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2020/12/16 Council Agenda Packet
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2020/12/16 Council Agenda Packet
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Council Agenda Packet
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12/16/2020
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6.4 Cessation of Benefits No person is entitled to Covered Services after termination of this Contract. <br />Termination of this Contract ends all obligations of the Company to provide Covered Services, even <br />if the Enrollee was receiving treatment while this Contract was in force or needs treatment for any <br />existing condition, except as specified otherwise. <br />6.5 Continuation Rights. The Policyholder agrees to administer continuation of coverage in <br />accordance with state and federal laws and notify all Enrollees of their right to continuation of <br />coverage. For more information regarding continuation rights, Enrollees should contact the <br />Policyholder. <br />6.5.1 Federal or State Mandated Continuation Coverage. Coverage for Enrollees may <br />continue during a leave of absence taken in accordance with any federally -mandated or <br />state -mandated leave act or law. <br />6.5.2 COBRA. Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), <br />as amended certain circumstances, called qualifying events, give Members and some <br />Dependents the right to continue coverage beyond the time it would ordinarily end. Federal <br />law governs COBRA continuation rights and obligations. The Policyholder is responsible <br />for administering COBRA continuation coverage. <br />6.5.3 Labor Disputes. If a Member's compensation is suspended or terminated as the result of <br />a strike, lockout, or other labor dispute, coverage may continue for up to 6 months if the <br />Member pays the Premium to the Policyholder as it becomes due, including the <br />Policyholder's portion, if any. The Policyholder shall notify the Member in writing of the <br />right to continue coverage. The Premium rates during a work stoppage are equal to the <br />Premium rates in place before the work stoppage. The Company may change the <br />Premium rates according to the provisions of this Contract. Coverage will terminate on the <br />earliest of the following events: <br />a. The last day of the month for which the Premium is paid, if the Premium is unpaid at <br />the end of the grace period; <br />b. The last day of the 6t" month following the date the work stoppage began; <br />c. The last day of the month after the Member begins full-time employment with another <br />employer or <br />d. The date of termination of this Contract. <br />If coverage is no longer available to the Member under this Contract, then the Member may <br />purchase an individual dental plan from the Company at a premium rate consistent with <br />premium rates filed with the Washington State Office of the Insurance Commissioner. <br />6.5.4 Leave of Absence. Coverage may be continued during a temporary, employer approved <br />leave of absence for up to 3 months. <br />6.5.5 If coverage ends because continuation rights expire, coverage may reinstate pursuant to <br />applicable federal or state law, if the Enrollee satisfies the applicable eligibility and <br />enrollment requirements. <br />001 L-WA811(5/20) 17 <br />
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