MICHIGAN CIVIL SERVICE COMMISSION

Employee Benefits Division

General Notice Of COBRA Continuation Coverage Rights Under COBRA

Introduction

You’re getting this notice because you recently gained coverage under the state’s group health,

vision, or dental 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

the Plan’s Summary Plan Description or contact the Plan Administrator.

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

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

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

• 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 employer must notify

the Plan Administrator of the following qualifying events:

• The end of employment or reduction of hours of employment;

Insurances, form CS-1820.

How is COBRA continuation coverage provided?

continuation coverage will be offered to each of the qualified beneficiaries. You will be sent an

election notice and an election form upon notification that you have experienced a qualifying

Commission, Employee Benefits Division, P.O. Box 30002, Lansing, MI 48909. If you do not

fully and timely made.

coverage provided under the plan to similarly situated employees or family members.

while on a leave, layoff, or separated. Your Open Enrollment change will be processed if your

current coverage is paid through September 30 and your COBRA eligibility allows the change.

REV 07/2020

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.

continuation coverage, for a maximum of 29 months. The disability would have to have started

the end of the 18-month period of COBRA continuation coverage. To qualify for this extension,

you must provide notification to the Employee Benefits Division (EBD) within 60 days after the

If COBRA continuation coverage is extended because of a disability, you must send to the EBD

any SSA determination that the person whose disability resulted in the extension is no longer

disabled within 30 days of receipt from the SSA.

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

If your family experiences another qualifying event during the 18 months of COBRA

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, Medicare, Medicaid,

Children's Health Insurance Program (CHIP) or other group health plan coverage options

(such as a spouse’s plan) through what is called a “special enrollment period.” Some of

many of these options at www.healthcare.gov.

In general, if you don’t enroll in Medicare Part A or B when you are first eligible because you are

still employed, after the Medicare initial enrollment period, you have an 8-month special

If you don’t enroll in Medicare and elect COBRA continuation coverage instead, you may have to

pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want

Part B later. If you elect COBRA continuation coverage and later enroll in Medicare Part A or B

before the COBRA continuation coverage ends, the Plan may terminate your continuation

coverage. However, if Medicare Part A or B is effective on or before the date of the COBRA

election, COBRA coverage may not be discontinued on account of Medicare entitlement, even if

you enroll in the other part of Medicare after the date of the election of COBRA coverage.

If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally

pay first (primary payer) and COBRA continuation coverage will pay second. Certain plans may

pay as if secondary to Medicare, even if you are not enrolled in Medicare.

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

Keep your Plan informed of address changes

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

This notice does not fully describe COBRA or the Plans. Questions on the plans or COBRA