When Your Dental
Coverage Ends

Your dental coverage will end:

if the plan is discontinued;

when you are no longer covered by a Medical Plan or an HMO sponsored by the City;

when you leave City employment for any reason;

when you die.

Continuing Coverage (As an Inactive Employee)

Employees who are temporarily off the payroll (inactive employees) are also allowed to continue their dental coverage. Your dental coverage may be continued under the following circumstances or as otherwise required by the Family and Medical Leave Act (FMLA) of 1993:

You must contact the Benefit Management Office within 30 days of the occurrence of one of the following qualifying circumstances:

If you are on ordinary disability and receiving pension plan ordinary disability payments, you may continue dental coverage according to PHSA guidelines for up to 18 months by paying your monthly premium plus the 2% administrative fee. If you or your eligible dependents experience a second "qualifying event" (see exhibit A) during the 18-month period, it may be possible to extend the period of eligibility for dental benefits.

If you are on an approved unpaid leave of absence (personal, maternity or medical) you may continue your dental coverage according to PHSA guidelines for up to 18 months by paying the monthly premium plus a 2% administrative fee.

If you are receiving paid or extended sick leave benefits and you are continuing your medical coverage, your dental coverage will continue for as long as you continue to pay the monthly employee contribution.

If you are receiving Duty Disability benefits from an employer pension plan and you are continuing your medical coverage, your dental benefits will continue for you and your eligible dependents if you choose to continue to pay the required monthly contribution for the length of the Workers' Compensation benefits.

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

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 personal 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 for coverage during the month you are laid off and for four months following your layoff.

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. 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.

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 dental 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.

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 dental benefits for yourself and your eligible dependents.

In accordance with the Public Health Service Act, when coverage under the Dental Plan ends, you or your covered dependents may be eligible to continue your dental benefits at your own expense for a temporary period. To be eligible, a "qualifying event" (see exihibit 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 Dental Plan ends, you or your covered dependents may be eligible to continue your dental 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 Dental 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 dental plan, unless coverage is delayed or denied because of a pre-existing condition; or

the City discontinues dental 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.

Continue