The Consolidated Omnibus Budget Reconciliation Act of 1985 allows employees and their dependents to have a temporary extension of their Plan after leaving their group.
This notice explains COBRA plan continuation, when it may become available to you and your family, and what you need to do to obtain it.
COBRA plan continuation is an extension of your Plan when it would otherwise end because of a life event. This is also called a “qualifying event.” After a qualifying event, COBRA plan continuation must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if enrollment in your Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA plan continuation must pay for COBRA plan continuation.
COBRA-eligible events include end of employment, reduction in hours of employment, death of employee, divorce or legal separation, entitlement to Medicare, and loss of dependent child status. After one of these events, you and your dependents are then eligible to continue your Optilegra plan as an individual for 18 months. (Certain qualifying events, or a second qualifying event during the initial period of continuation, may permit a beneficiary to receive a maximum of 36 months of continuation.) Here is how that process works with Optilegra:
- Once a termination has been processed, a COBRA packet will be available for you from our website (enter through the Members page)
- This packet allows you to contract with us for the plan you had with your employer over the next 18 months (for a 2% rate increase)
- Print and mail this packet to us (must be returned to us within 60 days)
Once we receive your form, your continuation will be effective from the date of your qualifying event
When is COBRA plan continuation available?
Optilegra will offer COBRA plan continuation to qualified beneficiaries only after Optilegra has been notified that a qualifying event has occurred. The employer must notify Optilegra of the following qualifying events:
- The end of employment or reduction of hours of employment;
- Death of the employee;
- The employee’s becoming entitled to Medicare benefits (under Part A, Part B, or both).
For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing enrollment in the plan as a dependent child), you must notify Optilegra within 60 days after the qualifying event occurs.
Disability extension of 18-month period of COBRA plan continuation
If you or anyone in your family enrolled in the Plan is determined by Social Security to be disabled and you notify Optilegra in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA plan continuation, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA plan continuation and must last at least until the end of the 18-month period of COBRA plan continuation.
Second qualifying event extension of 18-month period of plan continuation
If your family experiences another qualifying event during the 18 months of COBRA plan continuation, the spouse and dependent children in your family can get up to 18 additional months of COBRA plan continuation, for a maximum of 36 months, if Optilegra is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA plan continuation if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to be removed from the Plan had the first qualifying event not occurred.
Are there other vision plan options besides COBRA Plan Continuation?
Yes. Instead of enrolling in COBRA plan continuation, there may be other vision plan options for you and your family through the Health Insurance Marketplace, Medicaid, or other group vision plan options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA plan continuation.
Keep Optilegra informed of address changes
To protect your family’s rights, let Optilegra know about any changes in the addresses of family members. You should also keep a copy, for your records, of any notices you send to Optilegra.