuation coverage.  It is the qualified beneficiary’s responsibility to obtain this disability determination from the Social Security Administration and provide a copy of the determination to the City of Newton Human Resources, within 60 days after the date of determination and before the original 18 months expire.  It is also the qualified beneficiary’s responsibility to notify the City of Newton Human Resources Department, within 30 days when and if a final determination is made that they are no longer disabled.

Secondary Events – Another extension of the 18-month continuation period can occur, if during the 18 months of continuation coverage, a second event takes place (divorce, legal separation, death, Medicare entitlement, or a dependent child ceasing to be a dependent).  If a second event occurs, then the original 18 months of continuation coverage can be extended to 3 months from the date of the original qualifying event occurs, it is the qualified beneficiary’s responsibility to notify the City of Newton Human Resources Department, in writing within 60 days of the second event and within the original 18 month COBRA timelines.  In no event, however, will continuation coverage last beyond three years from the date of the event that originally made the qualified beneficiary eligible for continuation coverage.

If the original event causing the loss of coverage was the death of the employee, loss of coverage for a divorces spouse because the employee remarries, Medicare entitlement of a dependent child ceasing to be a dependent under one of our health plans, then each qualified beneficiary will have the opportunity to continue coverage for 36 months from the date of the qualifying event.

A qualified beneficiary does not have to show that he/she is insurable to elect continuation coverage, however, they must have been actually covered by the plan to be eligible for COBRA continuation coverage.  An exception to this rule is if while on continuation coverage a baby is born to or adopted by a qualified beneficiary.  If this occurs, the new born or adopted child can be added to the planned will gain the rights of all other qualified beneficiaries.  The City of Newton Human Resources Office, reserves the right to verify COBRA eligibility status and terminate continuation coverage retroactively if you are determined to be ineligible for if there has been a material misrepresentation of the facts.

A qualified beneficiary will have to pay all of the applicable premium plus a 2% administrative charge for continuation coverage.  These premiums will be adjusted in the future if the applicable premium amount changes.  In addition, if continuation coverage is extended from 18 months to 29 months due to a Social Security disability, the City of Newton can and will charge 150% of the applicable premium during the extended coverage period.  Qualified beneficiaries will be allowed to pay on a monthly basis.  In addition, there will be a maximum grace period of (30) days for the regularly scheduled monthly premiums.  At the end of the 18 months or three years of continuation coverage, a qualified beneficiary must be allowed to enroll in a non-group health plan provided under one of our health plans if a conversion plan is available at that time.

To insure that all covered individuals receive information properly and efficiently, it is important that you notify the City of Newton Human Resources Department, at the address listed above, of any address change as soon as possible.  Failure on your part to do so may result in delayed COBRA notifications or a loss of continuation coverage options.

The law provides COBRA continuation coverage will end prior to the maximum continuation period for any of the following reasons:

1. The City of Newton ceases to provide any group health plan to its employees;
2. Any required premium for continuation coverage is not paid in a timely manner;
3. A qualified beneficiary becomes covered under another group health plan that does not contain any exclusion or limitation with respect to any pre-existing condition of such beneficiary other than such an exclusion or limitation which does not apply to or is satisfied by such beneficiary by reason of the Health Insurance Portability and Accountability Act of 1996*;
4. A qualified beneficiary becomes entitled to Medicare, unless the Medicare entitlement is due to End Stage Renal Disease.
5. A qualified beneficiary extended continuation coverage to 29 months due to a Social Security disability and a final determination has been made that the qualified beneficiary is no longer disabled.
6. A qualified beneficiary notifies the City of Newton Human Resources Department, that they wish to cancel COBRA continuation coverage.

• Additional information on how the Health Insurance Portability and Accountability Act coordinates with COBRA will be provided to you at the time of a COBRA qualifying event.

If any covered individual does not understand any part of this summary notice or has questions regarding the information or your obligations, please contact the City of Newton Human Resources Department at 1000 Commonwealth Avenue, Newton Centre, MA 02459 or at 617‑796‑1260.