Proprietary 8-22 Important: The Farmers Agent Group Benefits Program currently treats the termination of an appointment agreement (other than for gross misconduct) as a qualifying event for COBRA purposes, even though this treatment is not required by law. We reserve the right to change or terminate this treatment at any time. To elect continuation coverage, you must complete a COBRA election form and send it to the address shown on the form within 60 days of the date health care coverage ends under the plan or the date of the COBRA notification, whichever is later. COBRA coverage applies only to your group dental and vision; it does not apply to life insurance, AD&D insurance or related to loss of income insurance, such as long-term disability coverage. However, you may be able to convert or port all or a portion of your life, AD&D, or long-term disability coverages to individual policies following termination. See the information about converting and porting these coverages described earlier in this guide. Qualifying events A “qualifying event” is defined as any of the events that result in a loss of health care coverage listed on page 38. Duration of COBRA coverage The duration of COBRA coverage depends on the type of qualifying event. General rule: 18-month maximum COBRA coverage for a qualified beneficiary (including you) begins the day after your health care coverage ends because of termination of an appointment agreement, termination of an agent or DM office staff member (for reasons other than gross misconduct) or a reduction in hours of work of an agent or DM office staff member to less than 20 hours per week, and may continue for up to 18 months. This general 18-month rule, however, has important exceptions that may lengthen or shorten the 18-month period of COBRA coverage. COBRA extension due to disability A qualified beneficiary may extend his or her COBRA continuation coverage for an additional 11 months beyond the original 18-month period, if he or she meets the following requirements: n Eligible for 18 months of COBRA continuation coverage because he or she experienced a loss of health care coverage due to termination of an appointment agreement or termination of employment or reduction in hours of work of an agent or DM office staff member (other than for gross misconduct); and n The Social Security Administration determines the qualified beneficiary is totally disabled at the time of the qualifying event or becomes totally disabled during the first 60 days of COBRA continuation coverage. To extend coverage for an additional 11 months beyond the original 18-month continuation coverage period, you and your dependents must notify the Farmers Agent Benefits Call Center of the Social Security Administration’s determination of disability. Evidence of the SSA’s determination of disability must be mailed to WageWorks, P.O. BOX 226101, Dallas, TX 75222, within 60 days of the SSA’s determination and before the end of the first 18 months of continuation coverage. Failure to comply with this deadline will result in the loss of all rights to the continuation coverage extension. The cost of continuation coverage for months 19 through 29 is 150% of the total premium rate of health care coverage. 39
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