Proprietary 8-23 COBRA 38 COBRA CONTINUATION COVERAGE VERY IMPORTANT NOTICE The Farmers Agent Group Benefits Program offers participants and their dependents a temporary extension of health care coverage (called “continuation coverage”) at group rates in certain instances where coverage under the plan would otherwise end. YOU, YOUR SPOUSE AND YOUR DEPENDENTS SHOULD READ THIS SECTION VERY CAREFULLY. It is important that you and your dependents are aware of this plan provision, since you and your dependents will be required to take specific actions to exercise your rights to continued coverage. Please review the following information carefully and save it for future reference. For additional information on continuation of coverages, see your summary plan description (SPD). COBRA continuation coverage applies to you and/or your dependents if: n You are not eligible for an extension of benefit coverage after you leave (see page 39). n You experience a qualifying event that leads to loss of dental or vision coverage (see “Qualifying Events” below). This section contains information about your right to elect continuation of dental and vision coverage, under the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA). Please read this section carefully. It explains the conditions that apply to continuation of your and/or your dependents’ dental and vision coverage under COBRA. You and/or your dependents will lose the right to continue coverage if you and/or your dependents do not make a timely election. The right to continue dental and vision coverage on your own, and at your own expense, applies to agents, district managers, staff members of agents and district managers, covered spouses and dependent children (“qualified beneficiaries”) covered through the Farmers Agent Group Benefits Program who lose dental and/or vision coverage as a result of a “qualifying event.” If your covered spouse and/or covered dependent child does not live with you when a qualifying event occurs, you must notify the Farmers Agent Benefits Call Center within 60 days following the qualifying event of his or her address so the Farmers Agent Benefits Call Center can provide him or her with COBRA information and a COBRA election form. Qualifying Events Individuals Eligible For COBRA Coverage COBRA Duration Termination of appointment agreement or of an office staff member for any reason (other than for gross misconduct) Covered agents, district managers and staff members of agents and district managers; covered spouse and/or covered dependent children 18 months Reduction in hours of work to less than 20 hours per week Covered staff members of agents and district managers; covered spouse and/or dependent children 18 months Death Covered spouse and/or covered dependent children 36 months Divorce, legal separation or annulment Covered spouse and dependent children 36 months Covered dependent child no longer qualifies for coverage as dependent Covered dependent child 36 months The occurrence of one of these events does not in itself create any rights to COBRA continuation coverage.
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