COBRA Insurance

Overview

The City of Saint Louis Offers COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) coverage for medical and dental insurance to employees whose status is other than an active status. The City of St. Louis Department of Personnel, as the Plan administrator, sends out COBRA notices to those eligible within 14 days of notification receipt of the qualifying event.

Federal Law requires that most group health plans (including this plan) give employees and their families the opportunity to continue their medical coverage when there is a "qualifying event" that would result in a loss of coverage under an employer's plan. Depending on the type of qualifying event, "qualified beneficiaries" can include the employee (or retired employee) covered under the group health plan, the covered employee's spouse, domestic partner and dependent children of the covered employee.

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Coverage

Continuation coverage is the same coverage that the Plan gives to other participants or beneficiaries under the Active employee group health plan who are not receiving continuation coverage. Each qualified beneficiary who elects continuation coverage will have the same rights under the Plan as other participants or beneficiaries covered under the Plan including open enrollment and special enrollment rights.

In the case of a loss of coverage due to end of employment or reduction in hours of employment, coverage generally may be continued only for up to a total of 18 months. In the case of losses of coverage due to an employee's death, divorce or legal separation, the employee's becoming entitled to Medicare benefits or a dependent child ceasing to be a dependent under the terms of the plan, coverage may be continued for up to a total of 36 months.  When the qualifying event is the end of employment or reduction of the employee's hours of employment, and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA continuation coverage for the qualified beneficiaries other than the employee may be continued up to 36 months from the date of Medicare entitlement.

Individuals are eligible for benefits under COBRA upon termination of coverage under the Active employee group health plan. When the City of St. Louis Employee Benefits Section receives official report of the employee separation from employment or discontinuation of premium deduction via payroll, medical coverage comes to an end.

COBRA continuation of coverage notification follows this event giving the individual the opportunity to continue to be covered (no gap in coverage) under the City COBRA plan. COBRA notifications are sent via USPS Certified Mail to the individuals address of record in the City payroll system. Individuals have 60 days from the qualification date to determine an enrollment selection.

Individuals desiring to enroll under the COBRA plan will need to complete and return the following documents within the timeframe provided in the Notification:

• COBRA selection form
• Medical insurance enrollment form
• Dental insurance enrollment form

Individuals have 45 days, after the enrollment notification to the City, to make an initial payment. The initial payment, made out to the City of St. Louis must be made in the form of a cashier’s check or money order.

Personal checks will be accepted after the initial payment. COBRA members are able to set up monthly payments via their online banking.

Payment is due upon the first day of each month of coverage. There is a 30-day grace period after each due date during which payment may still be made, however if payment is not received within the 30-day grace period coverage under COBRA will be lost. Checks are to be made out to City of St. Louis Employee Benefits Section and mailed to:

Termination of Coverage

Continuation coverage will be terminated before the end of the maximum period if:

• Any required premium is not paid in full on time;
• A qualified beneficiary becomes covered, after electing continuation coverage, under another group health plan;
• A covered member becomes entitled to Medicare benefits (under Part A, Part B, or both) after electing continuation coverage; or
• The employer ceases to provide any group health plan for its employees.

Continuation coverage may also be terminated if for any reason the Plan would terminate coverage of a participant or beneficiary found not to be entitled continuation coverage.

Extension of Coverage

An 11-month extension of coverage may be available if any of the qualified beneficiaries is determined by the Social Security Administration (SSA) to be disabled. The disability has to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. Each qualified beneficiary who has elected continuation coverage will be entitled to the 11-month disability extension if one of them qualifies. If the qualified beneficiary is determined by SSA to no longer be disabled, the beneficiary must notify the Plan of that fact within 30 days after SSA's determination.

An 18-month extension of coverage will be available to spouses and dependent children who elect continuation coverage if a second qualifying event occurs during the first 18 months of continuation coverage. The maximum amount of continuation coverage available when a second qualifying event occurs is 36 months. Such second qualifying events may include the death of a covered member, divorce or separation from the covered member, the covered member's becoming entitled to Medicare benefits (under Part A, Part B, or both), or a dependent child's ceasing to be eligible for coverage as a dependent under the Plan. These events can be a second qualifying event only if they would have caused the qualified beneficiary to lose coverage under the Plan if the first qualifying event had not occurred. You must notify the Plan within 60 days after any second qualifying event occurs if you want to extend your continuation coverage.

Plan Information

Please follow the link below for additional information:

COBRA Rate Information and Enrollment Forms

COBRA Health Certificate

For more information on COBRA please contact the Department of Personnel Employee Benefits Section at CityEmployeeBenefits@stlouis-mo.gov.

Medical Insurance for Retiring Employees

The City of St. Louis also has a Retiree group health plan accessible to employees who retire from the City.

The Retiree medical coverage is identical to the Active employee coverage except that the employer does not sponsor Retiree premiums, and retirees are responsible for the full premium rate. The Retiree plan is available for an extended, continuous period of time as long as the premium payments are made in full and on a timely basis.

City Retirees have the option of selecting COBRA continuation of coverage for the eligibility period, thus forfeiting their rights to the Retiree group health plan. If a retiree rejects COBRA continuation of coverage in favor of the retiree medical coverage then the retiree has no additional COBRA rights once the retiree medical coverage ceases under the terms of that program.

Eligible dependents will retain COBRA rights if the retiree, on the retiree group plan, ends their coverage due to the retiree's death, divorce, or other COBRA qualifying events.

The City Retiree Plan may last until the retiree reaches age 65. These rules are applicable to civilian City employees who have paid into Social Security.

Anthem Retiree Plan Booklet

Retiree Health Certificate

United Healthcare Medicare Advantage Plan

City of Saint Louis retirees may also choose to enroll in United Healthcare's Medicare Advantage Plan. The Medicare Advantage Plan is a Medicare supplement offered at no cost to City of St. Louis retirees. Plan information can be found here.