Under certain circumstances employees and/or their dependents that have lost group benefits under the Smithsonian Institution may elect to continue such coverage under provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) as amended. Monthly premiums are remitted on a direct pay basis.
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 due to a change in their benefits eligibility status 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 life 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. To be eligible, you must notify the SAO Benefits Office of these changes within 31 days of the qualifying life event.
(3) Children of employees who lose coverage because of loss of dependent status may continue coverage for up to 36 months. Note that children of employees may be covered until age 26, regardless of student status.
(4) 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. If employees are not deemed disbled under the group disability plan, but are eligible to receive Social Security payments due to disability, the employee may continue coverage under COBRA provisions for up to 29 months. You must contact the SAO Benefits Office for additional details.
How to Exercise Your Rights
The participant will be responsible for paying the COBRA premium timely. Unless deemed disabled according to the Smithsonian Institution's disability plan, the premium charged will equal 102% of the total monthly premium in effect at the time of the qualifying life event. This premium is subject to change annually. You have 60 days from the qualifying life event to elect temporary continuation of coverage. Such election is accomplished by notifying the SAO Benefits Office of the qualifying life event within the time frames specified. You will have 60 days to elect continuation of coverage upon receiving the COBRA Notice and payment instructions. 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 continuation coverage ceases upon:
- your failure to make a timely premium payment (within 30 days);
- the date you or your qualified beneficiary obtain coverage under certain other group health plans;
- the date you or your qualified beneficiary become entitled to Medicare benefits;
- the date you reach the end of your maximum eligibility period; or
- the date on which the Smithsonian ceases to maintain any group health plan (including successor plans).