Benefits Information Supplement

Your medical, dental, and life insurance coverage ends on the last day of the month in which you actively worked in a benefits-eligible position. After your termination date, you may elect to continue coverage under either (I) the Layoff Severance Program or (II) COBRA (Consolidated Omnibus Budget Reconciliation Act) Continuation Coverage.

Under Federal law (COBRA), employers must offer terminating employees the opportunity to continue their medical and dental insurance at their own expense for up to 18 months.

Under the terms of the Layoff Severance Program, if you have three or more full years of continuous service, the University will continue to contribute toward the cost of your medical and dental coverage for the period shown in the chart below. The contribution will be based on your level of coverage (employee-only or tier of family coverage), work location, and permanent residence on your last day of employment. If the University contribution is for less than 18 months, you may continue coverage for the balance of the 18 months at your own expense.

Please read the information provided and then complete the attached Benefits Election (DOCX) form.

Medical and Dental Benefits

Note: The continuation of benefits coverage available under COBRA (Section II) runs concurrently with the benefits extended after your termination date through the Layoff Severance Program.

I. Benefits under the Layoff Severance Program

1. Continuation of Coverage

   You may continue your medical and dental coverage that is in effect on your last day of employment, (i.e., employee-only or tier of family coverage) under your current plan, or such future plan as may apply to similarly situated active employees, until the earliest of the following:

   1. Up to 18 months following termination of employment;
   2. The date on which you become covered under a group medical plan of another employer that does not contain any exclusions or limitations for pre-existing conditions that apply to you or your dependents;
   3. The 30th day of delinquency in payment of your share of the premium; or
   4. The date of your death (see Special Coverage for Dependents).

   Family coverage generally lapses if your coverage ends, or in the case of divorce or loss of dependent eligibility (refer to Special Coverage for Dependents).

   Note: This continuation period may not be identical to the continuation offered under COBRA (Section II).

2. University Contribution for Your Coverage

   While your coverage is in force, the University will contribute toward the cost of your medical and dental coverage for the following periods:

   Periods for University Coverage by Length of Service

   Full years of continuous service	Period of University contribution
   Less than 3 years	University will NOT contribute See Section II COBRA
   3 through 4 years	University will contribute for up to 6 months Balance of up to 12 months at your expense
   5 through 9 years	University will contribute for up to 12 months Balance of up to 6 months at your expense
   10 years and over	University will contribute for up to 18 months

   The University's monthly contribution toward the cost of your medical and dental coverage during the specified period will be the same as for similarly situated active employees in the same work location and permanent residence from which you left employment with the University. If you or your spouse become eligible for Medicare before or during this subsidized period, you must apply for Medicare Part B, and Medicare becomes primary with the UPlan secondary for coverage.

   You will be responsible for payment of the balance of the monthly rate. For any period of coverage for which you are not eligible for the University contribution, you will be responsible for paying the entire rate.

   Benefits and cost of the plan are subject to annual change on January 1.

3. Changes in Coverage

   You may make a change in medical and/or dental plans during appropriate open enrollment periods. The effective date of the change in plans is the same as for active employees.

   You may add family coverage during open enrollment or if you have a change in family status due to 1) marriage, 2) birth or adoption of first child, or 3) loss of coverage by spouse. If you did not have family coverage in effect on your date of termination, you will be required to pay the full cost of the dependent portion of the tier of family coverage; the University will not make a contribution. Family coverage may be continued for as long as you are covered under the program, provided that the dependent(s) remain otherwise eligible under the terms of the contract.

4. Special Coverage for Dependents

   Family coverage may be continued for as long as you are covered under the program, provided that the dependent(s) remain otherwise eligible. If you have a dependent child who ceases to qualify as a dependent under the plan or if you become divorced while under this program, you should contact Employee Benefits to arrange COBRA continuation coverage for the ineligible dependent. There will be no employer contribution toward this coverage.

   If you die while under this program and have a surviving spouse and/or dependent children covered under the plan, your spouse and/or children could continue medical and/or dental coverage after your death.

   The University contribution for your surviving spouse and/or dependent children would continue until the earliest of the following events:

   1. University contribution would have ended, had you lived (depending on years of service — see chart in Section I-B).
   2. Surviving spouse and/or dependent children become covered under another group medical plan that covers pre-existing conditions.
   3. Dependent children who meet eligibility criteria until they reach age 26.

   At the end of the period of University contribution, your surviving spouse and/or dependent children will be eligible to continue coverage under COBRA. COBRA continuation would end on the date:

   1. Surviving spouse and/or dependent children become covered under a group medical plan that covers pre-existing conditions.
   2. Dependent children who meet eligibility criteria until they reach age 26.

   In no event would coverage for your spouse and/or dependent children continue any longer than it would have if you had lived.

5. Options Available When Your Coverage Ends

   At the end of the group coverage continuation period, you may elect to convert your coverage to an individual policy/contract that is offered by the plan at that time without showing evidence of good health. You have 31 days from the date your group coverage ends in which to file an application for individual coverage.

   If you meet the eligibility requirements for the UPlan Retiree Group, you may elect to continue your coverage with the retiree group. You must meet one of these requirements on your last day of employment:

   • You are age 50 or older with at least 15 years of service;
   • You are age 55 or older with at least 5 years of service; or
   • You have 30 or more years of service, regardless of age.

   If you do not receive notification 30 days preceding the end of your group coverage continuation period, please call the Employee Benefits Service Center at 612-624-9090 or 1-800-756-2363, and press option 2.

II. Benefits under COBRA (Consolidated Omnibus Budget Reconciliation Act) Continuation Coverage

Under federal law, you can continue your current medical and dental coverage at 102 percent of the group premium at your own expense. If you elect this option, the benefits will be continued until the earliest of the following:

1. 18 months after your coverage terminates as an ACTIVE employee,
2. You become a covered employee under a group medical plan that has no limitations or exclusions with respect to any pre-existing conditions that you (or your dependent) may have,
3. 36 months if a second qualifying event occurs during the initial 18-month continuation period, or
4. You fail to pay the monthly charge for this coverage on time.

During this continuation of coverage period, you may elect to add dependents during an open enrollment period or in the event of a change in family status (marriage, birth/adoption), under the same rules that apply to similarly situated active employees. You would also be eligible to make a change in your medical and dental plan during appropriate open enrollment periods. The benefits and cost of the plan are subject to change annually on January 1.

You have 60 days from the date you lose group coverage as an active employee to elect this option.

At the end of the group benefits continuation period, you may also elect to convert your medical coverage to any individual policy/contract that is offered under our plan at that time without showing evidence of good health. You have 31 days from the date your group medical coverage is canceled in which to file such an application.

Pre-Tax Health Care Flexible Spending Account

If you elected a health care flexible spending account, your pre-tax contributions to the account end with the pay period in which you terminate employment. Only expenses incurred while you are participating in the health care flexible spending account are eligible for reimbursement. Participation means that you continue to make contributions to the account. You must continue to make deposits to the account to be eligible for reimbursement for expenses that are incurred after you terminate employment.

Therefore, if you have a balance remaining in your account when you terminate and do not have health care expenses to submit to use the balance, you may wish to continue the account under COBRA provisions. The deductions for the remainder of the calendar year could be taken on a pre-tax basis from your last paycheck received prior to termination, provided the gross paycheck is large enough. You need to contact Employee Benefits at least two weeks prior to the date of your last regular paycheck to make this arrangement. Otherwise, the deductions for the remainder of the calendar year can be paid on an after tax basis in monthly installments. The maximum period of continuation of deposits is 18 months. Employee Benefits will bill you monthly for 1/12 of your annual election. Any money left in the account at the end of each calendar year will be forfeited under IRS guidelines.

If you have questions regarding the balance in your health care flexible spending account or regarding COBRA provisions for continuation of the account after termination of employment, contact the Employee Benefits Service Center at 612-624-9090 or 1-800-756-2363 and press option 3.

Life Insurance Continuation

COBRA Continuation Coverage

You may continue your basic and optional life insurance under the University of Minnesota group up to 18 months or until you obtain other group coverage, whichever occurs earlier. At the conclusion of the 18-month continuation period, you would be eligible to convert the group term coverage to an individual policy without evidence of good health. If you need to know the amount of coverage you currently have, please contact the Employee Benefits Service Center at 612-624-9090 or 1-800-756-2363 and press option 2.

Life Insurance Premium Rates

• All premium rates shown are MONTHLY rates.
• The rates are subject to an additional two percent administrative fee that is included in the rates shown for all life insurance coverages.

Basic Employee Life Insurance: Rate per $1,000 of face amount per month: $0.146.

Additional Employee Life & Spouse Life Insurance:

Instructions to Continue Medical, Dental, Life, and Health Care FSA Benefits

To continue your medical and dental coverage, group term life, or health care flexible spending account, you must submit the Benefits Election form to Employee Benefits within 60 days of the end of your employment.

Send the form to:

University of Minnesota
Employee Benefits
100 Donhowe
319 15th Avenue SE
Minneapolis, MN 55455-0103

DO NOT SEND MONEY WITH THE ELECTION FORM

You will receive a billing statement from the appropriate plan administrator. Your initial bill will cover the period retroactive to the date you lost group coverage, if applicable.