Clarity Qualifying Event Letter

This notice provides important information about your right to elect COBRA coverage. You are receiving this
notice because you have experienced a qualifying event, Involuntary Termination , that caused you to lose
health coverage through your employer

What is COBRA?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law that may allow you to
temporarily continue your health coverage after you lose it due to a qualifying event.

Your COBRA Rights

- Continuation Coverage: You have the right to elect continuation coverage for yourself and your qualified beneficiaries (spouse and dependent children). 

- Same Coverage: You can generally continue the same health coverage you had as an active employee.

- Independent Election: Each qualified beneficiary can choose whether or not to elect COBRA coverage independently 

- Election Period: You have 60 days from the latter of the date this notice was sent to you , or the earliest Loss of Coverage Date. If you do not make your election within this period of time, your opportunity to enroll in COBRA expires, without an opportunity to reinstate it.

How to Enroll

You now have two options for continuing your health coverage:
Elect COBRA coverage through Clarity Benefit Solutions, or
Explore private health insurance options that may better suit your needs.
To review both options and take action, visit:www.claritybenefitsolutions.com/COBRA

If you know you would like to enroll in COBRA, you can do so:
Online: Visit www.claritybenefitsolutions.com and log in to your account to complete the enrollment process.
By Mail: Complete and return the enclosed COBRA Election Form by the election deadline,  to:

Clarity Benefit Solutions

Dept 22

PO Box 981044

BOSTON MA 02298 US

If you decide?not to enroll in COBRA coverage, no action is required. Your COBRA rights will expire once the
formal election period ends.

Payment and Coverage Details 

- First Payment: Your first full payment must be received within 45 days of electing COBRA coverage. - Monthly Payments: Subsequent monthly payments are due on the 1st of each month. You have a 30-day grace period to make your payment.

- Coverage Reinstatement: Your coverage will be retroactively reinstated to the date of your qualifying event once your initial payment is received. 

Coverage Duration 

The maximum length of your COBRA continuation coverage depends on the type of qualifying event:

- Job Loss/Reduced Hours: Up to 18 months

- Second Qualifying Event for Dependents (Death, Divorce, Medicare Entitlement or Child Loss of Dependent Status under the plan): Up to 36 months

- Disability Extension: Up to 29 months (if a Social Security Administration disability determination is made during the first 60 days of COBRA coverage)

- USERRA: Up to 24 months if a military reservist is called to active duty. This arrangement should be discussed in detail with your employer.

Early Termination of Coverage

Coverage can, in some cases, be terminated before the maximum coverage period expires under the following circumstances:

- Payment for your coverage cost is not made timely

- You or your dependents become covered under another group health plan

- You become entitled to Medicare

- Your coverage is terminated for cause

- You or your dependent are deemed to no longer disabled (in the event of a disability extension)

- You returned to work from active military duty (in the event of USERRA continuation)

For additional details based on your state or special protections (such as USERRA) visit claritybenefitsolutiitons.com/COBRA and select the applicable state from the dropdown.  

Important Notes

- COBRA coverage can be expensive, so it's important to compare your options carefully.  

- If you have any questions about COBRA or your health coverage options, please contact us at 888-423-6359.  

- If the covered employee becomes entitled to Medicare, COBRA coverage may end for dependents, but other coverage options may be available.  

- COBRA coverage is offered to all qualified beneficiaries without discrimination on the basis of race, color, national origin, disability, age, sex, gender identity, or sexual orientation.

Plan Specific Information
Rate Table:

Medical BCBS $250 PPO Plan

Dental Guardian Dental

Vision Guardian Vision

Coverage Tiers with children show the premium if all children are on the plan. If you wish to elect only some children for a plan, the cost may be different. To see these cost, please elect online at
claritybenefitsolutions.com

Additional Helpful Information to Consider When Enrolling:

Coverage reinstatement does take time. You may contact your health plan directly to confirm if a reinstatement is complete. If reinstatement has not been completed within 10 business days from your initial COBRA payment, please contact us.  

For upcoming appointments, please notify your doctor’s office that you are in the process of enrolling in COBRA and schedule care accordingly.  

While waiting for COBRA coverage to take effect, you may have to pay out-of-pocket for covered expenses. Once your coverage has been reinstated, you may submit a claim to your health plan.  

Changes to your Coverage

If changes are needed to your COBRA coverage due to a life event, you must notify Clarity Benefit Solutions within 30 days of the event to update your coverage. Examples of changes could be marriage, divorce, birth or adoption of a dependent child, dependent loss of coverage, Medicare entitlement, address change or maintaining coverage under another health plan.  

Your Privacy

Your health information is protected by the Health Insurance Portability and Accountability Act (HIPAA). We will only use and disclose your information as permitted by law.