OklahomaContinuation Coverage Election Notice
Subject: You can continue your group health coverage on your own
Dear Member:
Aetna is sending this notification to you (even if you are currently on state continuation) to ensure all potential assistance eligible individuals are notified of the subsidy available under the American Recovery & Reinvestment Act of 2009. However, due to system limitations, you may receive this notification in error. If you are still an active employee or your employeris not eligible for state continuation please disregard this notification.
According to our records, your group health benefits with Aetna have ended. However, you may have the option to continue your coverage through theOklahomaGroup Health Continuation Law.
The Recovery and Reinvestment Act of 2009 (ARRA) and its impact toOklahomastate continuation.
This notice contains important information about your right to continue your group health care coverage with Aetna (the Plan). Please read this information very carefully.
For some people, ARRA reduces the amount they must pay for continuation coverage. If you receive this notice because you lost coverage on or after September 1, 2008, and before December 31, 2009, you may be eligible for a temporary premium reduction of sixty-five percent for up to nine months. To help determine if you are eligible for the ARRA premium reduction, you should read this notice and the attached documents carefully. Pay particular attention to the “Summary of the Continuation Coverage Premium Reduction Provisions under ARRA,” with details regarding eligibility, restrictions and obligations, and the “Application for Treatment as an Assistance Eligible Individual.”
Before we can accept your reduced premium, we must receive a completed “Employer Attestation ARRA State Continuation Employee Subsidy” form from your former employer. This form verifies that you are an Assistance Eligible Individual. It is your responsibility to have your former employer complete this form and return it to Aetna.
Switching continuation coverage benefits options
Group health plans can allow qualified beneficiaries to enroll in coverage that is different than the coverage they had at the time of the event that caused them to lose their coverage (the “qualifying event”). Changing coverage will not cause an individual to be ineligible for theOklahoma state continuation premium reduction, as long as:
- The premium for the different coverage is the same as or lower than the coverage the individual had at the time of the qualifying event;
- The different coverage is also offered to active employees; and
- The different coverage is not limited to only dental coverage, vision coverage, counseling coverage, a flexible spending account, or an on-site medical clinic.
To change your coverage option(s) to something different than what you had on the last day you were employed, you must complete the “Switching Continuation Coverage Benefits Options” form attached and return it to your employer who will verify your eligibility for the alternate plan and then request the plan change. You have 90 days after the date of this notice to decide whether you want to switch benefit options.
How to enroll on OklahomaState Continuation
To enroll inOklahomacontinuation coverage, complete the “OklahomaContinuation Coverage Election Form”, and if you believe you meet the criteria for the premium reduction, complete the “Application for Treatment as an Assistance Eligible Individual”.Return these forms to us with your initial payment.
Please contact Aetna member services for information on your premium. Members with HMO benefits should contact Aetna at 1-888-70-Aetna. Members with PPO-based and indemnity benefits should contact Aetna at 1-888-80-Aetna.
Return all forms with the necessary initial payment made payable to Aetna, to the applicable address below: You will have until the 60th day (as shown by postmark) after receiving this notice which is allowed by law, to electOklahomacontinuation coverage, or you will lose the right to continuation of coverage.
Standard MailOvernight Package
AetnaAetna
Attn: OklahomaState Continuation - IBAAttn: Oklahoma State Continuation - IBA
P. O. Box 211799 South Main St.
Fall River, MA02721-5303Fall River, MA 02721-5303
Sincerely,
Aetna
Aetna is the brand name used for products and services provided by one or more of the Aetna brand of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna). © 2009 Aetna Inc
OklahomaState Continuation Election Form
If you want to continue coverage, you must complete the Applicant section below and return it to us. If you choose to continue coverage, you must submit your check to cover the first payment along with the completed application. Your first payment must cover the number of full months from the effective date of your continuation to the date of your payment. (Example: If your effective date of coverage is April 1 and your payment date is June 1, the payment must be for April, May and June or 3 months.)
Please check reason for your loss of coverage (Qualifying Event):
□ End of employment□ Involuntary □ Voluntary
If you qualify for the premium reduction, you need to pay only 35 percent of the continuation coverage premium. This premium reduction is available for up to nine months and only for those whose qualifying event is due to involuntarily termination of employment. If yourOklahomastate continuation coverage extends beyond the nine months of premium reduction or your qualifying event is other than involuntary termination, you will have to pay the full amount to continue your coverage.
If you have any questions about your premium, contact Aetna Member Services. Members with HMO benefits should contact Aetna at 1-888-70-Aetna. Members with PPO-based and indemnity benefits should contact Aetna at 1-888-80-Aetna.
Rates are subject to change periodically. Any adjustments in premium will be communicated to you byAetna. After the first payment you must submit the same payment each month, until you have been notified of a general change for all participants. If you fail to make the monthly payment within 31 days of its due date, your coverage will end on that date and cannot be reinstated.
If you do not send this application to us within 60 days from the date of this notice, you will lose the right to continue coverage. By responding immediately you will assure early reinstatement of coverage and minimize claim delay.
Under Oklahomastate continuation you may elect to continue:
Aetna Medical Coverage - Core only: Aetna Medical/Aetna Rx
Initial monthly cost for continued group health coverage is:
Employee only:$______Employee & spouse:$______
Employee, spouse &child(ren$______Spouse only)$______
Employee & child(ren):$______Spouse & child(ren):$______
Child(ren) only:$______
Assistance-eligible individuals (AEIs) are eligible for a 65 percent premium subsidy. If you are an AEI, your premium rate will be 35 percent of the above rate and will apply to you for a maximum period of 9 months. At the end of the 9-month period the above rates would then apply if you continue your California state continuation coverage. You must complete the Application for Treatment as an assistance-eligible individual to confirm that you are an AEI.
Initial monthly cost for continued group health coverage is:
Employee only:$______Employee & spouse:$______
Employee, spouse &child(ren$______Spouse only)$______
Employee & child(ren):$______Spouse & child(ren):$______
Child(ren) only:$______
Applicant Section
1. Applicant’s Name (Last, First, Middle Initial) / 2. Employee's Social Security No. / 3. Relationship to Employee4. Applicant's Address / 5. Date of Birth / 6. Telephone No. / Aetna ID Number
7. I request continuation of the following Aetna coverage:
Medical/RX Coverage is for:Employee only Employee & Spouse Employee & Child(ren)
Spouse only Spouse & Child(ren) Child(ren) only
Employee, Spouse & Children
8. All Individuals to be Covered:
Name (First, Middle Initial, Last) Relationship Social Security No. Birthdate Full Time * PCP Office
Student?(Y/N) ID number
______
______
______
______
______
List the first name of the dependent(s) and the name of the school(s) being attended:
9. Applicant’s Signature (Required) ______Election Date______
Applicant’s Instructions for Completion of Applicant Section of election form
Item #1: Please complete your name: Last, First and Middle Initial.
Item #2: Fill in your Social Security number.
Item #3: Fill in your relationship to the employee at the time of the qualifying event. (that is, self, spouse or child)
Item #4: Give your complete address.
Item #5: Your date of birth.
Item #6: Your phone number, including area code, in case we need to contact you to process this application.
Item #7: Enrollment coverage will be the same for all continuing family members.
Item #8: List applicant’s and eligible dependents’ information.
- Name, relationship, Social Security number and birth date must be listed for all continuing individuals. All dependents must have been previously covered under the group.
- Put “Y” for Yes or “N” for No to indicate if the dependent is a full-time student. If yes, list the dependent and name of school he or she is attending.
- Locate the office ID number for the primary care physician from the appropriate directory or from DocFind®, Aetna's online provider directory, at
Item #9: Your signature and date. If the form is not signed, your request for coverage will be returned unprocessed and may result in a delay in obtaining coverage.
Your group health coverage will end on whichever occurs first:
- 63 days of continuation for non assistance eligible employees;
- 4 months of continuation for assistance eligible employees;
- the date the individual fails to submit the required premium;
- the date the individual becomes covered under similar benefits under another group plan;
- the date the employee or spouse becomes eligible for Medicare (please note that the term “eligible” for purposes of Medicare and Oklahoma state continuation means being enrolled in Medicare, and does not mean "being able to enroll" in Medicare)
Medical conversion option
When the continuation period ends, or if you do not elect continuation, you may be eligible to apply for conversion of your group medical benefits (but not non-medical coverage) to an individual policy, without medical examination, subject to the same conversion privilege that applies under the group plan and is described in your certificate of coverage.
If you elect to continue your group medical coverage, you may also have the right to convert to an individual policy after the entire continuation period ends. You must elect your conversion privilege within 31 days of the end of the continuation period.
Conversion coverage is not available when:
- The applicant is or could be covered by Medicare on the effective date of coverage.
- The applicant is or could be covered under other group insurance or the applicant is covered by another individual policy that has substantially similar benefits to the former group policy.
- The conversion coverage would create a situation of overinsurance by the insurer’s standards.
If you meet eligibility requirements, you and/or any of your family members covered at the time his or her coverage ends may elect the conversion option.
If you elect conversion coverage, the conversion policy will become effective the day following the date on which the above maximum period ends.
Please note that if you accept a conversion policy you will give up the right to be an “eligible individual” for guaranteed issuance of individual health coverage under the Health Insurance Portability and Accountability Act (HIPAA).
For more information about an individual conversion policy (including rates, coverage benefits, eligibility and an application), contact the following areas:
For indemnity or PPO-based plans:For HMO:
AetnaAetna
Attn.: Conversion UnitAttn: Individual Products, U36A
PO Box 2117PO Box 730
Fall River, MA 02722-2117Blue Bell, PA 19422-9529
Tel: 1-508-675-7887Tel: 1-800-453-8742
(This may be your only notification of this option)
Important Information about Your Continuation Coverage Rights
What is continuation coverage?
Oklahoma state law requires most group health insurance policies give employees and their families the opportunity to continue their coverage when a “qualifying event” occurs that would result in a loss of coverage under an employer’s plan. Depending on the type of qualifying event, “qualified beneficiaries” can include the employee (or retired employee) covered under the group health plan, the covered employee’s spouse, and the dependent children of the covered employee.
Continuation coverage is the same group coverage that is available to active participants or beneficiaries who are not receiving continuation coverage. Each qualified beneficiary who elects continuation coverage will have the same rights under the group plan as other participants or beneficiaries covered under the group plan, including open enrollment and special enrollment rights.
How long will continuation coverage last?
Your group health coverage will end on whichever occurs first:
- 63 days of continuation for non assistance eligible employees;
- 4 months of continuation for assistance eligible employees;
- the date the individual fails to submit the required premium;
- the date the individual becomes covered under similar benefits under another group plan;
- the date the employee or spouse becomes eligible for Medicare (please note that the term “eligible” for purposes of Medicare and Oklahoma state continuation means being enrolled in Medicare, and does not mean "being able to enroll" in Medicare)
How can you elect continuation coverage?
To elect continuation coverage, you must complete the applicant section of theOklahomaContinuation Coverage Election Notice.
When deciding whether to elect continuation coverage, you should consider that if you do not continue your group health coverage it will affect your future rights under federal law.
- First, if you have a 63-day gap in health coverage, you can lose the right to avoid having pre-existing condition exclusions applied to you by other group health plans. Election of continuation coverage may help prevent such a gap.
- Second, if you do not elect continuation coverage for the maximum time available to you, you will lose the guaranteed right to purchase individual health coverage that does not impose apre-existing condition exclusion.
- Finally, you should take into account that you have special enrollment rights under federal law and state law.
You have the right to request special enrollment in another group health plan for which you are otherwise eligible (such as a plan sponsored by your spouse’s employer) within 30 days after your group health coverage ends because of the qualifying event listed above. You will also have the same special enrollment right at the end of continuation coverage if you choose continuation coverage for the maximum time available to you.
How much does continuation coverage cost?
Oklahomastate continuation generally costs 100 percent of the amount charged for the coverage for active employees or dependents under the group plan.
The American Recovery and Reinvestment Act of 2009 (ARRA) reduces the continuation coverage premium in some cases. The premium reduction is available to certain individuals who experience a qualifying event that is an involuntary termination of employment that occurs between February 17, 2009, and December 31, 2009. If you qualify for the premium reduction, you need to pay only 35 percent of the continuation coverage premium. This premium reduction is available for up to nine months. If yourOklahomastate continuation coverage lasts for more than nine months, you will have to pay the full amount to continue your coverage. This premium reduction is available for the earlier of the period allowed by Oklahoma state continuation or nine months.
The Trade Act of 2002 created a tax credit for certain individuals who become eligible for trade adjustment assistance and for certain retired employees who are receiving pension payments from the Pension Benefit Guaranty Corporation (PBGC). Under the tax provisions, eligible individuals can either take a tax credit or get advance payment of 65 percent of premiums paid for qualified health insurance, including continuation coverage. ARRA made several amendments to these provisions, including an increase in the amount of the credit to 80 percent of premiums for coverage before January 1, 2011, and temporary extensions of the maximum period of COBRA continuation coverage for PBGC recipients (covered employees who have a nonforfeitable right to a benefit any portion of which is to be paid by the PBGC)and TAA-eligible individuals.
If you have questions about these provisions, you may call the HealthCoverageTaxCreditCustomerContactCenter toll-free at 1-866-628-4282. TTD/TTY callers may call toll-free at 1-866-626-4282. More information about the Trade Act is also available at