Allows for the provision of benefits for you and your eligible dependents in the event you become disabled.
The extension of benefits is ONLY available if your Schedule of Benefits includes a disability extension of benefits.
You are required to submit the following to the Administrative Office:
Coverage may extend for 12 or up to 18 months. Refer to your Summary Plan Description for complete details.
Coverage will continue until the earliest of:
Allows you to continue coverage for yourself and your eligible dependents in the event you lose eligibility as an active employee or disabled employee.
If you lose eligibility as an active employee or disabled employee, you may continue coverage for yourself and your eligible dependents (excluding any disability extension or weekly disability benefits) by paying the cost of coverage yourself.
Self-payments may be made for a maximum of 6 consecutive months. When you have exhausted the 6 months allowed for self-payment, you and your eligible dependents may continue the health care portion of your coverage under the provisions of COBRA. (Refer to information on COBRA below.)
Each self-payment must be sufficient to cover the cost of the coverage provided, plus the cost of administration, for one month.
The first self-payment must be received by the Administrative Office before the first day of the month for which coverage is desired. Subsequent self-payments must be received in the Administrative Office prior to the first day of the month for which coverage is desired. Self-payments must remain continuous
Provides the option to temporarily continue coverage if you or your qualified beneficiary lose eligibility.
A qualified beneficiary is any individual (your spouse or dependent child) who was covered under the Plan on the day before you experienced a qualifying event. A child who becomes your dependent while you are covered under COBRA is also a qualified beneficiary.
|Qualifying Event||Who May Continue Coverage|
|Your voluntary resignation;|
Termination of your employment for reasons other than gross misconduct; or
A reduction in your hours.
|You, your spouse, and/or your dependent children covered under the Plan.|
|Your death||Your spouse and/or your dependent children covered under the Plan.
|Your divorce or legal separation from your spouse.||Your former spouse and/or your dependent children covered under the Plan.|
|Your child ceases to meet the Plan’s definition of an eligible dependent.||The affected dependent child who was covered under the Plan.|
You must notify the Administrative Office when:
|Qualifying Event||Who May Continue Coverage|
|You become divorced or legally separated from your spouse.|
A child no longer qualifies as a “dependent child.”
A second qualifying event occurs while your dependents are in an 18-month COBRA continuation period.
|No later than 60 days after the later of (1) the date of the qualifying event; (2) the date on which coverage would be lost under the Plan as a result of the qualifying event; or (3) the date you are informed of your responsibility to provide notice to the Administrative Office.
|The Social Security Administration determines that the person receiving COBRA Continuation Coverage is no longer disabled.||No later than 30 days after the later of (1) the date of the Social Security Administration determination that the qualified beneficiary is no longer disabled.; or (2) the date you are informed of your responsibility to notify the Administrative Office.|
You should also notify the Administrative Office when you become eligible for Medicare.
Refer to your Summary Plan Description for complete details regarding COBRA continuation coverage and Medicare.
You must complete and sign the Fund’s COBRA Event Notification Letter. If you have questions about how to fill out the form, contact the Administrative Office at 323-278-7030 or 800-499-8121. Make a copy of the notice for yourself before mailing it to the address below. You may also send a letter to the Fund identifying your name, the qualifying event that has taken place, the date of the event, and the date coverage would be lost because of the event.
Address your notice to:
LOS ANGELES MACHINIST BENEFIT TRUST
PO Box 6149 Garden Grove, CA 92846
Once the Administrative Office is notified that you have experienced a qualifying event, it will send you and/or your dependents an election form and information regarding COBRA Continuation Coverage. You will have at least 60 days from the date your coverage terminates or, if later, 60 days from the date the Administrative Office sends you the notice to make a decision to elect COBRA Continuation Coverage.
The premium rate will be included in the notice sent to you by the Administrative Office.
If you are an HMO participant living in California, you can elect COBRA-like coverage. This coverage is not provided by the Los Angeles Machinist Benefit Trust. Call Member Services at your HMO for more information on your rights and how to elect coverage.