Common use of Continuation of Group Coverage Under Federal Clause in Contracts

Continuation of Group Coverage Under Federal. or State Law When a Member is no longer eligible for membership under your benefits plan, that Member may be eligible to continue this group coverage as provided by the Consolidated Omnibus Budget Reconciliation Act (COBRA) or under Massachusetts state law. If this is the case, you are responsible for: (a) determining Member eligibility for continued group coverage; and (b) promptly notifying Blue Cross and Blue Shield of changes that impact a Member’s eligibility for continued group coverage. These provisions apply to employer groups with two or more employees. You must provide all employees with a notice of their continuation of coverage rights at the time they first enroll in your health benefits plan. These continuation of coverage rights are fully described in the Subscriber Certificates for your benefits plan. When a Member becomes eligible to continue group coverage as provided by COBRA or state law, you must provide all required continuation of coverage notices to the Member. You must provide notice to the employee of his or her election rights within 14 days of knowledge of a qualifying event. (The employee must provide you with notice of divorce, legal separation or the loss of a dependent child’s eligibility as described in the Subscriber Certificates for your benefits plan.) You must allow employees 60 days from the qualifying event (or the day you provide notice, whichever is later) to make their continuation of coverage election. The day they make the election is their election date. Once the qualifying event has occurred and you have informed the Member of his or her continuation of coverage rights, Blue Cross and Blue Shield requests that you terminate the Member immediately from your group, while the Member decides whether to accept or decline the continuation of coverage option. If the Member accepts the continuation of coverage within the 60-day time period, he or she has 45 days from the election date to make the first payment to you. The first payment is for the period from the date the person’s group coverage ended, through the current month. If the Member pays the premium to the paid-through date, he or she will have group coverage reinstated, retroactive to the qualifying event. Reinstatement will not be allowed if the payment is not received within the 45-day time period. Once a Member has opted for continuation of coverage and has been reinstated in your group, Blue Cross and Blue Shield will xxxx you for the Member according to your regular monthly billing cycle. It is your responsibility to monitor and receive the Member’s monthly payment.