BNY Mellon Benefits Guide
COBRA Rights Notice–Health and Welfare Benefits
You are receiving this notice because you are currently covered under a group health plan under the BNY Mellon Group Health and Welfare Plan (the Plan). This notice contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. 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. When you become eligible for COBRA, you may also become eligible for other coverage options that may cost less than COBRA continuation coverage. For example, you may be eligible to buy an individual plan through the Health Insurance Marketplace (see the Marketplace notice in this packet for further details). By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse's plan), even if that plan generally does not accept late enrollees.
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 other members of your family when you would otherwise lose your group health coverage under the Plan. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage. For additional information about your rights and obligations under the Plan and under federal law, you should review your Summary Plan Description or contact the BNY Mellon Benefit Solutions Service Center.
What Is 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. After a qualifying event occurs, COBRA continuation coverage must be offered to each person who is a "qualified beneficiary".
You, your spouse, and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of a qualifying event. Qualified beneficiaries who elect COBRA continuation coverage must pay for that coverage.
You will become a qualified beneficiary if you lose your coverage under the Plan because either one of the following qualifying events happens:
  • Your hours of employment are reduced; or
  • Your employment ends for any reason other than your gross misconduct.
Your spouse will become a qualified beneficiary if he or she loses coverage under the Plan because any of the following qualifying events happens:
  • Your hours of employment are reduced;
  • Your employment ends for any reason other than your gross misconduct;
  • Your death;
  • Your entitlement to Medicare benefits (under Part A, Part B, or both); or
  • You become divorced or legally separated.
Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because any of the following qualifying events happens:
  • Your hours of employment are reduced;
  • Your employment ends for any reason other than your gross misconduct;
  • Your death;
  • Your entitlement to Medicare benefits (under Part A, Part B, or both);
  • Your divorce or legal separation; or
  • The dependent stops being eligible for coverage under the Plan as a "dependent child".
Sometimes, filing a proceeding in bankruptcy under Title11 of the United States Code can be a qualifying event. If a proceeding in bankruptcy is filed with respect to BNY Mellon, and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan, the retired employee will become a qualified beneficiary. The retired employee's spouse, surviving spouse, and dependent children will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan.
When Is COBRA Coverage Available?
BNY Mellon will offer COBRA continuation coverage to qualified beneficiaries only after it has been notified that a qualifying event occurred. For the following qualifying events, BNY Mellon will notify the BNY Mellon Benefit Solutions Service Center of the qualifying event:
  • Your hours of employment are reduced; Your employment ends;
  • Your death;
  • Your entitlement to Medicare benefits (under Part A, Part B, or both); or
  • BNY Mellon commences Chapter 11 bankruptcy proceedings.
You Must Give Notice For All Other Qualifying Events
For all other qualifying events (your divorce or legal separation from spouse or your dependent child's losing eligibility for coverage as a dependent child), you or a family member must notify the BNY Mellon Benefit Solutions Service Center within 60 days after the qualifying event occurs.
You must notify the BNY Mellon Benefit Solutions Service Center of the qualifying event by accessing the MyBenefit Solutions website at mybenefits.bnymellon.com or calling 1-800-947-4748, option 2.
How Is COBRA Continuation Coverage Provided?
Once the BNY Mellon Benefit Solutions Service Center receives notice that a qualifying event has occurred, COBRA continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. You may elect COBRA continuation coverage on behalf of your spouse and dependent children. Your spouse may also elect continuation coverage on behalf of your dependent children.
COBRA continuation coverage is a temporary continuation of coverage. When the qualifying event is one of the following events, COBRA continuation coverage lasts for up to a total of 36 months for your spouse and dependent children:
  • Your death;
  • Your divorce or legal separation; or
  • Your dependent stops being eligible for coverage under the Plan as a "dependent child".
When the qualifying event is one of the following events, COBRA continuation coverage lasts for up to a total of 18 months for qualified beneficiaries:
  • Your hours of employment are reduced; or
  • Your employment ends for any reason other than your gross misconduct.
When the qualifying event is your reduction in hours or your termination of employment and you were entitled to Medicare benefits prior to the qualifying event, additional coverage for your spouse and dependents may be available. Your spouse and dependents would be eligible to receive up to 36 months of COBRA continuation coverage from the date of your entitlement to Medicare. For example, if you became entitled to Medicare 8 months before the date your employment terminates, COBRA continuation coverage for your 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 prior to the qualifying event).
There are two ways in which an 18-month period of COBRA continuation coverage can be extended.
Disability Extension of 18-Month Period of Continuation Coverage
COBRA coverage may be available for you and your family for up to a total of 29 months at a higher premium if:
  • You, your covered spouse, or your covered dependents (including newborn and newly adopted children) are determined to be disabled as defined by the Social Security Act prior to the qualifying event or during the first 60 days of COBRA coverage;
  • The Social Security Administration's disability determination is received within the disabled individual's 18 months of COBRA coverage;
  • The disability must last at least until the end of the 18-month period of continuation coverage; and
  • The BNY Mellon Benefit Solutions Service Center is notified of the Social Security Administration's disability determination within 60 days of the disabled individual's receipt of a Social Security Disability award. If the disability determination occurred before COBRA coverage started, you're required to notify the BNY Mellon Benefit Solutions Service Center within the first 60 days of COBRA coverage.
You, your covered spouse, or your covered dependents must notify the BNY Mellon Benefit Solutions Service Center within 60 days of receipt of the disability determination and prior to the end of the initial 18-month continuation period in order to receive the coverage extension. To notify the BNY Mellon Benefit Solutions Service Center of the disability determination event, call 1-800-947-4748, option 2.
You, your covered spouse, or your covered dependents must notify the BNY Mellon Benefit Solutions Service Center within 30 days of the date the disability ends by calling 1-800-947-4748, option 2.
Second Qualifying Event Extension of 18-Month Period of Continuation Coverage
If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage, your spouse and dependent children can receive up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months if the BNY Mellon Benefit Solutions Service Center is properly notified about the second qualifying event. Additional continuation coverage is available only if the event would have caused your spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. These events include:
  • Your death;
  • Your entitlement to Medicare (under Part A, Part B, or both); Your divorce or legal separation; or
  • Your dependent stops being eligible for coverage under the Plan as a "dependent child".
You, your covered spouse, or your covered dependents must notify the BNY Mellon Benefit Solutions Service Center within 60 days after the event occurs in order to receive this additional coverage. To notify the BNY Mellon Benefit Solutions Service Center of the additional qualifying event, call1-800-947-4748, option 2.
Events That May Change Continued Coverage
Once your COBRA coverage begins, you may be able to change your COBRA coverage elections based on plan rules if you experience a qualified change in status. You, your covered spouse, or your covered dependents must notify the BNY Mellon Benefit Solutions Service Center by calling 1-800-947-4748, option 2 within 31 days of the qualified change in status to change your COBRA coverage. See your Summary Plan Description for detailed information on allowable changes in status. Adding family members to COBRA coverage may result in a higher premium for this additional coverage.
You may also change COBRA coverage if a child is born to the covered employee or placed for adoption with the covered employee during the 18-, 29-, or 36 -month continuation period. In such case, you must notify the BNY Mellon Benefit Solutions Service Center by calling 1-800-947-4748, option 2 within 31 days of the birth or placement to cover the new dependent as a qualified beneficiary under COBRA. There may be a higher premium for this additional coverage.
Events That End Continued Coverage
COBRA coverage will end automatically upon the expiration of the 18-, 29-, or 36-month continuation periods previously described. In addition, COBRA coverage will end automatically if any of the following situations occur:
  • BNY Mellon stops providing group health benefits;
  • Premiums are not paid within 60 days of the due date (with the exception of the initial premium which is due within 45 days of your election date); or
  • A person eligible for continued benefits becomes covered under any other group health plan or becomes entitled to Medicare.
If your coverage ends because of expiration of the 18-, 29-, or 36-month limit, you may be able to convert coverage to an individual policy if this right currently exists in the Plan.
Other Coverage Options
When you lose group health coverage, there may be other coverage options for you and your family through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse's plan) through what is called a "special enrollment period." Some of these options may cost less than COBRA continuation coverage. Additionally, you may qualify for a 30-dayspecial enrollment period for another group health plan for which you are eligible (such as a spouse's plan), even if that plan generally doesn't accept late enrollees. Some of these options may cost less than COBRA continuation coverage.
You can learn more about many of these options at www.healthcare.gov.
Address Information
Be sure to keep your current address information up to date with BNY Mellon. Doing so is the only way to ensure that important benefit information will reach you. You should also keep a copy, for your records, of any notices you send to BNY Mellon.
Your Rights Under ERISA
For more information about your rights under ERISA, including COBRA, the Patient Protection and Affordable Care Act, and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor's Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at www.dol.gov/ebsa .(Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA's website.) For more information about the Marketplace, visit www.healthcare.gov.
For More Information
BNY Mellon Benefit Solutions is providing COBRA administration services. Questions concerning the Plan or your COBRA continuation coverage should be directed to BNY Mellon Benefit Solutions. You can contact the BNY Mellon Benefit Solutions Service Center as follows:
  • Web: MyBenefitSolutions at mybenefits.bnymellon.com.
  • Phone: 1-800-947-4748, option 2, 8:30 a.m. to 8:00 p.m. Eastern Time Monday through Friday.
Please address any written correspondence to:
BNY Mellon Benefit Solutions
PO Box 563931
Charlotte, NC 28256-3931
.