2023/11/29 Council Agenda Packet

© Peak One Administration 2016 27 3. Processing COBRA Elections. (a) PSP will collect and process the Election Forms submitted by Qualified Beneficiaries and send a report to Client identifying which Qualified Beneficiaries elected COBRA coverage and the coverage they elected. An Election Form will be deemed by PSP to be timely sent by a Qualified Beneficiary if it received in the offices of PSP or, if earlier, is postmarked by a date that is no later than the date that is sixty-three (63) days from the date the notice was sent by PSP, except as otherwise instructed by the Client in writing. (b) PSP will process elections for COBRA Coverage under the applicable Health Plan. Determinations regarding eligibility for COBRA Coverage will be made in accordance with the written terms and conditions of the respective Plan. PSP will determine if a person is entitled to COBRA Coverage based upon information provided to it by Plan Administrator. PSP will refer to Plan Administrator any claim or class of claims specified in writing by Plan Administrator as well as any claim that is disputed after the initial denial. The Plan Administrator will have final discretionary authority to make all determinations regarding COBRA Coverage under the applicable Health Plan. 4. Reinstatement. Provided the individual elects COBRA Coverage and timely pays any required premiums within the timeframes described in the election notification, PSP will complete and submit any required documentation to insurance carriers, Health Plan and/or third party service providers regarding reinstatement of the coverage for COBRA Coverage purposes. 5. Open Enrollment and Changes in Coverage. PSP will send notices to Qualified Beneficiaries of the right to make changes to their coverage during the Client’s open Enrollment Period. Such notices will be distributed to the last known addresses of all Qualified Beneficiaries in the PSP records who are currently receiving COBRA coverage prior to the beginning of the annual enrollment period. PSP will also process any requested mid-year changes in elections in accordance with the Client’s plan documentation to the extent that Client has duly authorized PSP to do so with any health insurer or health plan. 6. Premium Billing and Collection. PSP will notify the Qualified Beneficiary of the amount due for the initial premium, which will be considered due forty-five (45) days after the date the election is made. PSP will provide Qualified Beneficiary with coupons (i.e. payment booklet) notifying the Qualified Beneficiary of the amount due and the due date. All subsequent premiums will be due thirty (30) days after the due date, which will be considered the first day of each month of the COBRA continuation coverage period unless instructed otherwise in writing by the Client. Premiums will be considered timely received if they are received in the offices of PSP or, if earlier, postmarked by applicable due date (including any grace periods). Premiums collected by PSP will be deposited into a PSP bank account but will be accurately accounted for in the books. PSP will send all premiums collected the previous month to Client by the tenth (10th) day after the end of the month, minus the administrative fee permitted under applicable law which PSP will retain as part of its administration fee. PSP will submit premiums to third parties upon written instruction from the Client. In addition, PSP will retain any interest earned on such funds while held in a PSP account as an administrative fee. Notwithstanding the previous two sentences, premiums will not be commingled with PSP’s own funds. 7. Notice of Termination and Conversion. If Client notifies PSP that conversion rights must be offered to a Qualified Beneficiary, PSP will send notice to the last known address of the Qualified Beneficiary in the PSP records that COBRA coverage is ending. PSP will simultaneously notify Qualified Beneficiaries that they are eligible for conversion coverage, where applicable