Under certain circumstances employees and/or their dependents that have lost group benefits (medical and/or dental insurance) may elect to continue the coverage they had in one of SAO's group health plans. Monthly premiums are remitted on a direct pay basis to SAO. The premium charged will equal 102% of the total monthly premium in effect at the time of the qualifying event. This premium is subject to change annually.
Employees and Dependents Eligible for Continuation of Coverage
(1) Employees who terminate employment (except in the case of dismissal for gross misconduct), change to an intermittent tour of duty or a tour of duty of less than 40 hours per pay period, or otherwise lose group coverage may temporarily continue coverage for up to 18 months. This extension includes coverage for the employee's dependents that were enrolled at the time of the qualifying event.
(2) Spouses and dependents of employees who lose coverage because of divorce, entitlement to Medicare benefits for the covered employee, or death of a covered employee may continue coverage for up to 36 months.
(3) Children of employees who lose coverage because of loss of dependent status may continue coverage for up to 36 months.
(4) Please note: SI policy allows employees, who have been deemed totally disabled according to the Smithsonian Institution's disability plan. to continue coverage for the entire period of disability. The employee will be required to pay only the employee portion of the premium during the period of disability.
How to Exercise Your Rights
You have 60 days from the qualifying event to elect temporary continuation of coverage. Such election is accomplished by notifying the Department of Human Resources, completing an election form, and completing an application (if necessary). If you do not exercise your rights within the allowed time period or fail to make the required premium payment, you will forfeit your right to continue coverage.
Loss of Coverage
Your coverage ceases upon:
- your failure to make a timely premium payment;
- the date you become covered under any other group health plan (which does not include a pre-existing conditions clause that applies to you);
- the date you reach the end of your maximum eligibility period;
- the date on which the Smithsonian Astrophysical Observatory ceases to maintain any group health plan (including successor plans); or
- the date you become covered for Medicare benefits.