Administrator Customer Service
Resume:
benefitexpress
P.O. Box ***8
Omaha, NE 68103
Michael McGarvey & Family
Candler, NC 28715
Dear Michael McGarvey & Family:
On 12/31/2021, you experienced an event of a/an Loss of Eligibility which constitutes a qualifying event under the Lincare group health plan(s). As a result, your coverage, and that of your covered dependent(s), if any, will end on the date(s) set forth on the COBRA Continuation Election Form accompanying this letter. Under the provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) this entitles you and your covered dependent(s) if any, to elect to continue coverage (referred to as COBRA coverage) under the plan(s) enrolled as active member(s). COBRA coverage is the same coverage that the Plan gives to other participants or beneficiaries who aren't on COBRA. Each "qualified beneficiary" who elects COBRA will have the same rights under the Plan as other participants or beneficiaries covered under the component or components of the Plan elected by the qualified beneficiary, including open enrollment and special enrollment rights. (Certain newborns, newly adopted children, and alternate recipients under QMCSOs may also be qualified beneficiaries. This is discussed in more detail in separate paragraphs below.) The first day of COBRA coverage and the maximum continuation period is determined by plan. Please refer to your COBRA Election Form enclosed to determine your first day of COBRA coverage and maximum continuation period ("Last Day of COBRA"). How to Elect COBRA Coverage
Under COBRA, you have a limited number of days to elect continuation coverage. Your election window is determined by the plan and is calculated from the date your coverage under the plan is lost because of the event described above or the date this notice of your election rights is sent to you, whichever is later. To elect COBRA coverage, you must complete and submit the enclosed election form to benefitexpress known as the Plan administrator, no later than the Election Period End date ("Last Day to Elect") listed on the enclosed COBRA Election Form. Failure to do so will result in loss of the right to elect COBRA coverage under the Plan. This same notice is being sent separately to your spouse, if any; however, only one of you needs to elect continuation coverage for your spouse and dependent child(ren), if any, who wish to continue coverage. Furthermore, because COBRA gives you the right to elect coverage independently, you, your spouse or dependent child(ren), if any, may elect single coverage and not include those individuals who do not wish to continue coverage. Other Health Coverage Options
In addition to COBRA coverage, other health coverage options may be available to you, such as coverage through the Health Insurance Marketplace at www.healthcare.gov or 1-800-***-****. You may also be eligible to enroll in coverage through Medicaid or another group health plan (like a spouse's plan), if you request enrollment within 30 days of the loss of coverage. Some of these options may cost less than COBRA continuation coverage. You should compare your other coverage options with COBRA continuation coverage and choose the coverage that is best for you. For example, if you move to other coverage you may pay more out of pocket than you would under COBRA because the new coverage may impose a new deductible. Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends?
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 initial enrollment period for Medicare Part A or B, you have an 8-month special enrollment period to sign up, beginning on the earlier of
- The month after your employment ends; or
- The month after group health plan coverage based on current employment ends. Page 1 of 10
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If you don't enroll in Medicare Part B 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 then 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 will pay second. Certain COBRA continuation coverage plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare. For more information visit https://www.medicare.gov/medicare-and-you. Payment of COBRA Coverage Premiums
The current amount of this premium and the due date for payment are explained in the enclosed COBRA Election Form. The premium may change in the future. We have used the information supplied by Lincare to calculate your maximum continuation period under the plan(s) you were insured prior to your qualifying event. If there is a discrepancy between our calculation and the underwriting insurance carrier, the insurance carrier always governs. Please contact your insurance carrier(s) to determine the exact end of your maximum continuation period. Length of COBRA Coverage Period
If you and your spouse or dependent child(ren), if any, elect coverage, it can last for a maximum continuation period
("Last Day of COBRA") described in the enclosed COBRA Election Form beginning on the date of your qualifying event, or loss of coverage, whichever is later. The first day of COBRA coverage will be determined by the plan. If you elect COBRA, you may be able to extend the length of COBRA coverage if a qualified beneficiary is disabled, or if a second qualifying event occurs. You must notify the Plan Administrator of a disability or a second qualifying event within a certain time period to extend the period of COBRA coverage. If you don't provide notice of a disability or second qualifying event within the required time period, you will lose your right to extend the period of COBRA coverage. The period of COBRA coverage under the Health FSA cannot be extended under any circumstances. The continuation period may be extended for the following reasons: 1. Death of employee, divorce, legal separation or change in dependent status If these events occur during the original maximum continuation period of COBRA coverage, the period of coverage for your spouse and dependent child(ren), if any, may be extended. These events extend the original maximum continuation period of COBRA coverage only if they would have caused your spouse or dependent child(ren), if any, to lose coverage under the plan if the original qualifying event had not occurred. Note that to receive this extension, you and/or your spouse and dependent child(ren), must notify the Lincare Plan Administrator within 60 days of the occurrence of these events.
2. Medicare entitlement of employee
If you became entitled to Medicare BEFORE your qualifying event, COBRA laws allow you to remain eligible for up to 18 months of COBRA coverage. However, your spouse and dependent child(ren), if any, may receive extended COBRA coverage for up to the greater of either: (a) 36 months from the date of your Medicare entitlement; or (b) 18 months from the date of your qualifying event, or loss of coverage, whichever is later. If you become entitled to Medicare AFTER your qualifying event but within the original maximum continuation period of your qualifying event, your spouse and dependent child(ren), if any, may receive an additional 18 months of COBRA coverage. Note that a person generally has become entitled to Medicare when he or she has applied for Social Security income payments or has filed an application for benefits under Part A or Part B of Medicare. 3. Disability determination
If any of the qualified beneficiaries is determined by the Social Security Administration to be disabled, the maximum COBRA coverage period that results from a covered employee's termination of employment or reduction of hours
(generally 18 months, as described above) may be extended to a total of up to 29 months. The disability must have started at some time before the 61st day after the covered employee's termination of employment or reduction of hours and must last at least until the end of the period of COBRA coverage that would be available without the disability extension (generally 18 months, as described above). Each qualified beneficiary who has elected COBRA coverage will be entitled to the disability extension if one of them qualifies. The disability extension is available only if you notify the Plan Administrator in writing of the Social Security Administration's determination of disability within 60 days after the latest of: Page 2 of 10
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(1) the date of the Social Security Administration's disability determination;
(2) the date of the covered employee's termination of employment or reduction of hours; and
(3) the date on which the qualified beneficiary loses (or would lose) coverage under the terms of the Plan as a result of the covered employee's termination or reduction of hours. You must also provide this notice within 18 months after the covered employee's termination of employment or reduction of hours in order to be entitled to a disability extension. If the notice is not provided to the Plan Administrator during the 60-day notice period and within 18 months after the covered employee's termination of employment or reduction of hours, then there will be no disability extension of COBRA coverage. If the qualified beneficiary is determined by the Social Security Administration to no longer be disabled, you must notify the Plan Administrator of that fact within 30 days after the Social Security Administration's determination 4. Bankruptcy filing
If the employer files for bankruptcy reorganization and retiree health coverage is lost within one year before or after the bankruptcy filing, COBRA coverage could continue until the death of a retiree (or a surviving spouse of a deceased retiree) or for 36 months from the retiree's death (after the bankruptcy filing) in the case of the spouse and dependent child(ren).
Newborns and Adoptees
A child who is born to or placed for adoption with you during a period of COBRA coverage will be eligible to become covered under the plan. In accordance with the terms of the Lincare group health benefits plan and the requirements of Federal law, these qualified beneficiaries can be added to COBRA coverage upon proper notification to the Lincare Plan Administrator of the birth or adoption. Early Termination of COBRA Coverage
COBRA coverage may terminate early if:
(1) The required premium payment is not paid when due.
(2) After the date of your COBRA election, you and your spouse or dependent child(ren), if any, become covered under another group health plan.
(3) After the date of your COBRA election, you, your spouse or dependent child(ren), if any, become entitled to Medicare benefits.
(4) All of Lincare group health plans are terminated.
(5) If coverage is extended an additional 11 months due to disability, a determination that the individual is no longer disabled.
(6) COBRA coverage may also be terminated for any reason the plan would terminate coverage of a participant or beneficiary not receiving COBRA coverage (such as fraud). Continuation coverage under COBRA is provided subject to your eligibility. The Lincare Plan Administrator reserves the right to terminate your COBRA coverage retroactively if you are determined to be ineligible for coverage. To be sure that you, your spouse and your dependent child(ren), if any, receive the necessary information concerning your rights, you should keep benefitexpress informed of any address changes. If I sign up for COBRA continuation coverage, can I switch to coverage in the Marketplace? What about if I choose Marketplace coverage and want to switch back to COBRA continuation coverage? You have 60 days from the time you lose your job -based coverage to enroll in the Marketplace. If you sign up for COBRA continuation coverage, you can switch to a Marketplace plan during a Marketplace open enrollment period. You can also end your COBRA continuation coverage early and switch to a Marketplace plan if you have another qualifying event such as marriage or birth of a child through something called a "special enrollment period." If you terminate COBRA continuation coverage early without another qualifying event, you'll have to wait to enroll in Marketplace coverage until the next open enrollment period and may be without health coverage in the interim. When you've exhausted COBRA continuation and the coverage expires, you'll be eligible to enroll in Marketplace coverage through a special enrollment period even if the Marketplace open enrollment has ended. If you sign up for Marketplace coverage instead of COBRA, you cannot switch to COBRA continuation coverage. What factors should I consider when choosing coverage options? When considering your options for health coverage, you may want to think about: Page 3 of 10
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Premiums: Your previous plan can charge up to 102% of total plan premiums for COBRA coverage. Other options, like coverage on a spouse’s plan or through the Marketplace, may be less expensive. Provider Networks: If you’re currently getting care or treatment for a condition, a change in your health coverage may affect your access to a particular health care provider. You may want to check to see if your current health care providers participate in a network as you consider options for health coverage. Drug Formularies: If you’re currently taking medication, a change in your health coverage may affect your costs for medication – and in some cases, your medication may not be covered by another plan. You may want to check to see if your current medications are listed in drug formularies for other health coverage. Severance payments: If you lost your job and got a severance package from your former employer, your former employer may have offered to pay some or all of your COBRA payments for a period of time. In this scenario, you may want to contact the Department of Labor at 1-866-***-**** to discuss your options. Service Areas: Some plans limit their benefits to specific service or coverage areas – so if you move to another area of the country, you may not be able to use your benefits. You may want to see if your plan has a service or coverage area, or other similar limitations.
Other Cost-Sharing: In addition to premiums or contributions for health coverage, you probably pay copayments, deductibles, coinsurance, or other amounts as you use your benefits. You may want to check to see what the cost-sharing requirements are for other health coverage options. For example, one option may have much lower monthly premiums, but a much higher deductible and higher copayments. Please be advised of your right to obtain a copy of the Summary Plan Description (SPD) for your group health plan by contacting the Lincare Human Resource Department at 727-***-****. The SPD contains a complete description of your benefits.
This notice is a summary of your COBRA rights. For answers to specific questions, please contact our Customer Service Department at 877-***-**** during business hours. Sincerely,
benefitexpress
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COBRA CONTINUATION COVERAGE ELECTION FORM
Lincare
IMPORTANT: PLEASE RETAIN A COPY OF THIS COBRA ELECTION FORM FOR FUTURE REFERENCE. THIS FORM CONTAINS INFORMATION ABOUT YOUR RIGHTS UNDER COBRA. To continue coverage, you must complete and submit this election form to benefitexpress no later than the Election Period End date ("Last Day To Elect") listed below. If this election form is not returned within the enrollment period described below for each plan, you will lose your right to elect coverage. After you have elected to continue coverage under COBRA, you must pay the Initial Premium, which includes the premiums for the period of coverage from your First Day of COBRA to the date of your election and any regularly scheduled monthly premiums that become due between your election date and the end of the Initial Premium Payment period. Your Initial Premium Period will end at the end of your Initial Grace Period which is listed below and which is measured as a number of days after the date of your election. To become "fully enrolled" under COBRA, you must "pay your account to current" no later than the end of your Initial Grace Period. You may certainly though "pay to current" and become fully enrolled under COBRA before the end of your Initial Grace Period. Paying to current is defined as paid to the month in which it currently is. All subsequent payments will be due on the 1st of each month, with a 30 day grace period.
If you waive coverage under COBRA before the end of the enrollment period, you can change your mind and continue coverage by submitting your completed election form before the end of the enrollment period described below for each plan. However, if you change your mind after first rejecting COBRA continuation coverage, your COBRA continuation coverage will begin on the date you submit the completed Election Form. If you have questions about COBRA or need assistance to complete your election form, please contact our Customer Service Department at 877-***-**** during business hours. Qualified Beneficiary(QB):
Michael McGarvey Event Date: 12/31/2021
28 Random Dr.
Candler, NC 28715
Event Type: Loss of Eligibility
Second Event: No
COBRA gives you the right to elect coverage independently. You, your spouse or dependent child(ren), if any, may elect single coverage and not include those individuals who do not wish to continue coverage. Premium Information:
Plan Name
Coverage
Level
Monthly
Premium
BCBS-PPO QB + Spouse $1,290.02
EyeMed QB + Spouse $17.51
MetLife PPO Buy Up QB + Spouse $70.13
Total Premium: $1,377.66
Continuation Information:
Plan Name
First Day
of COBRA
Last Day
of COBRA
#
Months
of
COBRA
Last Day
To Elect
Initial
Grace
Period
Days
Subsequent
Grace
Period
Days
BCBS-PPO 1/1/2022 6/30/2023 18 3/2/2022 45 30
EyeMed 1/1/2022 6/30/2023 18 3/2/2022 45 30
MetLife PPO Buy Up 1/1/2022 6/30/2023 18 3/2/2022 45 30 Election Options (Individuals Enrolled Prior to Qualifying Event): Please indicate the COBRA continuation coverage you are electing by checking the applicable box(es). Name Relationship
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Michael McGarvey QB
Accept Waive BCBS-PPO
Accept Waive EyeMed
Accept Waive MetLife PPO Buy Up
Tina McGarvey Spouse
Accept Waive BCBS-PPO
Accept Waive EyeMed
Accept Waive MetLife PPO Buy Up
Alternative Election Options:
Plan Name
Coverage
Level
First Day
of COBRA
Monthly
Premium
BCBS-PPO QB + Spouse 1/1/2022 $1,290.02
QB Only 1/1/2022 $614.30
Spouse Only 1/1/2022 $614.30
EyeMed QB + Spouse 1/1/2022 $17.51
QB Only 1/1/2022 $8.84
Spouse Only 1/1/2022 $8.84
MetLife PPO Buy Up QB + Spouse 1/1/2022 $70.13
QB Only 1/1/2022 $33.98
Spouse Only 1/1/2022 $33.98
For your benefit, we are documenting up to your next 12 months of continuation premiums. Please be advised, this table is prepared based upon current information and current rates in effect and is subject to change based upon completed elections and any changes made by Lincare during annual enrollment. Projected Plan Premiums
Premium
Due Date
Total Amount
Owed
01/01/2022 $1,377.66
02/01/2022 $1,377.66
03/01/2022 $1,377.66
04/01/2022 $1,377.66
05/01/2022 $1,377.66
06/01/2022 $1,377.66
07/01/2022 $1,377.66
08/01/2022 $1,377.66
09/01/2022 $1,377.66
10/01/2022 $1,377.66
11/01/2022 $1,377.66
12/01/2022 $1,377.66
Completed election forms and premium payments should be remitted directly to the address below. Payment must be in the form of a check or money order. DO NOT send cash. benefitexpress
P.O. Box 2798
Omaha, NE 68103
For all other correspondence please use the following address: benefitexpress
P.O. Box 2798
Omaha, NE 68103
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[ ] I have read this form and the notice of my election rights. I understand my rights to elect continuation coverage and would like to take the action indicated above. I understand that if I elect continuation coverage, my continuation coverage will terminate under several circumstances according to COBRA regulations, including: non-payment of premium, the date I or a continued dependent become covered under another Group Health Plan or become entitled to Medicare after the COBRA election, or on the date which this Group Plan ends. I also understand that if I was determined to be disabled by the Social Security Administration within 60 days of my Qualifying Event, I may be eligible for extended continuation coverage and that any break in continued coverage of more than 63 days may cause loss of coverage portability.
I understand that future premiums are due the first of each month. I also understand that failure to pay the required premiums will result in termination of COBRA rights and coverage. Signature Date
*NOTE: If signature line is on a second page, be sure to include all pages of the election form. We will not be able to process your election without the entire form. Page 7 of 10
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New Member Login Notice
An integral part of our broad service offering is our Member Self-Service Portal (Member Portal). We have designed the Member Portal to be an information-rich and secure website empowering you with the tools and information to efficiently and accurately manage your continuation under the Lincare group health plans. We encourage you to leverage the powerful tools contained in the Member Portal anytime, from any location. Examples of information and tools you'll find on the Member Portal include: 1. Payment Information (last received and next due) 2. Coverage Information (plans and critical dates) 3. Copies of all communications we've sent to you
4. Make Payments Online
Below is your unique registration identification number needed to become an authorized user of our website. Please visit www.mypremiumbill.com and click on "Login" under "For Participants" on the top menu bar. Click on the NEW USER link and follow the registration process as described. Please note you will be asked to supply a second piece of identification which will be your social security number (SSN). In order to expedite the registration process, please make sure you have this information with you before beginning the new user registration process. 7goWWAvY
Please retain a copy of this letter for future reference. Should you forget your password or want to reset it in the future you will need the registration code noted above. To protect your privacy, please do not share your registration code with any individuals unknown to you. You can now elect online through your Member Self-Service Portal (Member Portal). Online election is available for you to elect any combination of plans for yourself and your dependents (if any) that you had before your Qualifying Event. Online election is available until 11:59 PM Central Time on the Last Day to Elect listed on your COBRA Continuation Election Form. Electing online is a safe, fast and secure way to ensure your elections are processed. Please visit www.mypremiumbill.com to register and complete your online election. PREMIUM PAYMENT OPTIONS
Did you know you can make payments online at www.mypremiumbill.com? The online Member Portal allows you to make credit card payments (fee applies), make one-time ACH payments (fee applies) or schedule reoccurring ACH (free) for your monthly payments. ACH is a safe, fast and secure way to ensure your monthly payment is made on time, every time. To sign up, login to your Member Portal and enroll online. If you should ever have any questions or comments, please do not hesitate to contact our offices at 877-***-**** during business hours. Our entire staff is looking forward to getting to work for you. Sincerely,
benefitexpress
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PLEASE READ FOR INFORMATION ON EXTENSIONS TO YOUR COBRA DEADLINES On March 13, 2020, President Trump issued the Proclamation on declaring a national emergency concerning the Coronavirus (COVID-19) pandemic. In response to the COVID-19 pandemic, the U.S. Department of labor (DOL) released a rule that temporarily extends the COBRA election and payment deadlines to beyond the “Outbreak Period,” which it defines as March 1, 2020 to 60 days after the end of the declared COVID-19 national emergency.
The COBRA continuation coverage provisions generally provide a qualified beneficiary a period of at least 60 days to elect COBRA continuation coverage under a group health plan and 45 days to make your first payment after the day of the initial COBRA election. Under the new temporary rule, the 60-day timeframe will not start until the end of the declared
“Outbreak Period.” This temporary rule only extends your time to elect coverage. It does not extend the amount of time to remain on COBRA coverage. Please note: Although the COBRA election and payment deadlines have been extended 60 days beyond the “Outbreak Period”, the total premium will be due retroactive to your COBRA start date if you choose to elect coverage.
If you wish to extend your COBRA election and premium grace period beyond the “Last Day to Elect” date noted on your election form (included), you must contact benefitexpress to request the extension before the 60 days after the “Outbreak Period” expires. If you should ever have any questions or comments, please do not hesitate to contact us at
877-***-**** during business hours.
Sincerely,
benefitexpress
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