HomeMy WebLinkAbout0707 Continuation of Health Care Coverage109
707 Continuation of Health Care Coverage
City of Grapevine employees who are covered by the City sponsored health plan
have the right to choose the continuation coverage if group health coverage is lost
for reasons such as termination, retirement, or reduction in work hours. However,
continuation of health care coverage may be denied in cases of gross misconduct.
.01 If a covered employee is terminated for reasons other than gross misconduct, or
loses coverage due to a reduction in hours, the employee and covered dependents
will be afforded the opportunity for continued coverage for up to 18 months.
.02 A covered dependent may elect to continue coverage for up to 36 months, if such
dependent’s coverage terminates for any of the following reasons:
(1) death of the covered employee;
(2) divorce or legal separation from the covered employee;
(3) active employee becomes entitled to Medicare and elects Medicare as the
primary payer or covered employee continues coverage after termination and
then becomes entitled to Medicare during the continuation of coverage period;
(4) covered dependent ceases to be a “dependent child” as defined under the
plan.
.03 The employee or family member has the responsibility to inform Risk Management
in writing within 60 days of a divorce, legal separation, or when a child loses
dependent status.
.04 Risk Management has the responsibility to notify the health insurance company
within 30 days of the employee's death, termination, retirement, reduction in hours,
or entitlement to Medicare.
.05 When Risk Management notifies the Third Party Administrator of an event which will
result in a status change, the Third Party Administrator will notify the person within
14 days of the right to choose continuation coverage.
.06 A person has 60 days from the latter of the date of the event or the date notification
is sent to inform the City’s third party administrator that they want continuation
coverage.
.07 If a person chooses continuation coverage, the City is required to provide identical
coverage under the plan to similarly situated employees or family members at the
covered individual's expense.
.08 An individual's continuation coverage may be cut short for any of the following
reasons:
(1) the City no longer provides group health coverage;
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(2) the premium for continuation coverage is not paid on time;
(3) the covered person becomes insured under another group health plan;
(4) the covered person is entitled to Medicare.
.09 The individual requesting continuation coverage does not have to provide proof of
insurability.
.10 The above provisions apply only to the continuation of health care coverage and do
not apply to the continuation of other types of City insurance benefits.
Revised 03/26/2008