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Citv of Arden Hills Summary Plan Description If you are the spouse of an employee, you will become a qualified beneficiary if you will lose your . coverage under the Plan because any of the following qualifying events happens: 1. Your spouse dies; 2. Your spouse's hours of employment are reduced; 3. Your spouse's employment ends for any reason other than his or her gross misconduct; 4. Your spouse becomes enrolled in Medicare (Part A, Part B, or both); or 5. You become divorced or legally separated from your spouse. Your dependent children will become qualified beneficiaries if they will lose coverage under the Plan because any of the following qualifying events happens: I. The parent-employee dies; 2. The parent-employee's hours of employment are reduced; 3. The parent-employee's employment ends for any reason other than his or her gross misconduct; 4. The parent-employee becomes enrolled in Medicare (Part A, Part B, or both); 5. The parents become divorced or legally separated; or 6. The child stops being eligible for coverage under the plan as a "dependent child." COBRA continuation coverage is a temporary continuation of coveragc. When the qualifying event is the death of the employee, enrollment of the employee in Medicare (Part A, Part B, or both), your divorcc or legal separation, or a dependent child losing eligibility as a dependent child, COBRA continuation coverage lasts for up to 36 months. A qualified beneficiary must elect coverage by the date specified on the election form provided by the . Plan Administrator upon notification of a qualifying event. Failure to do so will result in loss of the right to elect continuation coverage under the Plan. A qualified beneficiary may change a prior rt:1ection of continuation coverage any time until that date. Generally, each qualified beneficiary may be required to pay the entire cost of continuation coverage. The amount a qualified beneficiary may be required to pay may not excecd 102 percent of the cost to the group health plan (including both employer and employee contributions) for coverage of a similarly situated plan participant or beneficiary who is not receiving continuation coverage (or, in the case of an extension of continualion coverage due to a disability, 150 percent). The Trade Act of 2002 created a new tax credit for certain individuals who become eligible for trade adjustment assistance (eligible individuals). Under the new tax provisions, eligible individuals can either take a tax credit or get advance payment of 65% of premiums paid for qualified health insurance, including continuation coverage. If you have questions about these tax provisions, you may call the Health Care Tax Credit Customer Contact Center toll-free at 1-866-628-4282. TTDrrrY callers may call toll-free at I -866-626-4282. More information about the Trade Act is also available at www.doleta.gov/tradeact/2002act index.asp. WHAT NOTICE OBLIGATIONS DO I HAVE UNDER COBRA? The Dcpartment of Labor's 2004 final COBRA regulations require plans to establish reasonable procedures for the fumishing of notices that covered employees or qualified beneficiaries are required to provide to the Plan Administrator. The following Procedures apply to the Plan and must be followed by a covered employee or qualified beneficiary providing any of the following COBRA notices: qualif'ying . SPD-14