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COBRA Continuation Coverage & Conversion Privileges

COBRA is continuation of group medical, dental and vision insurance coverage. If you lose eligibility for university insurance coverage, the university will offer you and your covered dependents the option to continue medical, dental, and/or vision insurance, without having to submit evidence of good health. It is only possible to continue the coverage that you or your dependents have at the time you or your dependents lose eligibility. In some cases, you may also continue your UT Flex flexible spending account. Please contact the Human Resource Service Center (HRSC) for questions regarding continuation of your UT Flex account.

You are responsible for paying the full premium for your selected COBRA coverage. To enroll, you must submit the COBRA/Conversion Application Request Form to the HRSC within 60 days of the date you lose coverage. The HRSC will then provide you with the COBRA application. You must submit the application directly to the insurance company with your payment. The application includes the mailing address for each insurance company.

Monthly COBRA Premium Rates

Effective September 1, 2009 - August 31, 2010

Plan

Subscriber Only

Subscriber & Spouse

Subscriber & Child(ren)

Subscriber & Family

UT Select PPO (BCBS)

$398.74

$781.53

$713.75

$1,084.58

UT Select Dental (Delta)

$30.56

$58.01

$63.94

$90.92

Assurant Dental DMO

$10.25

$19.48

$21.53

$30.75

Superior Vision

$6.94

$10.98

$11.18

$17.75

Effective September 1, 2008 - August 31, 2009

Plan Subscriber Only Subscriber & Spouse Subscriber & Child(ren) Subscriber & Family
UT Select PPO (BCBS) $374.30 $733.62 $670.00 $1,018.09
UT Select Dental (Delta) $28.83 $54.72 $60.32 $85.77
Assurant Dental DMO $10.25 $19.48 $21.53 $30.75
Superior Vision $7.51 $11.71 $11.97 $19.28

Conversion Privileges

You may also be eligible to continue term life, long-term disability and long-term care insurance coverage if you lose eligibility for university insurance coverage.

Term Life

If you are enrolled in term life insurance, you and your covered dependents may convert the university term life coverage to an individual whole life policy with the insurance company, regardless of your current health. You and your dependents are eligible for conversion even if you retire from the university. Please submit the COBRA/Conversion Application Request Form to the HRSC to receive the conversion application and premium rates. The application must be submitted to the insurance company within 31 days of the date you lose coverage.

Long-Term Disability (LTD)

If you are enrolled in LTD insurance, you may convert the coverage to an individual policy without having to submit evidence of good health. You are not eligible to continue LTD coverage if you retire from the university, you were not covered under the plan for at least 12 months, or you could not perform the duties of your occupation at the time of separation. Please submit the COBRA/Conversion Application Request Form to the HRSC to receive the conversion application, which includes a request for premium quotation by the insurance company. You must submit the application to the insurance company within 31 days of the date you lose coverage.

Long-Term Care (LTC)

If you are enrolled in long-term care insurance, you and your spouse may continue coverage through direct home billing. Direct home billing will not change your premium rate. Other covered family members may continue their direct home billing. To avoid cancellation of coverage, please contact the insurance company, CNA, at 1-888-825-0353 within 60 days of the date you lose coverage.