Proprietary 8-23 Eligibility for COBRA coverage You and each of your covered dependents who were covered through the Farmers Agent Group Benefits Program on the day before the qualifying event have the right to continue dental and/or vision coverage on a self-pay basis. However, the right to COBRA continuation coverage terminates when the covered individual, your spouse and/or dependent becomes covered under another dental and/or vision plan that does not limit or exclude coverage for pre-existing conditions. If the covered individual becomes covered under another health care plan and that plan contains a pre-existing condition limitation that affects you and/or your covered dependents, then COBRA continuation coverage for you and/or your covered dependents cannot be terminated. See “When COBRA Coverage Ends” on page 43 for a complete listing of events that cause COBRA continuation coverage termination. Whom to notify about a COBRA qualifying event A qualified beneficiary must notify WageWorks within 60 days of the date of a COBRA qualifying event, except for loss of 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. Failure to do so may result in loss of eligibility for COBRA continuation coverage. How to sign up for COBRA coverage When the Farmers Agent Benefits Call Center is notified on a timely basis that a qualifying event has occurred, they will send the qualified beneficiaries a COBRA package consisting of a cover letter, a notice and an election form. The information reflected on the forms will include the premium rates, which qualified beneficiaries were enrolled on the day before the qualifying event and what plans they were enrolled in (e.g. dental and vision coverage). 60 days to decide To elect COBRA continuation coverage, a qualified beneficiary must complete the COBRA election form and send it to WageWorks, at the address listed on the form, within 60 days of the later of (i) the date that health care coverage is lost because of a qualifying event, or (ii) the date that the COBRA package was sent to the qualified beneficiaries. Failure to comply with this deadline will result in the loss of all rights to continuation coverage. The initial payment for continuation coverage is due on the date that the COBRA election form is sent to WageWorks. The initial payment must include all retroactive premiums due (going back to your last day of active coverage). The initial payment for continuation coverage is considered to be made on a timely basis only if it is sent to WageWorks within 45 days of the date that the COBRA election form is sent to WageWorks. Failure to comply with this deadline will result in the loss of all rights to continuation coverage. The 60-day election period is not an extension of benefits; you, your spouse, and your dependents are not covered during this time unless the COBRA election form is completed and received by WageWorks on a timely basis, including the initial payment. Otherwise, coverage through the Farmers Agent Group Benefits Program ends on the date shown on the COBRA election form. COBRA coverage is implemented retroactively after a qualified beneficiary elects and pays for continuation coverage. Therefore, no break in coverage will occur if the COBRA election is made within the 60-day election period, and all COBRA premiums (current and retroactive) are paid in a timely manner. If these requirements are met, then claims for health care treatment and/or service during the 60-day election period will be processed. If a qualified beneficiary does not elect continuation coverage, health care coverage will end on the date shown on the COBRA election form. 41
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