FY1982 5th Amendment 12/29/1986
AMENDMENT #5
CLIENT NAME:
PLAN #:
Monroe County Board of Commissioners
100619
EFFECTIVE October 1, 1986, this Plan Document shall be amended by the
addition of the following:
SECTION SA -- CONTINUATION OF BENEFITS
(As Required By Federal Law)
Federal Legislation known as the Consolidated Omnibus Budget Reconciliation Act of 1985
(COBRA) requires that coverage for a Pa'1icipant and/or Dependent shall be continued after
the occurrence of any of the following events which would normally result in termination of
coverage under the Plan:
1. The death of the Participant;
2. The termination of employment (other than by reason of gross misconduct) of
the reduction of hours of a Participant;
3. The divorce or legal separation of the Participant from his/her spouse;
4. The Participant becomes eligible for Medicare and he is no longer considered
eligible for coverage under the Plan;
5. A Dependent child ceasing to be a Dependent under the terms of this Plan.
Coverage will be continued only for those Participants and/or Dependents who were covered
under the Plan on the day immediately preceding termination.
Coverage will not be continued beyond the earliest of the following dates:
1. With respect to a Participant, the end of an 18 month period;
2. With respect to a Dependent, the end of a 36 month period;
3. The date ending the period for which any required contribution has been paid;
4. The date the Participant or Dependent becomes covered under another group
health plan or entitled to Medicare;
5. The date the Dependent spouse remarries and becomes covered under another
group health plan;
6. The date the Employer ceases to provide any group health plan.
Any conversion privilege provided under this Plan will be available immediately when a
covered family member's medical coverage ceases, provided he has not reached age 65.
This section shall not apply to such Participants or Dependents for whom a greater period of
continuation is provided elsewhere in this Plan Document.
Conformity with the Law
If any provision of this Section is contrary to the Consolidated Omnibus Reconciliation Act of
1985, the provision is changed to comply with the law.
ACCEPTED <- / ~
BY: ~('- ~
DATE: /.:z/ 0 / / ,
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