D.C. Mun. Regs. tit. 6, r. 6-B2130

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 6-B2130 - CONTINUED HEALTH BENEFITS COVERAGE

2130.1

A person who is eligible for health benefits coverage in accordance with D.C. Official Code § 1-621.02 et seq., but who subsequently loses eligibility for coverage, may elect to continue coverage as provided in this section without regard to benefits available under any temporary extension of coverage or any non-group contract.

2130.2

Such a person may elect to continue health benefits coverage if the person is any of the following:

(a) An employee eligible for health benefits under this section who is separated from service on or after December 14, 1990, whether voluntarily or involuntarily, and, on the day before being separated from service, was enrolled in a health plan under this title;

(b) A person who ceases to be an unmarried dependent child on or after December 14, 1990, and was covered as a member of a family of an employee or annuitant under a health benefits plan on the day before ceasing to be an unmarried dependent child; or

(c) A person who ceases to be a spouse on or after December 14, 1990, and was covered as a family member of an employee or annuitant under a health benefits plan at some time during the preceding eighteen (18) months before the marriage ended, but who is not eligible to enroll for health benefits in accordance with D.C. Official Code § 1-529.01 et seq. because he or she either has remarried before reaching age fifty-five (55) or is not entitled to a portion of the employee's or annuitant's annuity benefit or a survivor benefit based on the employee's or annuitant's service.

2130.3

The personnel authority shall give written notice to any employee described in § 2130.2(a) stating that the employee may elect to continue health benefits coverage prior to the expiration of thirty (30) days after the date on which coverage would otherwise end.

2130.4

The personnel authority, within fourteen (14) work days of receiving notice from the employee or annuitant, shall give notice to any person described in § 2130.2(b) stating that the person may elect to continue health benefits coverage under this title, if the employee or annuitant has provided appropriate written notice to the personnel authority prior to the expiration of sixty (60) days after the date that such a person ceased to be an unmarried dependent child.

2130.5

The personnel authority, within fourteen (14) work days of receiving notice from the employee, annuitant, or former spouse, shall give notice to any person described in § 2130.2(c) that the person may elect to continue health benefits coverage under this title, if the employee, annuitant, or the person himself or herself has provided written notice to the personnel authority prior to the expiration of sixty (60) days after the date such person ceased to be a spouse.

2130.6

In order to continue health benefits coverage, an employee described in § 2130.2(a) shall submit an appropriate written election prior to the expiration of sixty (60) days from the later of any of the following:

(a) The effective date of separation from service;

(b) The date that notice required by § 2130.3 was given to the employee; or

(c) In the event that the notice required by § 2130.3 was mailed, the date the notice was posted.

2130.7

In order to continue health benefits coverage, a person described in § 2130.2(b) shall submit an appropriate written election prior to the expiration of sixty (60) days from the later of any of the following:

(a) The date the person ceased to be an unmarried dependent child;

(b) The date that the notice required by § 2130.4 was given to the person; or

(c) In the event that the notice required by § 2130.4 was mailed, the date the notice was posted.

2130.8

In order to continue health benefits coverage, a person described in § 2130.2(c) shall submit an appropriate written election prior to the expiration of sixty (60) days from the later of any of the following:

(a) The date the person ceased to be a spouse of an employee;

(b) The date the person ceased to be eligible for health benefits under the provisions of D.C. Official Code § 1-529.01 et seq.;

(c) The date the notice required by § 2130.5 was given to the person; or

(d) In the event that the notice required by § 2130.5 was mailed, the date the notice was posted.

2130.9

An election made in accordance with either § 2130.6, § 2130.7, or § 2130.8 may be for coverage either as an individual or family.

2130.10

If the person's coverage expires before the person makes an election in accordance with either § 2130.6 or § 2130.7, that coverage shall be restored retroactively, as if no break in coverage had occurred.

2130.11

If the person's coverage expires before the person makes an election in accordance with § 2130.8, that coverage shall be restored retroactively to the later of either of the following:

(a) The date the person ceased to be the spouse of an employee; or

(b) The date the employee ceased to be eligible for health benefits under the provisions of D.C. Official Code § 1-529.01 et seq.

2130.12

Continued health benefits coverage shall be available to any employee who makes an election under § 2130.6 for a period of eighteen (18) months from the effective date of the employee's separation.

2130.13

Continued health benefits coverage shall be available to any person who makes an election under § 2130.7 for a period of thirty-six (36) months from the earlier of either of the following:

(a) The date the person ceased to be unmarried dependent child; or

(b) In the case of a person who was covered as a family member by continuing benefits under this section at the time the person ceased to be an unmarried dependent child, the date of separation from service of the employee on whom the person was dependent.

2130.14

Continued health benefits coverage shall be available to any person who makes an election under § 2130.8 for a period of thirty-six (36) months from one (1) of the following, as appropriate:

(a) The date the person ceased to be a spouse;

(b) In the case of a person who was covered as a family member by continuing benefits under this section at the time the person ceased to be a spouse, the date of separation from service of the employee to whom the person was married; or

(c) In the case of a person who had health benefits coverage under the provisions of D.C. Official Code § 1-529.01 et seq., from the date eligibility for coverage under those provisions ceased.

2130.15

Any person who elects to continue coverage under this section shall pay to the District of Columbia Treasurer, or to a contractor or other agent designated by the Director of Personnel, one hundred percent (100%) of the premium plus two percent (2%) of the sum of such contributions.

2130.16

Any person who is eligible for retroactive coverage under § 2130.10 shall pay for the coverage restored retroactively in a manner prescribed by the Director of Personnel.

D.C. Mun. Regs. tit. 6, r. 6-B2130

As amended by Final Rulemaking published at 50 DCR 3027 (April 18, 2003)