07-D TML Health Reimbursement Acct

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d. Participant must Give Notice of Some Qualifying Events For the other qualifying events (divorce or legal separation of the Participant and Spouse or a Dependent child's losing eligibility for coverage as a Dependent child), the Participant must notify the Administrator within 60 days after the qualifying event occurs. The Employee must provide this notice to: TML Intergovernmental Employee Benefits Pool, 1821 Rutherford Lane, . Suite 300, Austin, Texas 78754, (512) 719-6500. . e. How Is Continuation of Coverage Provided? Once the Administrator receives notice that a qualifying event has occurred, Continuation of Coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect Continuation of Coverage. Participants may elect Continuation of Coverage on behalf of their Spouses, and parents may elect Continuation of Coverage on behalf of their children. Continuation of Coverage is a temporary continuation of coverage. When the qualifying event is the death of the Participant, the Participant's becoming entitled to Medicare benefits (Part. A, Part B or both), divorce or legal separation of the Participant from his or her Spouse or a Dependent child's losing eligibility as a Dependent child, Continuation of Coverage lasts for up to a total of 36 months. When the qualifying event is the end of employment or reduction of the Particpant's hours of employment, and the Participant became entitled to Medicare benefits less than 18 months before the qualifying event, Continuation of Coverage for qualified beneficiaries other then the Participant lasts until 36 months after the date of Medicare entitlement. For example, if a Participant becomes entitled to Medicare 8 months before the date on which his or her employment terminates, Continuation of Coverage for the Participant's Spouse and Dependent children can last up to 36 months after the date of Medicare entitlement, which. is equal to 28 months after the date of the qualifying event (36 months minus 8 months). Otherwise, when the qualifying event is the end of employment or reduction of the Participant's hours of employment, Continuation of Coverage generally lasts for only up to a total of 18 months. There are two ways in which this 18-month period of Continuation of Coverage can be extended. f. Disability Extension of 18-Month Period of Continuation of Coverage If a Participant or a Dependent covered under the Plan is determined by the Social Security Administration to be disabled and the Participant notifies TML Intergovernmental Employee Benefits Pool in a timely fashion, the Participant and any of his or her Dependents may be entitled to receive up to an additional 11 months of Continuation of Coverage for a total maximum of 29 months. The disability must have started at some time before the 60th day of Continuation of Coverage and must last at least until the end of the 18-month period of Continuation of Coverage. g. Second Qualifying Event Extension of 18.Month Period of Continuation of Coverage If a Covered Individual who originally was covered under this Plan as a Dependent Spouse or child experiences another qualifying event while receiving 18 months of Continuation of Coverage, The Covered Individual may get up to 18 additional months of Continuation of Coverage, for a maximum of 36 months, if notice of the second qualifying event is properly given to the Plan. This extension may be available to the Spouse and any Dependent children receiving Continuation of Coverage if the Participant or former Participant dies, becomes entitled to Medicare benefits (Part A, Part B or both) or gets divorced or legally separated, or if the Dependent child stops being eligible under the Plan as a Dependent child, but only if the event would have caused the Spouse or Dependent child to lose coverage under the Plan had the first qualifying event not occurred. 6.8 Coordination of Benefits; Health Flexible Spending Account to Reimburse First Benefits under this Plan are intended to reimburse Participants 'solely for Medical Care Expenses not previously reimbursed or reimbursable elsewhere. To the extent that an otherwise eligible Medical Care Expense is payable or reimbursable from another source, that other source shall payor reimburse prior to payment or reimbursement from this Plan. Without limiting the foregoing, if the Participant's Medical Care Expenses are covered by both this Plan and by a Health Flexible Spending Account, then this Plan is not available for reimbursement of such Medical Care Expenses until after amounts available for reimbursement under the Health Flexible Spending Account have been exhausted. Page 8