Legal Notices

A Qualified Medical Child Support Order (QMSCO) is a court order providing for child support, alimony or marital property rights to a spouse, former spouse, child or other dependent, according to a state domestic relations law. If a court of law issues a QMCSO, benefits may be payable to someone other than you. The Plan Administrator is responsible for determining whether or not the order is qualified and notifying you of the status. Please contact the Benefits Department if this applies to you.

All of our medical plans provide benefits for mastectomy related services in a manner determined in consultation with the attending physician and the Covered Person. For each covered person who has had a mastectomy as a result of breast cancer, the plan will cover (1) all stages of reconstruction of the breast on which the mastectomy has been performed; (2) surgery and reconstruction of the unaffected breast to produce a symmetrical appearance; (3) prostheses and physical complications of all stages of mastectomy, including lymph edema.

Group health plans and health insurance companies generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours, following a vaginal delivery, or less than 96 hours following a cesarean section. However, federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours, as applicable). In any case, plans and issuers may not, under federal law, require that a provider obtain authorization fromthe plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours).

The Christian Brothers Medical Plan offers a maximum 18-month extension of benefits for qualified participants. This extension of benefits must be available to all qualified participants, without discrimination; or the qualified participant must have been enrolled in the benefits program for at least three months, and must not be covered by any other group or individual plan or state or federal plan, including Medicare.

If a qualified participant chooses to apply for an Extension of Benefits, he or she should complete part II, Election of Continued Benefits section, of the Statement of Change of Active Employment request. The completed request must be returned to Human Resources.

By federal regulation, the Christian Brothers Trust is considered a church plan and is exempt from the guidelines governing the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). Therefore, the election to continue benefits must be made by the participant at the time of termination or loss of coverage.

Payments (personal checks) received by the Trust from participants covered under the Extension of Benefits Provision will not be accepted; financial arrangements must be made between Iona University and the participant.

Qualified Participants

The following participants qualify for an extension of benefits and must complete the Statement of Change of Active Employment request:

• A participant (and any covered dependents) whose benefits end due to (a) termination of employment for a reason other than gross misconduct or (b) a reduction in work hours.
• A participant’s surviving spouse and children whose benefits end due to the participant’s death.

Qualified Dependent

The following dependents qualify for an extension of benefits, and the participants must complete the Change of Dependent Coverage Form:

• A participant’s child whose benefits end because the child ceases to be an eligible dependent under the terms of the Plan. In this scenario, the dependent is moved into his/her own file, and an ID card is issued in his/her name. If a participant terminates employment and elects “family” continuation of coverage and later one of the dependents reaches maximum age, the dependent may continue coverage for the remainder of the first qualifying event.
• A participant’s spouse and children whose benefits end due to the participant’s election to drop the group plan and become covered by Medicare. If the participant turns 65 while on an extension of benefits, his/her dependents may elect a dependent extension for the remainder of the original extension.
• A participant’s spouse whose benefits end because of divorce.
• A participant’s spouse and children whose benefits end due to the participant’s death. If the participant’s dependents are all under the age of 18, coverage continues to the end of the month from the date of death.
• A participant on an extension of benefits later marries or acquires a dependent or dependents; he/she can add the dependent(s) for coverage effective on the date of the qualifying event. The Special Enrollment request must be completed and sent to our office within 31 days of the qualifying event.
• A retiree’s surviving spouse and children whose benefits end due to the retiree’s death. If the surviving spouse and children enrolled with Christian Brothers as secondary, coverage may be continued for a maximum of six months.
• If a participant is on an extension of benefits and acquires a dependent for the first time. The dependent may be added provided the dependent does not have other medical coverage.

NOTE: Dependents under age 18 are not eligible to continue coverage unless the parent/legal guardian is also eligible to continue coverage.

Contracted Academic Employee

When determining the eligibility and the start date for the extension of benefits for a contracted academic participant, we use the actual last day worked provided on the Statement of Change of Active Employment request.

NOTE: If the participant works under a teacher’s contract, coverage for the participant and/or dependents may be continued through the end of the teacher’s contract as indicated on the Statement of Change of Active Employment request without regard to the other coverage. If the (former) participant obtains coverage through another Member Employer, but before the prior contract end date, the CBEBT becomes the secondary payer. The new carrier acts as the primary payer.

If the contracted participant requests an extension beyond the end of the contract date, normal extension guidelines apply and the total extension months as elected by the Member Employer (up to 18 months) are counted from the first of the month following the actual last day worked.

Continuation Period

The Extension of Benefits begins on the first of the month following the actual last day worked or no longer an eligible participant.

The Extension of Benefits ends no later than:

• A maximum of 18 months from the first of the following month in which benefits ended as an eligible participant or dependent.
• The date the qualified participant becomes covered under another Group Health Plan or Medicare. Benefits terminate if any of these conditions for termination are met:
  • the proper contribution is not made; or
  • the Member Employer ceases to provide part or all of the benefits package; or
  • the Plan terminates

You’re getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan’s Summary Plan Description or contact the Plan Administrator.

You may have other options available to you when you lose group health coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse’s plan), even if that plan generally doesn’t accept late enrollees.

What is COBRA continuation coverage?

COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is also called a “qualifying event.” Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.

If you’re an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

• Your hours of employment are reduced, or
• Your employment ends for any reason other than your gross misconduct.

If you’re the spouse of an employee, you’ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

• Your spouse dies;
• Your spouse’s hours of employment are reduced;
• Your spouse’s employment ends for any reason other than his or her gross misconduct;
• Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or
• You become divorced or legally separated from your spouse.

Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:

• The parent-employee dies;
• The parent-employee’s hours of employment are reduced;
• The parent-employee’s employment ends for any reason other than his or her gross misconduct;
• The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
• The parents become divorced or legally separated; or
• The child stops being eligible for coverage under the Plan as a “dependent child.”

When is COBRA continuation coverage available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The Plan Administrator must be notified 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 eligibility for coverage as a dependent child), you must notify the Plan Administrator within 60 days after the qualifying event occurs. You must provide this notice to Human Resources.

How is COBRA continuation coverage provided?

Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.

COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.

There are also ways in which this 18-month period of COBRA continuation coverage can be extended:

Disability extension of 18-month period of COBRA continuation coverage

If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of 29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage.

Second qualifying event extension of 18-month period of continuation coverage

If your family experiences another qualifying event during the 18 months of COBRA continuation coverage, the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months, if the Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage 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 lose coverage under the Plan had the first qualifying event not occurred.

Are there other coverage options besides COBRA Continuation Coverage?

Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov.

If you have questions

Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.) For more information about the Marketplace, visit www.HealthCare.gov.

Keep your Plan informed of address changes

To protect your family’s rights, let the Plan Administrator 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 the Plan Administrator.

Plan contact information

For more information, please contact Human Resources.

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents' other coverage). However, you must request enrollment within 30 days, or any longer period that applies under the plan, after you or your dependents' other coverage ends (or after the employer stops contributing toward the other coverage).

In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within 31 days, or any longer period that applies under the plan, after the marriage, birth, adoption, or placement for adoption.

The Plan must allow a HIPAA special enrollment for employees and dependents who are eligible but not enrolled if they lose Medicaid or CHIP coverage because they are no longer eligible, or they become eligible for a state’s premium assistance program. Employees have 60 days from the date of the Medicaid/CHIP event to request enrollment under the Plan. If you request this change, coverage will be effective the first of the month following your request for enrollment. Specific restrictions may apply, depending on federal and state law.

To request special enrollment or obtain more information, contact the Benefits Department.

If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.

If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1877-KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.

If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call (866) 444-EBSA (3272).

If you live in one of the following states, you may be eligible for assistance paying your employer health plan premiums. The following list of states is current as of July 31, 2018. Contact your State for more information on eligibility.

To see if any other states have added a premium assistance program since August 10, 2017, or for more information on special enrollment rights, contact either:

U.S. Department of Labor Employee Benefits Security Administration
Website: https://www.dol.gov/agencies/ebsa
Phone: (866) 444-EBSA (3272)

U.S. Department of Health and Human Services Centers for Medicare & Medicaid
Website: www.cms.hhs.gov
Phone: (877) 267-2323, Menu Option 4, Ext. 61565

According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512. I

The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0137.

If you leave your job to perform military service, you have the right to elect to continue your existing employer-based health plan coverage for you and your dependents (including spouse) for up to 24 months while in the military. Even if you do not elect to continue coverage during your military service, you have the right to be reinstated in your employer’s health plan when you are reemployed, generally without any waiting periods or exclusions for pre-existing conditions except for service-connected injuries or illnesses.

Please read this notice carefully and keep it where you can find it. This notice has information about your current prescription drug coverage with the Christian Brothers Employee Benefit Trust (CBEBT) and prescription drug coverage available for people with Medicare. It also explains the options you have under the Medicare prescription drug program and can help you decide whether or not you want to enroll. The end of this notice includes information about where you can get help to make decisions about your prescription drug coverage.

There are two important things you need to know about your current coverage and Medicare’s prescription drug coverage.

1. Medicare prescription drug coverage (Medicare Part D) became available in 2006 through a) Medicare prescription drug plans and b) Medicare Advantage plans that offer prescription drug coverage. All Medicare prescription drug plans provide at least a standard level of coverage set by Medicare. Some plans may also offer more coverage for a higher monthly premium.
2. Christian Brothers Health Benefit Services has determined that the prescription drug coverage offered by the CBEBT is, on average for all plan participants, equivalent to or better than the standard Medicare prescription drug coverage. For this reason, CBEBT coverage is considered Creditable Coverage by Medicare, which means that you can keep CBEBT coverage and not pay a higher monthly premium if you later decide to enroll in a Medicare prescription drug plan.  

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Individuals can enroll in a Medicare prescription drug plan when they first become eligible for Medicare and each year from October 15th through December 7th. Beneficiaries leaving their current creditable prescription drug coverage, through no fault of their own, will also be eligible for a two (2) month Special Enrollment Period (SEP) to join a Medicare drug plan.

You should compare your current coverage — including which drugs are covered — with the coverage and cost of the plans offering Medicare prescription drug coverage in your area.

If you do decide to enroll in a Medicare prescription drug plan and drop your CBEBT prescription drug coverage, be aware that you and your dependents will not be able to re-enroll.

Please contact us for more information about what happens to your coverage if you enroll in a Medicare prescription drug plan.

When Will You Pay a Higher Premium (Penalty) To Join A Medicare Drug Plan?

You should also know that if you drop or lose your coverage with Christian Brothers Employee Benefit Trust and do not enroll in a Medicare prescription drug plan within 63 continuous days after your current coverage ends, you may pay more (a penalty) to enroll in Medicare prescription drug coverage later.

If you go 63 days or longer without (creditable) prescription drug coverage that is at least as good as Medicare’s prescription drug coverage, your monthly premium may go up at least 1 percent of the Medicare base beneficiary premium per month for every month that you did not have that coverage. For example, if you go 19 months without creditable coverage, your premium may consistently be at least 19 percent higher than the Medicare base beneficiary premium. You may have to pay this higher premium (a penalty) as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the following October to enroll.

For more information about this notice or your current prescription drug coverage…

Contact our office for further information at (800) 807-0400 from 7 a.m. to 7 p.m. CST. NOTE: You will receive this notice annually and at other times in the future, including, for example, to remind you of the next enrollment period for Medicare prescription drug coverage and to announce changes in your coverage through the Christian Brothers Employee Benefit Trust. You also may request a copy of this notice at any time.

For more information about your options under Medicare prescription drug coverage…

More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare & You handbook. You’ll get a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. For more information about Medicare prescription drug coverage:

• www.medicare.gov
• Call your State Health Insurance Assistance Program (see your copy of the Medicare & You handbook for their telephone number) for personalized help.
• Call (800) MEDICARE [(800) 633-4227]. TTY users should call (877) 486-2048.

 

For people with limited income and resources, extra help paying for Medicare prescription drug coverage is available. Information about this assistance is available from the Social Security Administration (SSA) online at www.socialsecurity.gov, or by phone at (800) 772-1213 [TTY (800) 325-0778]. 

Date: October 4, 2018
Name of Entity/Sender: Christian Brothers Health Benefit Services
Contact--Position/Office: Adam Smith, Director of Operations
Address: 1205 Windham Parkway, Romeoville, IL 60446-1679
Phone Number: (800) 807-0100