| (8) Continuation of coverage for a spouse who is divorced
from a member and/or the spouse's dependent child/children. The divorced
spouse and/or the spouse's dependent child/children of an employee/retiree
who, in accordance with §81.5(j)(4) of this chapter, elect to
continue coverage may do so by submitting the required election notification
and enrollment forms to ERS. The enrollment form, including all insurance
required contributions due for the election/enrollment period, must
be postmarked or received by ERS on or before the date indicated on
the continuation of coverage enrollment form. Continuing coverage
will begin on the first day of the month following the month in which
the divorce decree is signed, provided all insurance required contributions
due for the month in which the divorce decree is signed and for the
election/enrollment period have been paid in full.
(9) Continuation of coverage for a dependent child
who has attained 26 years of age. A 26-year-old dependent child (not
provided for by §81.5(c) of this chapter) of a member who, in
accordance with §81.5(j)(5) of this chapter, elects to continue
coverage may do so by submitting the required election notification
and enrollment forms to ERS. The enrollment form, including all insurance
required contributions due for the election/enrollment period, must
be postmarked or received by ERS on or before the date indicated on
the continuation of coverage enrollment form. Continuing coverage
will begin on the first day of the month following the month in which
the dependent child of the member attains 26 years of age, provided
all insurance required contributions due for the month in which the
dependent child attained age 26 and for the election/enrollment period
have been paid in full.
(10) Extension of continuation of coverage for certain
dependents of former employees who are continuing coverage under the
provisions of paragraph (6) of this subsection.
(A) The surviving dependent of a deceased former employee,
who, in accordance with §81.5(j)(6)(A) of this chapter, elects
to extend continuation coverage may do so by submitting the required
election notification and enrollment forms to ERS. The enrollment
form, including all insurance required contributions due for the election/enrollment
period, must be postmarked or received by ERS on or before the date
indicated on the continuation enrollment form. The election/enrollment
period begins on the first day of the month following the month in
which the former employee died.
(B) A spouse who is divorced from a former employee
and/or the divorced spouse's dependent child/children, who, in accordance
with §81.5(j)(6)(B) of this chapter, elects to extend continuation
coverage may do so by submitting the required election notification
and enrollment forms to ERS. The enrollment form, including all insurance
required contributions due for the election/enrollment period, must
be postmarked or received by ERS on or before the date indicated on
the continuation enrollment form. The election/enrollment period begins
on the first day of the month following the month in which the divorce
decree was signed.
(C) A dependent child who has attained 26 years of
age, who, in accordance with §81.5(j)(6)(C) of this chapter,
elects to extend continuation coverage may do so by submitting the
required election notification and enrollment forms to ERS. The enrollment
form, including all insurance required contributions due for the election/enrollment
period, must be postmarked or received by ERS on or before the date
indicated on the continuation enrollment form. The election/enrollment
period begins on the first day of the month following the month in
which the dependent child attained age 26.
(11) Continuation coverage defined. Continuation coverage
as provided for in paragraphs (6) - (10) of this subsection means
the continuation of only GBP health, dental and vision coverage which
meets the following requirements.
(A) Type of benefit coverage. The coverage shall consist
of only the GBP health, dental and vision coverage, which, as of the
time the coverage is being provided, are identical to the GBP health,
dental and vision coverage provided for a similarly situated person
for whom a cessation of coverage event has not occurred.
(B) Period of coverage. The coverage shall extend for
at least the period beginning on the first day of the month following
the date of the cessation of coverage event and ending not earlier
than the earliest of the following:
(i) in the case of loss of coverage due to termination
of an employee's employment for other than gross misconduct, reduction
in work hours, or end of maximum period of LWOP, the last day of the
18th calendar month of the continuation period;
(ii) in the case of loss of coverage due to termination
of an employee's employment for other than gross misconduct, reduction
in work hours, or end of maximum period of LWOP, if the employee,
spouse, or dependent child has been certified by the Social Security
Administration as being disabled as provided in §81.5(j)(3) of
this chapter, up to the last day of the 29th calendar month of the
continuation period;
(iii) in any case other than loss of coverage due to
termination of an employee's employment for other than gross misconduct,
reduction in work hours, or end of maximum period of LWOP, the last
day of the 36th calendar month of the continuation period;
(iv) the date on which the employer ceases to provide
any group health plan to any employee/retiree;
(v) the date on which coverage ceases under the plan
due to failure to make timely payment of any insurance required contribution
as provided in subsection (h) of this section;
(vi) the date on which the participant, after the date
of election, becomes covered under any other group health plan under
which the participant is not subject to a preexisting conditions limitation
or exclusion; or
(vii) the date on which the participant, after the
date of election, becomes entitled to benefits under the Social Security
Act, Title XVIII.
(C) Insurance required contribution costs. The insurance
required contribution for a participant during the continuation coverage
period will be 102% of the employee's/retiree's GBP health, dental
and vision coverage rate and is payable as provided in subsection
(h) of this section.
(i) The insurance required contribution for a participant
eligible for 36 months of coverage will be 102% of the employee's/retiree's
GBP health, dental and vision coverage rate and is payable as provided
in subsection (h)(1)(A) of this section.
(ii) The insurance required contribution for a participant
eligible for 29 months of coverage will increase to 150% of the employee's/retiree's
GBP health, dental and vision coverage rate for the 19th through 29th
months of coverage and is payable as provided in subsection (h)(1)(A)
of this section.
(D) No requirement of insurability. No evidence of
insurability is required for a participant who elects to continue
GBP health coverage under the provisions of §81.5(j)(1) - (6)
of this chapter.
(E) Conversion option. An option to enroll under the
conversion plan available to employees/retirees is also available
to a participant who continues GBP coverage for the maximum period
as provided in subparagraph (B)(i) - (iii) of this paragraph. The
conversion notice will be provided to a participant during the 180-day
period immediately preceding the end of the continuation period.
(h) Payment of Insurance Required Contributions.
(1) A member whose monthly cost of coverage is greater
than the combined amount contributed by the state or employer for
the member's coverage must pay a monthly contribution in an amount
that exceeds the combined monthly contributions of the state or the
employer. A member shall pay his/her monthly insurance required contributions
through deductions from monthly compensation or annuity payments or
by direct payment, as provided in this paragraph.
(A) A member who is not receiving a monthly compensation
or an annuity payment, or is receiving a monthly compensation or annuity
payment that is less than the member's monthly insurance required
contribution, shall pay his/her monthly insurance required contribution
under this subparagraph.
(i) An employee whose monthly compensation is less
than the employee's monthly insurance required contribution shall
pay his/her monthly insurance required contribution through his/her
employer. A non-salaried board member of an employer shall pay his/her
monthly insurance required contributions through the employer for
which he/she sits as a board member.
(ii) A retiree whose monthly annuity payment is less
than the retiree's monthly insurance required contribution shall pay
his/her monthly insurance required contributions directly to ERS.
Cont'd... |
