When Your Medical Coverage Ends

Your medical coverage will end:

if the plan is discontinued;

when you are no longer part of an employee group which can participate in these medical plans.

when you leave City employment for any reason other than disability or death;

if you take an unpaid leave of absence;

on the date it is determined that you have knowingly presented bills for services that haven't been received or for a dependent who is not eligible;

after the fifth consecutive working day that you are absent without pay; (however, if you are an hourly employee on a medical leave of absence in the Labor and Trades Coalition Bargaining Group and you make the required employee contribution, your coverage will continue through the end of the current month and also continue for one additional month).

on the 31^st day of a suspension lasting longer than 30 days;

when you fail to make the required contributions;

if you receive a lifetime award from the Industrial Commission; or

when you die.

Continuing Coverage (As an Inactive Employee)

The Benefits Management Office administers a direct pay program so that inactive employees can continue coverage.

You must contact the Benefits Management Office within 30 days of the occurrence of one of the following qualifying circumstances or as otherwise required by the Family and Medical Leave Act of 1993:

If you are on ordinary disability and receiving pension plan ordinary disability benefits, you may continue medical coverage by paying the full cost of coverage.

If you are on an approved unpaid personal or medical leave, you may continue coverage for up to six months by paying the full monthly cost of coverage.

If you are receiving paid or extended sick leave benefits, you can continue coverage for the length of the benefits, if you make the required employee contributions through payroll deductions.

If you are receiving Duty Disability benefits from an employer pension plan, you may continue coverage for the length of the Workers' Compensation benefits, if you make the required employee contributions.

If you are receiving both Duty Disability benefits from an employer pension plan and a Lifetime Award from the Industrial Commission, you may continue coverage for yourself according to PHSA guidelines for up to 18 months by paying the full monthly premium plus the 2% administrative fee.

If you are receiving both Duty Disability benefits from an employer pension plan and a Lifetime Award from the Industrial Commission, you may continue medical coverage for your eligible dependents by paying the required monthly contribution for the length of the disability or until the earlier of the following:

- your dependent child reaches the end of eligibility

- you retire or reach age 65

- you die

- If you are receiving Workers' Compensation benefits, other than a Lifetime Award from the Industrial Commission, you may continue coverage for yourself and your eligible dependents for the length of the benefits, if you make the required employee contributions.

If you are a School Crossing Guard, your coverage will be continued, at no cost, during the summer vacation period.

If you are a School Crossing Guard and on an approved medical leave of absence, your medical coverage may continue for up to five months each year provided you complete and return the Continuation of Coverage enrollment application.

If you are suspended for more than 30 days, you may continue your coverage after the 30^th day by paying the full cost of coverage.

If you are on an approved unpaid leave of absence of less than 30 days, you may continue your coverage by paying the monthly cost of coverage on a pro-rated basis.

If you are laid off, and you are an employee represented by a Labor and Trades or AFSCME bargaining unit and you make the required employee contributions, the City will pay its share of the cost of coverage during the month you are laid off and for four months following your layoff.

If you are totally disabled at the time coverage would otherwise terminate, benefits will continue, at no cost, for expenses incurred for that continuing disability as follows:

for three months for hospital benefits;

for the period of time you were covered by the plan if less than 12 months, for non-hospital benefits;

for 12 months if you were covered by the plan at least 12 months, for non-hospital benefits; or

until the date you are covered under another plan that will pay expenses related to your disability for non-hospital benefits, if less than the above-stated time frames.

When you return to work after an approved leave of absence, you must complete an Employee Information Form and submit it to the Benefits Management Office to reinstate your coverage. You have 30 days from the date you return to work to submit the completed form, otherwise you will have to wait until the next open enrollment period to enroll for coverage for the next January 1^st.

When Your Dependent's Coverage Ends

Coverage for your dependents ends at the same time your coverage ends (or earlier if your dependent no longer qualifies for coverage). However, your dependent can continue medical benefits under the following circumstances:

Your spouse's coverage ends on the day of divorce. You must submit a Spouse Information Form and a certified divorce decree within 30 days of the event. You will be billed the cost of coverage, if you fail to notify the Benefits Management Office of your divorce within the required time frames.

If you die your dependent's coverage will continue, at no cost, for the lesser of 90 days or until they are no longer eligible dependents, as defined by the plan. Note: Your eligible dependents must be covered under your plan at the time of your death.

If your dependent is totally disabled at the time coverage would otherwise terminate, benefits will continue, at no cost, for expenses incurred for that continuing disability as follows:

for three months for hospital benefits;

for the period of time your dependent was covered by the plan if less than 12 months, for non-hospital benefits;

for 12 months if he or she was covered by the plan at least 12 months, for non-hospital benefits; or

until the date he or she is covered under another plan that will pay expenses related to the disability, if less than the above-stated time frames.

Family and Medical Leave Act of 1993

The Family and Medical Leave Act of 1993 ("FMLA") is a federal law which allows eligible employees to take up to twelve (12) weeks of unpaid leave in a twelve (12) month period. You are entitled to the same health benefits coverage from the City during your FMLA leave under the same conditions as if you were working. The FMLA leave is unpaid; however, if you have accrued paid time available you may elect to use this time toward this leave. Once you are off the payroll, accrued paid time may not be used to extend the FMLA leave.

You are eligible if you:

1. have worked for the City for at least twelve (12) months, and

2. have worked at least 1,250 hours with the City during the 12-month period before the leave begins, and

3. meet one or more of the following reasons for requesting an FMLA leave:

(a) The birth of a child of the employee in order to care for such child.

(b) The placement of a child with the employee for adoption or foster care.

(c) In order to care for the spouse, or a child or parent of the employee if such spouse, child or parent has a serious health condition.

(d) A serious health condition that makes the employee unable to perform the functions of the position of such employee.

You are not required to use paid time before requesting an unpaid FMLA leave. If you elect to use accrued paid time during an FMLA leave, your employee health care contribution will be deducted from your paycheck.

If you are on an approved FMLA leave and have used available paid time, or if you elected not to use paid time, you can continue coverage for the length of the leave, if you make the required employee contributions. You will be sent an application for continuing coverage and a billing statement after the Benefits Management Office has received your approved FMLA paperwork from your department. Failure to make the required contributions will result in termination of coverage.

Once you are on an unpaid leave you are not eligible to use paid leave to extend the leave. If you have taken an unpaid leave you will not be able to use sick, vacation or other accrued leave at the end of the 12 weeks of FMLA leave to extend the leave.

If you remain on an approved leave of absence after you have exhausted the 12 weeks of FMLA leave, you may be eligible to continue coverage through the Direct Pay program or through the Public Health Service Act. Contact the Benefits Management Office in regard to continuing coverage after an FMLA leave.

When you return to work after an FMLA leave you must complete an Employee Information Form and submit it to the Benefits Management Office to reinstate your coverage. This form can be obtained from your personnel department
benefits liaison. It can also be downloaded from the City of Chicago web site: www.cityofchicago.org/finance.

You have 30 days from the date you return to work to submit the completed form, otherwise you will have to wait until the next open enrollment period to enroll for coverage for the next January 1^st.

Example:

Mary has requested an FMLA leave to care for her newborn child. Mary has a total of 15 sick days available plus 10 vacation days, but elects not to use her accrued sick and vacation time while on her leave. She will be on an unpaid FMLA leave. At the end of her 12 weeks leave, Mary decides that she is not yet ready to leave the newborn child to return to work. She requests to use her sick and vacation time to extend her leave beyond the 12 weeks.

Mary is not allowed to extend her leave using sick, vacation or any other accrued time at the end of the 12 week leave because Mary has not returned to active work from her leave of absence.

Continuing Coverage

In 1985, Congress enacted continuation health coverage requirements in Title X of the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA amended the Public Health Services Act (PHSA) to protect certain terminated employees and their dependents when they lose their coverage under a group health plan. Employees who are only temporarily off the payroll can also continue to receive health coverage for themselves and their dependents.

By enrolling in the Continuation Coverage Program administered by the Benefits Division, you are able to make direct payment to the City of Chicago for the cost of coverage and continue receiving health care benefits for yourself and your eligible dependents.

In accordance with the Public Health Service Act, when coverage under the Medical Plan ends, you or your covered dependents may be eligible to continue your medical benefits at your own expense for a temporary period. To be eligible, a "qualifying event" (see exhibit A) causing the loss of coverage must occur.

Exhibit A

Continuing Your Coverage After Termination

In accordance with the Public Health Service Act, when coverage under the Medical Plan ends, you or your covered dependents may be eligible to continue your medical benefits at your own expense for a temporary period. To be eligible, a "qualifying event" causing the loss of coverage must occur.

The chart below shows who is eligible to continue under the plan and how long coverage may continue.

The benefits provided will be the same as those offered to eligible employees who are covered under the Medical Plan. If the plan or cost for active employees changes, these benefits or costs will also change.

The City's continuation coverage will stop before the maximum continuation period shown in the chart if one of the following events occurs:

failure to pay the full cost for coverage on or before the date specified;

coverage is started under another group health plan, unless coverage is delayed or denied because of a pre-existing condition; or

the City discontinues medical coverage offered to employees.

Multiple Qualifying Events

If coverage continues because of a qualifying event for which the continuation period is 18 months, this 18-month period can be extended in some instances. If another qualifying event occurs while you are on continuation coverage, the 18- month period may be extended for a longer period of time, but not longer than 36 months from your original qualifying event.

Coverage Cost

If you or your dependents choose to continue coverage, you will have to pay the full cost of the coverage, plus 2% for administrative charges. The City's Benefits Management Office can tell you the cost to continue coverage. This cost may change each year.

How to Apply for Continuing Coverage

The City of Chicago will notify you or your covered dependents of the opportunity to continue coverage for the following reasons:

you lose coverage because of a reduction of hours or your employment ends;

you die; or

you choose Medicare as your primary coverage.

You or your dependents must elect, within 60 days of the date of the notice, whether or not to accept continuation coverage. The full premium payment is due within 45 days of your enrollment. This payment must include all premiums due since your date of separation.

You or your dependents must notify the Continuation Coverage Administrator at the Benefits Management Office within 60 days of:

your divorce;

your legal separation;

your child losing dependent status; or

your death.

Keep in mind that failure to provide the required notice will result in the loss of eligibility to continue benefits.

Converting Your Medical Coverage

If you leave City employment or when your continuation coverage ends, you can apply to your medical plan provider for an individual policy within 31 days after coverage ends. The benefits and provisions of the individual policy may differ from the city's plan. When a dependent's coverage ends, he or she can also convert to an individual policy within 31 days after coverage ends. It is your responsibility to obtain forms from your medical plan provider and apply for coverage.

Certificate of Coverage

The Federal Health Insurance Portability and Accountability Act (HIPAA) requires the Plan to provide a Certificate of Coverage to plan participants at the time coverage is cancelled. The Certificate provides evidence of prior coverage to the participant in case the participant becomes covered under a new group plan that excludes coverage for certain medical conditions (pre-existing conditions) the participant may have. The Certificate will provide information to a new insurer in regard to if, or for how long, the new insurer can exclude covering services for a pre-existing condition.

November 2002

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