The University of Washington offers a continuation provision to the Graduate Appointee Insurance Program (GAIP) coverage allows you or your eligible dependents to continue your insurance should you lose eligibility for UW-paid coverage.
Please note that the self-pay rules have not changed. Continuation coverage is different from self-pay and the qualifying events that activate continuation coverage eligibility are outlined below. Find out more about self-pay while on leave. Please review the information below carefully to ensure that you understand your rights and responsibilities.
This notice contains important information about your right to continuation coverage, which is a temporary extension of coverage under the plan. This notice generally explains 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.
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 below. After a qualifying event, continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse/Same-Sex Domestic Partner (SSDP), and your dependent children could become qualified beneficiaries if coverage under the plan is lost because of a qualifying event. Under the plan, qualified beneficiaries who elect continuation coverage must pay for it.
If you are a graduate appointee enrolled in GAIP, you will become a qualified beneficiary if you lose your coverage under the plan because of either one of the following qualifying events:
If you are the spouse/SSDP of a GAIP-eligible graduate appointee, you will become a qualified beneficiary if you lose your coverage under the plan because of any of the following qualifying events:
Your dependent children will become qualified beneficiaries if they lose coverage under the plan because of any of the following qualifying events:
The plan will offer continuation coverage to qualified beneficiaries only after the plan administrator has been notified that a qualifying event has occurred. The employer must notify the plan administrator of the qualifying event, when the event is any of the following:
For the other qualifying events (divorce or legal separation of the graduate appointee and spouse/SSDP or a dependent child’s losing eligibility for coverage as a dependent child) you must notify the plan administrator within 60 days after the qualifying event. You must provide this notice to:
P.O. Box 21325
Seattle, WA 98111
Once the plan administrator receives notice that a qualifying event has occurred, continuation coverage will be offered to each of the qualified beneficiaries. Each qualified beneficiary will have an independent right to elect continuation coverage. Covered graduate appointees may elect continuation coverage on behalf of their spouse/SSDP, and parents may elect continuation coverage on behalf of their children.
Continuation coverage is a temporary continuation of coverage. Continuation coverage lasts for up to a total of 36 months when the qualifying event is any of the following:
When the qualifying event is the end of employment or reduction of the graduate appointee's hours of employment, and the graduate appointee became entitled to Medicare benefits less than 18 months before the qualifying event, continuation coverage for qualified beneficiaries other than the graduate appointee lasts until 36 months after the date of Medicare entitlement. For example, if a covered graduate appointee becomes entitled to Medicare eight months before the date on which his or her employment terminates, continuation coverage for his or her spouse/SSDP and children can last up to 36 months after the date of Medicare entitlement (36 months minus eight months equals 28 months). Otherwise, when the qualifying event is the end of employment or reduction of the graduate appointee’s hours of employment, continuation coverage generally lasts for only up to a total of 18 months. There are two ways in which this 18-month period of continuation coverage can be extended.
However, an extension is available only if the event would have caused the spouse/SSDP or dependent child to lose coverage under the plan had the first qualifying event not occurred.
All questions concerning your plan or your continuation coverage rights should be addressed to the plan administrator. See GAIP Contacts.
In order to protect your rights and/or those of your family, you should keep the plan administrator informed of any address changes. Keep a copy of any notices or correspondence for your records.
For more information about your continuation coverage rights, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, contact the Centers for Medicare and Medicaid.