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Reference
Appendix and Legal Notices
or registered domestic partner, surviving legal spouse
or registered domestic partner and dependent children
will also be offered continuation coverage if bankruptcy
results in the loss of their coverage under the Plan.
When Is COBRA Coverage Available?
The Plan will offer COBRA continuation coverage to
qualified beneficiaries only after the plan administrator
has been notified that a qualifying event has occurred.
When the qualifying event is the end of employment or
a reduction in the hours of employment, death of the
employee, commencement of a proceeding in bankruptcy
with respect to the Company, or the employee’s
entitlement to Medicare benefits (under Part A, Part B or
both), the Company must notify the plan administrator of
the qualifying event.
You Must Give Notice of Some Qualifying Events
You are responsible for notifying the plan administrator
within 60 days of a qualifying event that is not listed in the
“When is COBRA Coverage Available?” section of this
notice. These events include divorce, legal separation or
the termination of a domestic partnership and the termi-
nation of a child’s dependent status. Provide notice to:
Benefits Department
Aflac Incorporated
P.O. Box 5248
Columbus, Georgia 31906-0248
706-317-0770
Here’s a sample of the notice and information you should
provide to the Benefits Department:
To: Benefits Department
Aflac Incorporated
P.O. Box 5248
Columbus, Georgia 31906-0248
From: Name and address of covered employee, legal
spouse, registered domestic partner and/or child
Telephone number: _ ____________________________
Date of this notice: ______________________________
Re: Aflac Employee Health Plan
In accordance with the provisions of the Consolidated
Omnibus Budget Reconciliation Act of 1985 (COBRA),
this notice is given to inform you of the occurrence of
the event(s) indicated below with respect to the health
coverage provided by the Aflac Employee Health Plan:
• Divorce, legal separation or termination of the domes-
tic partnership of the covered employee and legal
spouse or registered domestic partner.
• Termination of a child’s dependent status under the
terms of the health plan.
Date the event occurred
Signature of covered employee, legal spouse or registered domestic partner
How Is COBRA Coverage Provided?
Once the plan administrator is notified that a qualifying
event has occurred, COBRA continuation coverage will
be offered to each eligible individual. These individuals will
each have the independent right to elect COBRA contin-
uation coverage. Covered employees may elect COBRA
continuation coverage on behalf of their legal spouses
or registered domestic partners, and parents may elect
COBRA continuation coverage on behalf of their children.
Premium Payments
COBRA continuation coverage is at your expense. The
monthly cost of COBRA continuation coverage will be
included in the election notice sent to you. The amount
you must pay for COBRA continuation coverage will not
exceed 102 percent of the cost for this coverage to the
Plan (including both the Company’s and your contribu-
tions) for a similarly situated participant or beneficiary who
is not receiving COBRA continuation coverage, (or in the
case of an extension of COBRA continuation coverage
due to a disability, 150 percent of that cost). You will have
to pay COBRA premiums on an after tax basis.
For coverage to continue, the first premium must be
received by the date stated in the notice sent to you.
Normally, this date will be 45 days after COBRA contin-
uation coverage is elected. Premiums for every following
month of COBRA continuation coverage must be paid
monthly on or before the premium due date stated in the
notice sent to you. There is a 30-day grace period for
these monthly premiums. If they are not paid within 30
days after their due date, COBRA continuation coverage
will end as of the first day of that period of coverage
and cannot be reinstated. If a partial premium payment
is made that falls short of the current amount due by a
minimal amount, you will be notified, and, if the shortfall is
not paid within 30 days of the date the notice is received,
COBRA continuation coverage will end as of the first day
of that monthly period of coverage.
