If you have and/or will become covered under the Bowling Green State University (BGSU) Group Insurance Plan (the Plan) it is important to know your COBRA rights. The Plan sponsors two medical plans  including prescription drug coverage, two dental plans, two vision plans and a Health FSA.

Below is a sample notice of Continuaton Coverage Rights Under COBRA:

You're getting this notice because you recently gained coverage under a group health plan (the Plan). This notice has important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. This notice explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect your right to get it. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage.

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end. For more information about your rights and obligations under the Plan and under federal law, you should review the Plan's Summary Plan Description or contact the Plan Administrator.

You may have other options available to you when you lose group health coverage. For example, you may be eligible  to buy an individual plan through the Health Insurance Marketplace. By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse's plan), even if that plan generally doesn't accept late enrollees.

The employer listed above has contracted with Chard Snyder to provide administrative functions on its behalf, including sending this notice to you. You must notify Chard Snyder Benefit Continuation Department of any covered family members who live at a different address. If you fail to notify us, they may not receive notice of their COBRA rights.

While this notice contains important information, it does not fully explain COBRA or your rights . For more information about your rights and obligations under the Plan and under federal law, you should review the Plan's Summary Plan Description or contact the Plan Administrator.

What Is COBRA Continuation Coverage?

COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event. This is called a "qualifying event." Specific qualifying events are listed later in this notice. After a qualifying event, COBRA continuation coverage must be offered to each person who is a "qualified beneficiary." You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Under the Plan, qualified beneficiaries who elect COBRA continuation coverage are required to pay for the coverage.

If you're an employee, you'll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

• Your hours of employment are reduced, or 
• Your employment ends for any reason other than your gross misconduct.

If you're the spouse of an employee, you'll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events:

• Your spouse dies;
• Your spouse's hours of employment are reduced;
• Your spouse's employment ends for any reason other than his or her gross misconduct ; Your spouse becomes entitled to Medicare benefits (under Part A, Part B, or both); or
• You become divorced or legally separated from your spouse. Also, if your spouse (the employee) reduces or eliminates your group health coverage in anticipation of a divorce or legal separation, and a divorce or legal separation later occurs, then the divorce or legal separation may be considered a qualifying event for you even though your coverage was reduced or eliminated before the divorce or separation.

Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events:

• The parent-employee dies;
• The parent-employee's hours of employment are reduced;
• The parent-employee's employment ends for any reason other than his or her gross misconduct; The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
• The parents become divorced or legally separated; or
• The child stops being eligible for coverage under the Plan as a "dependent child."

Sometimes, filing a proceeding in bankruptcy under title I 1 of the United States Code can be a qualifying event. If a proceeding in bankruptcy is filed with respect to the employer named above , and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan, the retired employee will become a qualified beneficiary. The retired employee's spouse, surviving spouse, and dependent children will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan.

More Information About Individuals Who May Be Qualified Beneficiaries

A child born to, adopted by, or placed for adoption with a covered employee during a period of COBRA coverage is a qualified beneficiary if the covered employee is also a qualified beneficiary and has elected COBRA coverage.

COBRA coverage for the child begins when the child is enrolled in the Plan (through "special enrollment" rights or during open enrollment), and it lasts for as long as COBRA coverage lasts for other family members of the employee.

Children Receiving Benefits Through a QMCSO

A child of the covered employee who is receiving benefits under the Plan due to a Qualified Medical Child Support Order (QMCSO) is entitled to the same rights to elect COBRA as an eligible dependent child of the covered employee.

When Is COBRA Continuation Coverage Available?

The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. The employer must notify the Plan Administrator of the following qualifying events:

• The end of employment or reduction of hours of employment;
• Death of the employee;
• Commencement of a proceeding in bankruptcy with respect to the employer;]; or
• The employee's becoming entitled to Medicare benefits (under Part A, Part B, or both).

For all other qualifying events (divorce or legal separation of the employee and spouse or a dependent child's losing eligibility for coverage as a dependent child), you must provide notice within 60 days after the qualifying event occurs.

How is COBRA continuation coverage provided?

Once the Plan Administrator receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their child ren.

COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, the employee's becoming entitled to Medicare benefits (under Part A, Part B, or both), your divorce or legal separation, or a dependent child's losing eligibility as a dependent child, COBRA continuation coverage lasts for up to a total of 36 months. Otherwise, when the qualifying event is the end of employment or the reduction of the employee's hours of employment, COBRA continuation coverage generally lasts for 18 months .

There are also ways in which this 18-month period of COBRA continuation coverage can be extended:

Disability extension of 18-month period of COBRA continuation coverage

If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion, you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage, for a maximum of29 months. The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of COBRA continuation coverage.

Second qualifying event extension of 18-month period of continuation coverage

If your family experiences another qualifying event during the 18 months of COBRA continuation  coverage, or during a disability extension period as described above, the spouse and dependent children getting COBRA continuation coverage can get up to 18 additional months of COBRA continuation coverage, for a maximum of36 months, if the  Plan is properly notified about the second qualifying event. This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies; becomes entitled to Medicare benefits (under Part A, Part B, or both); gets divorced or legally separated; or if the dependent child stops being eligible under the Plan as a dependent child. This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred.

A Special Note About Medicare: When the qualifying event is the end of employment or reduction of the employee's hours, and the employee became entitled to Medicare less than 18 months before the qualifying event, COBRA coverage for the employee's spouse and dependents can last until 36 months after the date the employee becomes entitled to Medicare. For example, if a covered employee becomes entitled to Medicare eight months before the date his/her employment ends (termination of employment is the COBRA qualifying event), COBRA coverage for his/her spouse and children would last 28 months (36 months minus eight months).

The COBRA coverage periods described above are maximum coverage periods. Continuation coverage may end before the dates noted above in certain circumstances like failure to pay premiums, fraud, or the individual becomes covered under Medicare or another group health plan. More information is available in the Plan's summary plan description (SPD).

Health FSAs and COBRA

Special rules apply to electing continuation coverage under the Health FSA component. Only qualified beneficiaries who have "underspent accounts" may elect to continue their Health FSA component under COBRA. An account is underspent if the amount remaining in the account is greater than the cost to continue Health FSA coverage under COBRA for the remainder of the plan year (for example, ifit would cost $612 to continue the health FSA under COBRA for the remainder of the year, but the amount left in the account is greater than $612, the account is underspent).

If elected, continuation coverage for the Health FSA is equal to the coverage in force at the time of the qualifying event (i.e ., the health FSA election amount reduced by the amount of any reimbursable claims submitted up to the time of the qualifying event).

Unlike other components, coverage under the Health FSA is only available through the end of the current Health FSA plan year. For example, if you terminate in June and your health FSA has a calendar plan year, continuation coverage for the health FSA is only available through December 31, even though your maximum COBRA coverage period is 18 months.

Are there other coverage options besides COBRA Continuation Coverage?

Yes. Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medic are, Medicaid , Children's Health Insurance Program (CHIP). or other group health plan coverage options (such as a spouse's plan) through what is called a "special enrollment period ." Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov .

Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends? In general, if you don't enroll in Medicare Part A or B when you are first eligible because you are still employed, after the Medicare initial enrollment period, you have an 8-month special enrollment period* to sign up for Medicare Part A or B, beginning on the earlier of:

• The month after your employment ends; or
• The month after group health plan coverage based on current employment ends.

If you don't enroll in Medicare and elect COBRA continuation coverage ins tead, you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later enroll in Medicare Part A or B before the COBRA continuation coverage ends, the Plan may terminate your continuation coverage. However, if Medicare Part A or Bis effective on or before the date of the COBRA election, COBRA coverage may not be discontinued on account of Medicare entitlement, even if you enroll in the other part of Medicare after the date of the election of COBRA coverage.

If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare.

For more information visit htt.ps: //www.med ic are.gov/medicare-and-you .

*https://www.medicare.gov/sign-up-change-plans/how-do- i- get-parts-a-b/part-a-part-b-sign-up-periods . These rules are different for people with End Stage Renal Disease (ESRD).

If you have questions

Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below . For more information about your rights under the Employee Retirement Income Security Act (ERISA), including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) in your area or visit www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA's website .) For more infonnation about the Marketplace, visit www.HealthCare.gov.

Keep your Plan informed of address changes

To protect your family's rights , let the Plan Administrator know about any changes in the addresses of family members . You should also keep a copy, for your records, of any notices you send to the Plan Administrator.

Appeals

If you believe that you have rights under COBRA that you were not permitted to exercis e, you may file an appeal by completing and returning the form available online at https://bit.Iy/uhr-appeal- form.  You must submit  your appeal  by  the appropriate deadline:

• Within sixty (60) days of the presumed qualifying event date if you believe that you should have received a COBRA election notice but did not
• In all other instances, no later than sixty (60) days after receiving an adverse determination from Chard Snyder Benefit Continuation Department (e.g., you receive notice that your coverage is ending for failing to make a timely payment, your request for coverage was denied, etc.).

Upon receipt of your appeal, Chard Snyder Benefit Continuation Department will furnish your appeal to the Plan Administrator. The Plan Administrator will review your appeal and issue a decision within sixty (60) days ofreceiving your timely appeal. If you do not agree with the Plan Administrator's final determination you may take legal action in accordance with ERISA Section 502; however, you cannot take legal action unless you have exhausted the plan's COBRA appeal process.

Contact information

For additional information about your rights and obligations under COBRA, please review the Plan's Summary Plan Description or contact the plan administrator (see contact information below).

You may also contact Chard Snyder Benefit Continuation Department toll-free at 1-888-993-4646. Representatives are available Monday through Friday from 8 a.m. to 8 p.m. Eastern Time (excluding holidays) . You may also contact us by email at HealthBenefitSuppo rt@wexinc.com.

Plan Name:                                            Bowling Green State University Health & Welfare Plan

Plan Administrator:                                  Bowling Green State University 1851 N. Research Drive Bowling Green, Ohio 43403

Duration of COBRA Coverage:

Once the Office of Human Resources receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. Covered employees may elect COBRA continuation coverage on behalf of their spouses, and parents may elect COBRA continuation coverage on behalf of their children.

COBRA coverage is a temporary continuation of coverage. When the qualifying event is death of the employee, the covered employee’s divorce or legal separation, or a dependent child’s losing eligibility as a dependent child, COBRA coverage can last for up to 36 months. However, COBRA coverage under the health FSA component, if elected, can last only until the end of the year in which the qualifying event occurred. (Please refer to Health FSA Component paragraph on Page 5 of this notice.)

If the qualifying event is a result of the end of employment or reduction of the employee’s hours of employment and the employee became entitled to Medicare benefits less than 18 months before the qualifying event, COBRA coverage for qualified beneficiaries (other than the employee) who lose coverage as a result of the qualifying event can last up to 36 months after the date of Medicare entitlement. Example:

If a covered employee becomes entitled to Medicare eight months before the date on which his employment terminates, COBRA coverage under the Plan’s medical/prescription drug/dental components for his/her spouse and children who lost coverage as a result of his/her termination can last up to 36 months after the date of Medicare entitlement, which is equal to 28 months after the date of the qualifying event (36 months minus eight months). This COBRA period is available only if the covered employee becomes entitled to Medicare within 18 months before the termination or reduction of hours. However, COBRA coverage under the Health FSA component if elected, can last only until the end of the year in which the qualifying event occurred.

When the qualifying event is the end of employment or reduction of the employee’s hours of employment, COBRA coverage generally can last for up to a total of 18 months.

The COBRA coverage periods described above are maximum coverage periods. However, COBRA coverage can end before the end of the maximum coverage periods described in this notice for several reasons, which are described in the Plan’s SPD.

There are two ways in which COBRA coverage resulting from a termination of employment or a reduction of hours can be extended. (The period of COBRA coverage under the health FSA component cannot be extended under any circumstances.)

Disability Extension of COBRA:

An 18-month period of continuation coverage may be extended for up to 11 months (for a total of 29 months of continuation coverage), if you or anyone in your family covered under the Plan is determined by the Social Security Administration (SSA) to be disabled. The disability has to have started at some time before the 61st day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. The disability extension is available only if you notify the Office of Human Resources in writing of the SSA’s determination of disability within 60 days after the latest of:

• The date of the SSA’s disability determination;
• The date of the covered employee’s termination of employment or reduction of hours;
  

            or,

• The date on which the qualified beneficiary loses coverage under the terms of the Plan as a result of the covered employee’s termination of employment or reduction of hours.

You must also provide this notice within 18 months after the covered employee’s termination of employment or reduction of hours in order to be entitled to a disability extension.

Second Qualifying Event Extension of COBRA Coverage:

If a second qualifying event occurs within the 18-month or 29-month coverage period, the maximum coverage period becomes 36 months from the date of the initial termination or reduction in hours.

If your dependents experience another qualifying event while receiving COBRA continuation coverage, the spouse and dependent children in your family can get additional months of COBRA continuation coverage, up to a maximum of 36 months if notice of the second qualifying event is properly given to the Office of Human Resources. This extension may be available to the spouse and any dependent children receiving COBRA coverage if the employee or former employee dies, becomes entitled to Medicare benefits (under Part A, Part B, or both), or gets divorced or legally separated, or if the dependent child stops being eligible under the Plan as a dependent child, but only if the event would have caused the spouse or dependent child to lose coverage under the Plan, had the first qualifying event not occurred.

This extension due to a second qualifying event is available only if you notify the Office of Human Resources in writing of the second qualifying event within 60 days after the later of the date of the second qualifying event; and the date on which the qualified beneficiary would lose coverage under the terms of the Plan as a result of the second qualifying event, if it had occurred, while the qualified beneficiary was still covered under the Plan.

Health FSA Component:

COBRA coverage under the health FSA will be offered only to qualified beneficiaries losing coverage who have under-spent accounts. A qualified beneficiary has an under spent account if the annual limit elected by the covered employee, reduced by reimbursements up to the time of the qualifying event, is equal to or more than the amount of premiums for health FSA COBRA coverage that will be charged for the remainder of the plan year. COBRA coverage will consist of the health FSA coverage in force at the time of the qualifying event, (i.e., the elected annual limit reduced by expenses reimbursed up to the time of the qualifying event.) The use-it-or-lose-it rule will continue to apply, so, any unused amounts will be forfeited at the end of the Plan year, and health FSA COBRA coverage will terminate at the end of the Plan year. Unless otherwise elected, all qualified beneficiaries who were covered under the health FSA will be covered together for health FSA COBRA coverage. However, each beneficiary has separate election rights and could alternatively elect separate COBRA coverage to cover that beneficiary only, with a separate health FSA annual limit and a separate premium. If you are interested in this alternative, contact the Office of Human Resources for more information.

Other Individuals Who May be Qualified Beneficiaries:

If, during the period of continuation coverage, a child is born to the covered employee, or is placed for adoption with the covered employee, the child is considered a qualified beneficiary and will be treated like all other COBRA-qualified beneficiaries with respect to the same qualifying event. The maximum coverage period for such a child is measured from the same date as for other qualified beneficiaries with respect to the same qualifying event (and NOT from the date of the child’s birth or placement for adoption). The covered employee or guardian has the right to elect continuation coverage for the child, provided the child satisfies the applicable plan eligibility requirements. The Office of Human Resources must be notified within 30 days of the birth or placement to enroll the child on COBRA.

A child of the covered employee who is receiving benefits under the Plan pursuant to a Qualified Medical Child Support Order (QMCSO) received by the Office of Human Resources during the covered employee’s period of employment with the employer is entitled to the same rights under COBRA as a dependent child of the covered employee, regardless of whether that child would otherwise be considered a dependent.

If You Have Questions:

Questions concerning your Plan or your COBRA rights should be addressed to the contact identified on the first page of this notice. For more information about your rights under ERISA, including COBRA, the
Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, you may contact the nearest Regional or District Office of the U. S. Department of Labor’s Employee Benefits Security Administration (EBSA). Addresses and phone number of Regional and District EBSA Offices are available through EBSA’s website at www.dol.gov\ebsa.

Keep Your Employer Informed of Address Changes:

In order to protect your rights as well as your dependent’s rights, you should keep the Office of Human Resources informed of any changes in the address that may occur on behalf of you and/or your family
members. You should also keep a copy, for your records, of any notices you send to the Office of Human Resources.

Plan Contact Information:

You may obtain information about the Plan and COBRA coverage on request from the Office of Human Resources.