CCP 12-13-2004 - Laserfiche WebLink

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. . . Citv of Arden Hills Summary Plan Description event notices, second qualifying event notices, disability notices, and change of disability status notices. Failure to follow these Procedures shall reduce or completely eliminate the period of COBRA coverage. Qualifving Event Notice CQBRA requires that each covered employee or qualified beneficiary is responsible for notifying the Plan Administrator within 60 days after coverage would be lost following the occurrence of the triggering events listed below: . Divorce or legal separation of a covered employee from his or her spouse; . Enrollment in Medicare; and . A dependent child's losing dependent status under the Plan. The Qualifying Event Notice must indicate the specific triggering event causing the Notice and the date of the triggering event. Second Qualifying Event Notice The Plan requires, qualified beneficiaries to provide the Plan Administrator with notice of a second qualifying event occurring after a qualified beneficiary has become entitled to COBRA coverage with a maximum coverage period of 18 or 29 months. Second qualifying evcnts include: . Death of a covered employee; Divorce or legal separation from the covered employee; The Covered employee's becoming entitled to Medicare benefits (under Part A, Part B, or both); A dependent child's ceasing to be eligible for coverage as a dependent under the Plan. . . The Second Qualifying Event Notice must indicate the specific qualifying event causing the Notice and Ihe date of the second qualifying event. The Notice must be delivered within 60 days of the occurrence of the second qualifying event, or before the end of the first COBRA continuation period, whichever is earlier. Disabilitv Notice A qualified beneficiary who is determined by thc Social Security Administration to be disabled must notify the Plan Administrator of the disability determination within 60 days after the date the Social Security makes the determination and before the end of the first 18 months of COBRA coverage. The notice must include a copy of the correspondence received from the Social Security Administration. Change of Disabilitv Status Notice A qualified beneficiary with respect to whom a notice of disability determination has been provided to the Plan Administrator must notify thc Plan Administrator of a subsequent determination by the Social Security Administration that he or she is no longer disabled. Such Notice must be provided within 30 days after the date of the final determination and must include a copy of the correspondence received from the Social Security Administralion. All Notices Described Above All the Notices described above must be delivered in writing to City of Arden Hills at the address listed in this Summary Plan Description for the Plan Administrator. All Notices must be delivered in person, by first class mail, by courier, or by messenger. All Notices may be delivered by the covered employee or qualifying beneficiary, or their representative, if such representative has first hand knowledge of the occurrence of the triggering event. All of the above Notices are required even if the Plan Administrator may have independent knowledge of the occurrence of a triggering event. There is no prescribed form SPD-15