Continuing
Your Coverage—COBRA
When your Company-sponsored coverage ends for
Medical, Dental, Vision or the Health Care FSA, you and your enrolled
dependents may be eligible to continue coverage at your own expense under
certain circumstances.
COBRA Cov erage
If your employment ends for any reason except
gross misconduct, or if your hours are reduced below the minimum required to be
eligible for coverage in the Company’s program, you and your enrolled eligible
dependents may continue your Medical, Dental and Vision coverage and/or
participation in the Health Care FSA under a program required by law, commonly
known as the Consolidated Omnibus Budget
Reconciliation Act of 1985 (COBRA).
The following summarizes the maximum COBRA continuation period for various events:
|
Event |
Maximum COBRA Continuation Period |
|
n If your employment ends for any reason except gross misconduct or n If your hours are reduced below the minimum required to be eligible for coverage in the Company’s program. |
18 months for you and your eligible dependents. |
|
n You or your eligible dependents are disabled when your coverage ends or become disabled within the first 60 days of COBRA continuation coverage. |
29 months (standard 18-months plus an 11-month extension) for the disabled individual. Non-disabled eligible dependents may also continue coverage. |
|
n You die n You and your spouse are divorced or legally separated n Your child is no longer eligible for coverage n You become entitled to Medicare or n Your domestic partnership relationship ends. |
36 months for your eligible dependents. |
Notification and Payment Deadlines for COBRA
The following summarizes the various COBRA continuation deadlines:
|
Event |
Deadline |
|
n Your employment ends n Your hours are reduced below the level eligible for coverage. |
The administrator must notify you of your COBRA rights within 14 days of receiving notice of the event from the Company. |
|
n You die n You and your spouse are divorced or legally separated n Your child is no longer eligible for coverage n You become eligible for Medicare n Your domestic partnership ends. |
You or your eligible family members must notify the Company within 60 days of the qualifying event. |
|
n You are disabled when your coverage ends or within the first 60 days of COBRA coverage, and you want the 11-month extension. |
You must notify the COBRA administrator within 60 days of the date you receive your Social Security disability determination, and within the initial 18 months of COBRA coverage. |
|
n You give birth to or adopt a child or a child is placed with you for adoption while covered under COBRA and you want to add the child to your coverage. |
You must notify the COBRA administrator to enroll the child within 30 days after birth, adoption or placement for adoption. |
|
n Paying your COBRA premiums. (A third party may elect coverage and pay the premium on your behalf.) |
You must make the first payment within 45 days of electing your COBRA rights. You must make all subsequent payments within 30 days of the due date. |
The COBRA
administrator will not accept elections or payments received after the
deadline. If your COBRA rights expire, they will not be reinstated.
Cost of COBRA Cov erage
For Medical, Dental and Vision
If your coverage ends and you elect COBRA continuation coverage for Medical, Dental and/or Vision, you pay the full cost of coverage for you and your dependents plus a 2% administration fee; in other words, 102% of the premium. If you are totally disabled and qualify for the COBRA extension, the cost for the additional 11 months (from the 19th through the 29th month) will be 150% of the cost for all covered participants.
For the Health Care FSA
The purpose of COBRA continuation for the
Health Care FSA is to allow you to continue to have access to money in your
account even if you leave the Company. Keep in mind that you are no longer
receiving a paycheck. This means your continued contributions are made on an after-tax basis and you will no longer
receive the same tax advantages you did as an employee.
You are responsible for sending a check to
the COBRA administrator each month in the amount of your after-tax contribution (plus a 2% administrative fee). Then you can
file a claim for expenses you incur during the remainder of the calendar year.
You have until March 31 after the Plan Year ends to submit claims for expenses
you incurred up through December 31. This deadline applies even if you stop
contributing because you have reached the maximum COBRA continuation period.
When COBRA Cov erage Begins
Your COBRA coverage begins when your company coverage ends, as long as you meet the notification and payment deadlines shown on page 2.
When COBRA Cov erage Ends
COBRA continuation coverage ends on the earliest of the following:
n The date you or your dependents, after electing COBRA, become covered under another group plan, unless the new group plan contains any exclusions or limitations for pre-existing conditions that would apply to you or your dependents
n The date you or your dependents, after electing COBRA, become entitled to Medicare (COBRA coverage ends only for the person who is entitled to Medicare)
n When you do not pay your premiums within 30 days of the due date
n The date the Company plan ends and no health coverage is provided
n The first day of the month beginning more than 30 days after the date an individual, on the 11-month extension described on page 3, is determined to be no longer disabled, according to the Social Security Administration. You must notify the COBRA administrator within 30 days of receiving the final Social Security determination
n At the end of the maximum COBRA continuation period (as shown on page 1)
n If you move to an area not serviced by any of the plans that are available to active employees or you move to an area to which the plan is unable to extend coverage.
Benefit and Plan Changes
During the time you or your dependents have COBRA coverage, there may be benefit changes to the Company plan, such as new deductibles or covered expenses. All changes to the plan will also apply to your COBRA coverage.
You can change your medical, dental or vision plans during the annual open enrollment period.
Special Enrollment
A qualified beneficiary receiving COBRA coverage has the same right to enroll family members under the HIPAA special enrollment rules as active employees. Refer to “Special Enrollment Periods” under the Medical section of this binder.
Cov erage Certification
So that you can prove to a new employer that you had prior
health coverage, you will receive a certificate when COBRA coverage is lost
under the Company medical plan, identifying your and your dependents’ prior
health coverage. Keep a copy of the coverage certificate you receive, so you
can prove you had prior health coverage when you join a new plan. You and your
dependents, or someone on your behalf, may also request a coverage certificate
within 24 months of when coverage was lost. To make the request, please contact
the COBRA administrator or your former
medical carrier.
Your
ERISA Rights
As a participant in the Company’s benefits
program, you have certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). This
section summarizes the rights you have as a member of the plans covered by
ERISA—rights that ERISA guarantees. ERISA provides that all plan participants
are entitled to:
n Examine, without charge, at the Plan Administrator’s office, all plan documents, trust agreements and copies of all documents filed by the plan with the U.S. Department of Labor, such as annual reports and Summary Plan Descriptions
n Obtain copies of all plan documents and other plan information by writing to the Plan Administrator. There may be a reasonable charge for these copies
n Receive a summary of the plan’s annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report
n Obtain a statement telling you whether you have the right to receive a pension at age 65, and what your benefits would be if you stopped working at that time. If you do not have the right to a pension, this statement will tell you how long you have to work to earn a right to a pension. You must request this statement in writing and it need not be given more than once a year. It must be provided free of charge.
Plan Fiduciaries
In addition to creating rights for plan participants, ERISA imposes duties on the people responsible for the operation of the employee benefit plan. The people who operate the plan, called “fiduciaries” of the plan, have a duty to do so prudently and in the interest of you and other plan participants and beneficiaries.
Protection of Your Rights
No one, including your employer or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a benefit or exercising your rights under ERISA. If your claim for a benefit is denied, in whole or in part, you must receive a written explanation of the reason for the denial. You have the right to have the plan review and reconsider your claim.
Ensuring Your ERISA Rights
Under ERISA, there are steps you can take to enforce these rights. For instance, if you request materials from the Plan Administrator and do not receive them within 30 days, you may file suit in a federal court. In such cases, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent for reasons beyond the control of the Plan Administrator.
If you have a claim for benefits that is denied or ignored, in whole or in part, you may file suit in a state or federal court. If it should happen that plan fiduciaries misuse the plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court.
The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees (for example, if it finds that your claim is frivolous).
Claims for Benefits
The law provides that each plan subject to ERISA must establish reasonable rules for filing a claim for benefits. Therefore, the plan document sets forth the procedures to follow. In general, you (or your beneficiary where applicable) must file a written claim on the appropriate form. Claim forms are available from the insurance carriers or plan administrator.
For all ERISA plans, the law allows the Plan Administrator a reasonable amount of time to evaluate a claim and to decide whether to pay benefits, based on the information contained in the written claim.
Under normal circumstances, you are entitled to receive written notice of the status of your claim within 90 days of filing—whether it is to be allowed, in full or in part, or denied. But if the Plan Administrator cannot reach a decision within 90 days, the law allows a 90-day extension, provided you are notified of the reason for the delay before the original 90-day period expires.
If a Claim Is Denied
The law requires every ERISA plan to establish rules for reviewing denied claims. The rules must be full and fair. Moreover, the insurance carriers or plan administrator (depending on the plan to which the denial applies) must have authority to reach a final decision on the claim under review.
As part of the review process, you must be allowed to:
n See all plan documents and other pertinent materials that affect your claim
n Appeal the denial in writing and
n Have someone act as your representative in the review process.
Furthermore, the plan’s rules must give you at least 60 days after the claim is denied to request a claim review. In most cases, the reviewer must review and decide on the appeal within 60 days after you file your request for a review. But if the reviewer requires an extension, a written notice will be sent to you and a decision will be made not later than 120 days after the receipt of your request for review.
Once a decision is reached, the reviewer must notify you in writing of the outcome. The notice must give exact reasons for the decision—not just general statements—and it must be written in clear, understandable language.
Legal Process
If it should become necessary for you or your beneficiary to take legal action against the Company over the terms of the plan or your rights under ERISA, legal process should be served to the Company at the address listed on page 9 under “Plan Sponsor, Administrator and Service of Legal Process.”
Service of legal process with respect to the Savings Plan may also be made on the Trustee.
A Final Word
If you have any questions about your benefits under any plan
or about your rights under ERISA, you should first go to your Plan
Administrator. If you still have questions you should next contact the nearest
office of the Pension and Welfare Benefits Administration, U.S. Department of
Labor, listed in your telephone directory or the Division of Technical
Assistance and Inquiries, Pension and Welfare Benefit Administration, U.S.
Department of Labor,
Statement
of ERISA Rights
Administration and Important Facts About Your Plans
|
Name of Plan |
Type |
Group Contract # |
Plan Name |
Plan # |
|
|
Welfare |
3079 |
Southern California Gas Company Medical Plan |
514 |
|
Blue Cross CaliforniaCare HMO |
Welfare |
57M33 |
Southern California Gas Company Medical Plan |
514 |
|
Blue Cross POS Plan |
Welfare |
57E42 |
Southern California Gas Company Medical Plan |
514 |
|
Blue Cross Safety Net Plan |
Welfare |
1201M |
Southern California Gas Company Medical Plan |
514 |
|
Blue Cross Out-of-Area Plan |
Welfare |
1201N |
Southern California Gas Company Medical Plan |
514 |
|
CIGNA HMO |
Welfare |
1244 |
Southern California Gas Company Medical Plan |
514 |
|
Health Net HMO |
Welfare |
51208 |
Southern California Gas Company Medical Plan |
514 |
|
Kaiser Permanente HMO |
Welfare |
104236 |
Southern California Gas Company Medical Plan |
514 |
|
Maxicare HMO |
Welfare |
0129 |
Southern California Gas Company Medical Plan |
514 |
|
Employee Assistance Plan (EAP) |
Welfare |
NA |
Combined Group Health and Welfare Program of
Southern California Gas Company |
505 |
|
Delta Dental Plan |
Welfare |
8484 |
Combined Group Health and Welfare Program of
Southern California Gas Company |
505 |
|
SafeGuard Dental Plan |
Welfare |
4362 |
Combined Group Health and Welfare Program of
Southern California Gas Company |
505 |
|
Vision Service Plan (VSP) |
Welfare |
00111402 |
Combined Group Health and Welfare Program of
Southern California Gas Company |
505 |
|
SafeGuard Premier Vision Plan |
Welfare |
268 |
Combined Group Health and Welfare Program of
Southern California Gas Company |
505 |
|
Basic Life Insurance |
Welfare |
28331 |
Combined Group Health and Welfare Program of
Southern California Gas Company |
505 |
|
Business Travel Accident Insurance |
Welfare |
668608 |
Combined Group Health and Welfare Program of
Southern California Gas Company |
505 |
|
Group Universal Life (GUL) Insurance |
Voluntary |
M102330 |
N/A |
N/A |
|
Voluntary AD&D |
Voluntary |
01519030 |
N/A |
N/A |
|
Long-Term Disability Insurance |
Welfare |
N/A |
Disability Benefit Plan |
504 |
|
Flexible Spending Accounts |
Welfare |
1400 |
521-Southern California Gas Company |