COBRA Coverage Information
Overview
To All Retirees, Spouses and Dependents

Federal law requires the Harrison Trust to offer retirees and dependents the opportunity to elect a temporary extension of medical, prescription drug, dental, and vision coverage (called "COBRA Continuation Coverage"). This coverage is offered at group rates in certain instances where coverage under this Plan and any insured plan offered by the Board of Trustees would otherwise end. You do not have to show you are insurable to elect COBRA Continuation Coverage. However, you must pay the total premium and administrative costs for COBRA Continuation Coverage.

This section is intended to summarize your rights and obligations under COBRA. The Harrison Trust offers no greater COBRA rights than what the COBRA statute requires, and this section should be construed accordingly.

Qualifying Events
If you are a retiree covered by this Plan or an insured plan offered by the Board of Trustees, you have the right to elect COBRA Continuation Coverage for yourself, your spouse and your dependents if you lose coverage because of any one of the following two qualifying events:

1. Termination of your employment;

2. Reduction in the hours of your employment.

If you are the spouse of a retiree covered by this Plan or an insured plan offered by the Board of Trustees, you have the right to elect COBRA Continuation Coverage for yourself and your dependents if you lose coverage because of any of the following four qualifying events:

1. The death of your spouse (the retiree);

2. The termination of your spouse's employment or reduction in his/her hours of employment;

3. Divorce or legal separation from your spouse. Also, if your spouse drops you from coverage in anticipation of divorce or legal separation, and the divorce or legal separation later occurs, then the later divorce or legal separation will be considered a qualifying event even though the spouse lost coverage earlier. If you (the former spouse) notify the Plan Administrator within sixty days of the divorce or legal separation and can establish that the coverage was dropped earlier, in anticipation of the divorce or legal separation, then COBRA Continuation Coverage may be available for the period following the divorce or legal separation;

4. Your spouse enrolls in Medicare Part A or Part B.

If you are a dependent child of a retiree covered by this Plan or an insured plan offered by the Board of Trustees, you have the right to elect COBRA Continuation Coverage if you lose coverage because of any of the following five qualifying events:

1. The death of your parent (the retiree);

2. The termination of your parent's employment or reduction in the parent's hours of employment;

3. Dissolution of your parent's marriage or legal separation;

4. Your parent enrolls in Medicare Part A or Part B; or5. You cease to be a dependent under this Plan or an insured plan offered by the Board of Trustees.

Notices and Election
Under this Plan, your spouse's group coverage ends the day that a divorce or legal separation occurs (coverage is lost for the spouse only). Under this Plan, a dependent child's group coverage ends on the last day of the month in which the dependent child loses dependent status.

Under COBRA, you, your spouse or your dependents have the responsibility to notify the Plan Administrator of divorce, legal separation, or child losing dependent status. You, your spouse or your dependents must give this notice to the Plan Administrator no later than 60 days after the divorce, legal separation, or child losing dependent status. If you, your spouse or your dependent fails to notify the Plan Administrator during the 60-day notification period, any family member who loses coverage will not be offered the option to elect COBRA Continuation Coverage.

You may be liable for claims if coverage continues beyond the termination date of a divorce, legal separation, or child losing dependent status, because you, your spouse or your dependent has failed to notify the Plan Administrator. Once the Plan Administrator is notified, coverage will end retroactively (as of the day of the divorce or legal separation or the last day of the month in which the child loses dependent status). You, your spouse or dependent must reimburse the Plan for claims paid, if any, after the coverage end date. The same termination and reimbursement requirement will apply if you, your spouse, or dependent child gives notice of the qualifying event within the 60-day notice period, but then fails to timely elect and pay for COBRA Continuation Coverage.

If the Plan Administrator is notified in a timely manner of divorce, legal separation or a child losing dependent status, the Plan Administrator will notify the family member of the right to elect COBRA Continuation Coverage. You, your spouse or dependent will also be notified of the right to elect COBRA Continuation Coverage automatically (without any action required by you or a family member) when group health coverage is lost because your employment ends, reduction in hours, death, or becoming enrolled in Medicare Part A or Part B.

You, your spouse or dependents must elect COBRA Continuation Coverage within 60 days after group health coverage ends or, if later, 60 days after the Plan Administrator sends you or your family member notice of the right to elect COBRA Continuation Coverage. If you, your spouse or your dependents do not elect COBRA Continuation Coverage within the 60-day election period, you will lose your right to elect COBRA Continuation Coverage. The election to accept COBRA Continuation Coverage is effective on the date the election is sent to the Plan Administrator.

Benefits Available Under COBRA Continuation Coverage
You, your spouse and each dependent has the right to elect COBRA Continuation Coverage for medical and prescription drug benefits only, or for medical, prescription drug, dental and vision benefits. Any other benefits provided to you or a family member are not subject to the COBRA continuation provisions. COBRA Continuation Coverage is identical to the coverage provided to similarly situated retirees and dependents. If the benefits available to similarly situated retirees and dependents are modified, COBRA Continuation Coverage will be modified in the same way.
Making the Necessary Payments
You or a family member must pay the premium for the initial premium months by the 45th day after electing COBRA Continuation Coverage. The initial premium months are the months that end on or before the 45th day after the day of the COBRA election. All other premiums are due on the first of the month, subject to a 30-day grace period. A premium payment is made on the date it is sent to the Plan Administrator.
How Long COBRA Continuation Coverage Lasts
1. 36 months. If your spouse or your dependent child loses coverage because of death, divorce, legal separation, your enrollment in Medicare Part A or Part B, or because your dependent child loses his/her status as a dependent under this Plan or an insured plan offered by the Board of Trustees, the maximum coverage period (for the spouse and dependent child) is three years from the date coverage would otherwise end.

2. 18 months. If you, your spouse, or dependent child loses coverage because your (the retiree's) employment ends or reduction in hours, the maximum COBRA Continuation Coverage period (for you, your spouse and dependent child) is 18 months from the date coverage would otherwise end. There are three exceptions:

a. If you, your spouse, or dependent child is disabled (as that term is defined in the Social Security Act) at any time during the first 60 days of COBRA Continuation Coverage, the COBRA Continuation Coverage period for all qualified beneficiaries is 29 months from the date coverage was lost. The Social Security Administration must formally determine that the disability exists and when it began. For the 29-month COBRA Continuation Coverage period to apply, notice of the determination of disability under the Social Security Act must be provided by the disabled individual to the Plan Administrator within the 18-month coverage period and within 60 days
after the date of the determination. If there is a subsequent determination by the Social Security Administration that the qualified beneficiary is no longer disabled, COBRA Continuation Coverage will end.

b. If a second qualifying event gives rise to a 36-month COBRA Continuation Coverage period (for example, you die or there is a divorce or legal separation) during the 18-month or 29-month COBRA Continuation Coverage period, the maximum COBRA Continuation Coverage period becomes three years from the date coverage was initially lost because of termination of employment or reduction in hours.

c. If your spouse or dependent has COBRA Continuation Coverage because the original qualifying event was your termination of employment or reduction in hours and this qualifying event occurs within 18 months after you become enrolled in Medicare, your spouse's and dependent's maximum COBRA Continuation Coverage period ends three years from the date you became enrolled in Medicare.

Newborn Children and Children Placed for Adoption with the Retiree After the Qualifying Event
If, during the COBRA Continuation Coverage, a child is born to you or is placed for adoption with you, the child is considered a qualified beneficiary entitled to COBRA Continuation Coverage. You or your spouse has the right to elect COBRA Continuation Coverage for the child, provided the child satisfies the otherwise applicable eligibility requirements (for example, age). You or your spouse must notify the Plan Administrator of the birth or placement of a child for adoption.
Termination of COBRA Continuation Coverage Before the End of the Maximum Period
COBRA Continuation Coverage for you, your spouse or your dependent will automatically end (even before the end of the maximum coverage period) on the last day of the month in which any of the following events occur:

1. The premium for the COBRA Continuation Coverage is not paid on time;

2. After the election of COBRA Continuation Coverage, you, your spouse, or dependent becomes enrolled in Medicare Part A or Part B;

3. The Harrison Trust no longer provides group health coverage to any of its participants;

4. Your last employer no longer participates in the Harrison Trust and establishes one or more group health plans that cover a significant number of employees who were formerly covered under the Harrison Trust or your last employer begins contributing to another multiemployer plan. In such a case, the new employer plan or multiemployer plan must assume this Plan's COBRA Continuation Coverage obligation.

5. After the election of COBRA Continuation Coverage, you, your spouse, or your dependent child becomes covered under another group health plan (as an employee or dependent) that has no exclusion or limitation with respect to any preexisting condition. If the new group health plan has exclusions or limitations for preexisting conditions, your COBRA Continuation Coverage will end after the exclusion or limitation no longer applies. For example: after a six-month waiting period, or under the federal law that requires portability of health care coverage (the Health Insurance Portability and Accountability Act of 1996) after the preexisting condition clause expires.

A preexisting exclusion or limitation of another group health plan may not apply to you, or may be satisfied by you, depending on the length of your coverage under this Plan or another group plan.

Automatic Coverage for Your Spouse and Dependent Children Choosing COBRA Continuation Coverage
When you elect COBRA Continuation Coverage, coverage for your spouse and your dependent children will continue automatically unless your spouse independently declines COBRA Continuation Coverage. If you choose not to elect COBRA Continuation Coverage, your spouse and your dependent children may still choose COBRA Continuation Coverage. Of course, in all circumstances, anyone electing COBRA Continuation Coverage must pay the required premium.
Transfer Rights
If you are covered by an HMO that covers a limited geographic area and relocate to another area where employers contributing to the Harrison Trust have an active work force, you may be entitled to elect coverage available to other retirees residing in that area. If you find yourself in this situation, call or write the Plan Administrator. Of course, under no circumstances would such a transfer prolong your maximum COBRA Continuation Coverage.
Other Information
If you, your spouse, or your dependent child has any questions about COBRA Continuation Coverage, please contact the Plan Administrator.

If your marital status changes, a dependent is no longer a dependent eligible for coverage, or your or your spouse's address changes, you must immediately notify the Plan Administrator.

The Plan Administrator is:

A & I Benefit Plan Administrators, Inc.
1220 SW Morrison Street
Suite 300
Portland, OR 97205

In Portland: 1-503-224-0048, ext. 1679
Outside Portland: 1-800-547-4457, ext. 1679
All information provided on this web site is in summary and intended to provide highlights of your plans. We strongly recommend referring to the Plan booklet for complete details before making any decisions related to your eligibility, benefits and coverage.