Common use of Type of Coverage Clause in Contracts

Type of Coverage. Under Oregon continuation, you can continue the coverage you had before the qualifying event. Oregon continuation benefits are always the same as your employer’s current benefits. Your employer has the right to change the benefits of its health plan or eliminate the plan entirely. If that happens, any changes to the plan will also apply to everyone enrolled in continuation coverage. We can provide you uninterrupted coverage when the existing Group Policy is replaced. If you are laid off and then rehired by your employer within nine months, you will not have to satisfy another waiting period. Your health coverage will resume coinciding with the date of return to work from layoff and again meet your employer’s minimum hour requirement. If your family members were covered before your layoff, they can resume coverage at that time as well. You must re-enroll your family members by submitting an enrollment application to Samaritan Health Plans within the 30 day initial enrollment period following your return to work. Failure to submit the application within the 30 day initial enrollment period to Samaritan Health Plans will cause you to be considered a late enrollee and coverage will be deferred until the next open enrollment date. Continuation for Spouses or Domestic Partners over Age 55‌ Subject to the general provision of the plan, if you die, become divorced, legally separated, or discontinue your domestic partnership, and your covered spouse or domestic partner is then age 55 or over, your spouse or domestic partner and any other covered dependents may continue medical coverage under the plan on a self-pay basis until the earliest to occur of the following events: • Failure to pay premiums when due; • Termination of the Group Policy, unless another group health plan is made available by the employer to its employees; • Your legally separated, divorced or surviving spouse or domestic partner becomes covered under another group health plan or becomes eligible for Medicare; or • Covered dependents no longer meet the eligibility requirements of the plan. In order to be eligible for continued coverage, your spouse, domestic partner or dependent must give written notice of the legal separation, termination of marriage or domestic partnership, or death of the employee to the employer within: • Thirty days of the date of the employee’s death • Sixty days of the date of legal separation (or dissolution of domestic partnership) • Sixty days of the date of entry of the divorce decree Federal COBRA Continuation‌ If your employer has 20 or more employees, you and/or your eligible dependents (including domestic partners and their dependents) may be eligible to continue your health care coverage on a self-pay basis under certain qualifying events. This continuation coverage is made available pursuant to the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended. The following sections describe your rights to continuation under COBRA, and the requirements you must meet to enroll in continuation coverage. If you have questions about your COBRA continuation coverage, you should contact your employer. You, your spouse or domestic partner, and your dependents, as applicable, may only continue the health coverage that was in effect when the qualifying event took place. The coverage will be the same as that provided under the plan for active employees. A child who is born to or adopted by you while you are receiving continuation coverage is also entitled to continuation coverage. Written notice of a child born to or adopted by you while you are receiving continuation coverage must also be provided to the employer within 60 days of that event. Individuals entitled to COBRA continuation coverage have the same rights afforded similarly- situated plan members who are not enrolled in COBRA. COBRA participants may add newborns, a new spouse or newly eligible domestic partner, and adopted children (or children placed for adoption) as covered dependents in accordance with the plan’s eligibility and enrollment rules, including the plan’s special enrollment rules. A “qualifying event” is the event that causes your regular coverage under the plan to end and makes you eligible for continuation coverage. If you are an employee, you will become a qualified beneficiary if you lose coverage under the plan because either one of the following qualifying events happens: • Your hours of employment are reduced; or • Your employment ends for any reason other than your gross misconduct. Your spouse or domestic partner will become a qualified beneficiary if they lose coverage under the plan because any of the following qualifying events happens: • You die; • Your hours of employment are reduced; • Your employment ends for any reason other than for gross misconduct; or • You become divorced or legally separated, or terminate your domestic partnership. Your covered eligible children will become qualified beneficiaries if they lose coverage under the plan because any of the following qualifying events happens: • You die; • Your hours of employment are reduced; • Your employment ends for any reason other than for gross misconduct; • You become divorced or legally separated from your spouse, or terminate your domestic partnership; or • Your child is no longer eligible for coverage under the plan.

Type of Coverage. Under Oregon continuation, you can continue the coverage you had before the qualifying event. Oregon continuation benefits are always the same as your employerEmployer’s current benefits. Your employer Employer has the right to change the benefits of its health plan Plan or eliminate the plan Plan entirely. If that happens, any changes to the plan Plan will also apply to everyone enrolled in continuation coverage. We can provide you uninterrupted coverage when the existing Group Policy is replaced. If you are laid off and then rehired by your employer within nine months, you will not have to satisfy another waiting period. Your health coverage will resume coinciding with the date of return to work from layoff and again meet your employer’s minimum hour requirement. If your family members were covered before your layoff, they can resume coverage at that time as well. You must re-enroll your family members by submitting an enrollment application to Samaritan Health Plans within the 30 day initial enrollment period following your return to work. Failure to submit the application within the 30 day initial enrollment period to Samaritan Health Plans will cause you to be considered a late enrollee and coverage will be deferred until the next open enrollment date. [Continuation for Spouses or Qualified Domestic Partners over Age 55‌ Subject to the general provision of the planPlan, if you die, become divorced, or legally separated, or discontinue terminate your domestic partnership, and your covered spouse Spouse or domestic partner Qualified Domestic Partner is then age 55 or over, your spouse Spouse or domestic partner Qualified Domestic Partner and any other covered dependents Dependents may continue medical coverage under the plan Plan on a self-pay basis until the earliest to occur of the following events: • Failure to pay premiums when due; • Termination of the Group Policy, unless another group health plan is made available by the employer Employer to its employees; • Your legally separated, divorced or surviving spouse Spouse or domestic partner Qualified Domestic Partner becomes covered under another group health plan or becomes eligible for Medicare; or • Covered dependents Dependents no longer meet the eligibility Eligibility requirements of the planPlan. In order to be eligible for continued coverage, your spouseSpouse, domestic partner or dependent Qualified Domestic Partner or Dependents must give written notice of the legal separation, termination of marriage or domestic partnership, or death of the employee to the employer Employer within: • Thirty days of the date of the employee’s death death; • Sixty days of the date of legal separation (or dissolution of domestic partnership) ; or • Sixty days of the date of entry of the divorce decree decree.] Federal COBRA Continuation‌ If your employer Employer has 20 or more employees, you [and/or your eligible dependents (including domestic partners and their dependents) Dependents] may be eligible to continue your health care coverage under the Plan on a self-pay basis under certain qualifying events. This continuation coverage is made available pursuant to the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), as amended. The following sections describe describes your rights to continuation under COBRA, and the requirements you must meet to enroll in continuation coverage. If you have questions about your COBRA continuation coverage, you should contact your employerEmployer. You[A domestic partner who was covered at the time of the qualifying event may elect COBRA continuation coverage. Domestic partners have the same COBRA rights as a Spouse. Where this section refers to divorce or legal separation, your spouse or dissolution of domestic partner, partnership applies.] You [and your dependents, as applicable, Dependents] may only continue the health coverage that was in effect when the qualifying event took place. The coverage will be the same as that provided under the plan Plan for active employees. [A child who is born to or adopted by you while you are receiving continuation coverage is also entitled to continuation coverage. Written notice of a child born to or adopted by you while you are receiving continuation coverage must also be provided to the employer Employer within 60 days of that event. .] Individuals entitled to COBRA continuation coverage have the same rights afforded similarly- situated plan members Members who are not enrolled in COBRA. [COBRA participants Participants may add newborns, a new spouse or newly eligible domestic partnerSpouse, [a new Qualified Domestic Partner,] and adopted children (or children placed for adoption) as covered dependents Dependents in accordance with the planPlan’s eligibility Eligibility and enrollment rules, including the planPlan’s special enrollment rules. .] A “qualifying event” is the an event that causes your regular coverage under the plan Plan to end and makes you eligible for continuation coverage. If you are an employee, you will become a qualified beneficiary if you lose coverage under the plan Plan because either one of the following qualifying events happens: • Your hours of employment are reduced; or • Your employment ends for any reason other than your gross misconduct. [Your spouse Spouse [or domestic partner Qualified Domestic Partner] will become a qualified beneficiary if they lose coverage under the plan Plan because any of the following qualifying events happens: • You die; • Your hours of employment are reduced; • Your employment ends for any reason other than for gross misconduct; or • You become divorced or legally separatedseparated [, or terminate dissolve your domestic partnership]. Your covered eligible children will become qualified beneficiaries if they lose coverage under the plan Plan because any of the following qualifying events happens: • You die; • Your hours of employment are reduced; • Your employment ends for any reason other than for gross misconduct; • You become divorced or legally separated from your spouseSpouse [, or terminate dissolve your domestic partnership]; or • Your child is no longer eligible for coverage under the planPlan.]