** Continuation Coverage Rights Under COBRA**
Introduction
You are receiving this notice because you have recently become covered or are already covered under the New York City District Council of
Carpenters Welfare Fund (the "Plan"). This notice contains important information about your right to COBRA continuation coverage, which is
a temporary extension of coverage under the Plan. The right to COBRA continuation coverage was created by a federal law, the Consolidated
Omnibus Budget Reconciliation Act of 1985 ("COBRA"). COBRA continuation coverage can become available to you and to other members of
your family who are covered under the Plan when you would otherwise lose your group health coverage. This notice generally explains
COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive
it. This notice gives only a summary of your COBRA continuation coverage rights. For more information about your rights and obligations
under the Plan and under federal law, you should review the Plan's Summary Plan Description.
The Plan Administrator is the Board of Trustees, New York City District Council of Carpenters Welfare Fund, 395 Hudson Street, New York, NY
10014, (212) 366-7300. The Plan Administrator is responsible for administering COBRA continuation coverage.
COBRA Continuation Coverage
COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as
a "qualifying event." Specific qualifying events are listed later in this notice. COBRA continuation coverage must be offered to each person
who is a "qualified beneficiary." A qualified beneficiary is someone who will lose coverage under the Plan because of a qualifying event.
Depending on the type of qualifying event, employees, spouses of employees, and dependent children of employees may be qualified
beneficiaries. Certain newborns, newly-adopted children and alternate recipients under Qualified Medical Child Support Orders ("QMCSOs")
may also be qualified beneficiaries. This is discussed in more detail in separate paragraphs below. Domestic partners of employees are not
qualified beneficiaries.
If you are an employee, you will become a qualified beneficiary if you will lose your coverage under the Plan because either one of the following
qualifying events happens:
1. Your hours of employment are reduced, or
2. Your employment ends for any reason other than your gross misconduct.
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; or
4. You become divorced 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:
1. 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; or
4. The child stops being eligible for coverage under the plan as a "dependent child."
A covered employee's spouse and dependent children do not lose their coverage under the Plan because the covered employee enrolls in
Medicare. Similarly, a covered employee's dependent children do not lose coverage under the Plan because the covered employee and the
covered employee's spouse become legally separated or divorced. Finally, a covered employee's spouse does not lose coverage under the Plan
because he or she becomes legally separated from the covered employee.
Sometimes, filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event. If a proceeding in bankruptcy
is filed with respect to a participating employer, and that bankruptcy results in the loss of coverage of any retired employee covered under the
Plan, the retired employee is a qualified beneficiary with respect to the bankruptcy. The retired employee's spouse, surviving spouse, and
dependent children will also be qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan.
Generally, under the Plan, qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage.
The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been timely notified that a
qualifying event has occurred. You must notify the Plan Administrator when the qualifying event is divorce of the employee and spouse
or a dependant child's loss of dependent child status. The Plan requires you to notify the Plan Administrator in writing, using the
procedures specified in the box below entitled "Notices Procedures," within 60 days after either of these qualifying events occur. IF THE
PROCEDURES SPECIFIED BELOW ARE NOT FOLLOWED OR IF THE NOTICE IS NOT PROVIDED IN WRITING TO THE PLAN
ADMINISTRATOR DURING THE 60-DAY NOTICE PERIOD, ANY SPOUSE OR DEPENDENT CHILD WHO LOSES COVERAGE WILL NOT
BE OFFERED THE OPTION TO ELECT CONTINUATION COVERAGE. For all other qualifying events, the Plan Administrator determines
if and when coverage under the Plan will end. Covered employees are strongly encouraged to call the Fund office at 1-800-529-3863 to check
their eligibility status whenever they feel it is necessary.
Notice Procedures:
Any notice that you provide must be in writing. Oral notice, including notice by telephone, is not acceptable. You must mail your notice to the
Plan Administrator at this address:
Board of Trustees
New York City District Council of Carpenters Welfare Fund
395 Hudson StreetNew York, New York 10014
Attention: COBRA
Your notice must be postmarked no later than the last day of the required notice period. Any notice you provide must state the name of the
Plan (the New York City District Council of Carpenters Welfare Fund), the name, address and social security number of the employee covered
under the Plan, and the name(s), address(es), birthdate(s) and social security number(s) of the qualified beneficiary(ies). Your notice must also
name the qualifying event and the date it happened. If the qualifying event is a divorce, your notice must include a copy of the divorce decree.
Your notice of a second qualifying event also must name the event and the date it happened. If the qualifying event is a divorce, your
notice must include a copy of the divorce decree.
Your notice of disability also must include the name of the disabled qualified beneficiary, the date when the qualified beneficiary became
disabled and the date the Social Security Administration made its determination. Your notice of disability must include a copy of the Social
Security Administration's determination.
Once the Plan Administrator receives timely notice or determines that a qualifying event has occurred, COBRA continuation coverage will be
offered to each of the qualified beneficiaries. For each qualified beneficiary who timely elects COBRA continuation coverage, COBRA
continuation coverage will begin on the date that Plan coverage would otherwise have been lost.
Notwithstanding the foregoing, if a covered employee dies, the spouse and dependent children of the covered employee, if any, automatically
will be provided with COBRA continuation coverage under the Plan, without formally electing such coverage. In addition, the Plan will pay the
premium payments for continuation coverage under the Plan for the spouse and dependent children of the deceased covered employee.
COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is the death of the employee, your divorce,
or a child losing eligibility as a dependent child, COBRA continuation coverage lasts for up to 36 months.
When the qualifying event is the end of employment or reduction of the employee's hours of employment, COBRA continuation coverage lasts
for up to 18 months. There are three ways in which this 18-month period of COBRA continuation coverage can be extended.
1. Disability extension of 18-month period of continuation coverage
If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled at any time during the
first 60 days of COBRA continuation coverage and you notify the Plan Administrator in a timely fashion, you and your entire family can receive
up to 11 months of additional COBRA continuation coverage, for a total maximum of 29 months. You must make sure that the Plan Administrator
is notified in writing, using the procedures specified in the box above entitled "Notices Procedures," of the Social Security Administration's
determination within 60 days of the date of the determination and before the end of the 18-month period of COBRA continuation coverage.
IF THE PROCEDURES SPECIFIED ABOVE ARE NOT FOLLOWED OR IF THE NOTICE IS NOT PROVIDED IN WRITING TO THE PLAN
ADMINISTRATOR WITHIN THE REQUIRED PERIOD, THEN THERE WILL BE NO DISABILITY EXTENSION OF COBRA CONTINUATION
COVERAGE.
2. Second qualifying event extension of 18-month period of continuation coverage
If your family experiences another qualifying event while receiving COBRA continuation coverage, the spouse and dependent children in your
family can get additional months of COBRA continuation coverage, up to a maximum of 36 months. This extension is available to the spouse
and dependent children if the former employee dies or gets divorced. The extension is also available to a dependent child when that child
stops being eligible under the Plan as a dependent child. In all of these cases, you must make sure that the Plan Administrator is notified in
writing, using the procedures specified in the box above entitled "Notices Procedures," of the second qualifying event within 60 days of the
second qualifying event. IF THE PROCEDURES SPECIFIED ABOVE ARE NOT FOLLOWED OR IF THE NOTICE IS NOT PROVIDED IN
WRITING TO THE PLAN ADMINISTRATOR WITHIN THE REQUIRED 60-DAY PERIOD, THEN THERE WILL BE NO EXTENSION OF
COBRA CONTINUATION COVERAGE DUE TO A SECOND QUALIFYING EVENT.
3. Medicare Extension for Spouse and Dependent Children
If a qualifying event that is a termination of employment or reduction of hours occurs within 18 months after the covered employee becomes
entitled to Medicare, then the maximum coverage period for the spouse and dependent children of the covered employee will end three years
from the date the covered employee became entitled to Medicare (but the covered employee's maximum coverage period will be 18 months).
Children Born to or Placed for Adoption With the Covered Employee During COBRA Period
A child born to, adopted by or placed for adoption with a covered employee during a period of continuation coverage is considered to be a
qualified beneficiary provided that, if the covered employee is a qualified beneficiary, the covered employee has elected continuation coverage
for himself or herself. The child's COBRA coverage begins when the child is enrolled in the Plan, whether through special enrollment or open
enrollment, and it lasts for as long as COBRA coverage lasts for other family members of the employee. To be enrolled in the Plan, the child
must satisfy the otherwise applicable Plan eligibility requirements (for example, regarding age).
Alternate Recipients Under QMCSOs
A child of the covered employee who is receiving benefits under the Plan pursuant to a QMCSO received by the Plan Administrator during the
covered employee's period of employment with the employer is entitled to the same rights under COBRA as a dependent child of the covered
employee, regardless of whether that child would otherwise be considered a dependent.
If You Have Questions
If you have questions about your COBRA continuation coverage, you should contact the New York City District Council of Carpenters
Welfare Fund (212-366-7300) or you may contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefits
Security Administration ("EBSA"). Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA's web
site at www.dol.gov/ebsa.
Keep Your Plan Informed of Address Changes
In order to protect your family's rights, you should keep the Plan Administrator informed of any changes in the addresses of family members.
You should also keep a copy, for your records, of any notices you send to the Plan Administrator.
Sincerely,
BOARD OF TRUSTEES
NEW YORK CITY DISTRICT COUNCIL OF CARPENTERS WELFARE FUND
