Welfare Summary Plan Description

14.5 HOW TO ELECT COBRA CONTINUATION COVERAGE

In order to preserve your rights under COBRA, you must meet certain notification, election and payment deadline requirements.

Once the Administrative Office is notified of a Qualifying Event, it will send you information concerning your continuation options, including the necessary COBRA election forms. It is your responsibility to inform the Administrative Office of a death, divorce or of a child losing eligible Dependent status under the Plan. If the Administrative Office is not notified within 60 days of a death or divorce or of a child losing eligible Dependent status, you and your Dependents will lose the right to elect COBRA. You must elect COBRA to be effective the day following your last day of regular coverage under the Plan. So there can be no gap in Plan coverage.

You will have 60 days from the later of the date of the loss of coverage due to the Qualifying Event or the date the COBRA notice was mailed to you in which to send your COBRA election to the Administrative Office. You or your Spouse may make the election for all Qualified Beneficiaries in your family. If you do not make your election within this 60-day period, you will forfeit all rights to COBRA.

Your Dependents will be given the opportunity to elect coverage independently from you, within this same 60-day period, if they were covered under the Plan at the time of the Qualifying Event. Qualified Beneficiaries may elect COBRA even if they are covered by another group health plan or Medicare at the time of the Qualifying Event.

THE ADMINISTRATIVE OFFICE WILL NOTIFY YOU OF THE COST OF COBRA WHEN IT NOTIFIES YOU OF YOUR RIGHT TO THIS COVERAGE. TO REINSTATE YOUR PLAN COVERAGE, YOU MUST SUBMIT YOUR FIRST PAYMENT WITHIN 45 DAYS OF THE DATE YOU MAIL YOUR ELECTION FORM TO THE ADMINISTRATIVE OFFICE, OR YOUR PLAN COVERAGE WILL REMAIN CANCELLED. IF YOU WAIT UNTIL THE END OF THE ELECTION PERIOD, PAYMENT FOR THE FIRST OF EACH MONTH PASSED SINCE THE DATE COVERAGE TERMINATED MUST BE INCLUDED WITH THE FIRST PAYMENT. THE ADMINISTRATIVE OFFICE MUST RECEIVE YOUR CHECK OR MONEY ORDER ON OR BEFORE THE FIRST DAY OF EACH MONTH FOR WHICH COVERAGE IS ELECTED. YOU HAVE A 30-DAY GRACE PERIOD TO SEND IN YOUR COBRA PAYMENT FROM THIS DUE DATE.