17 • You and your Spouse become divorced or legally separated; or • Your dependent child no longer meets the eligibility requ irements under the Plan. For example, the dependent child reaches age 26 and no longer meets the eligibility definition as of the end of the month of his or her 26th birthday. Who Is a Qualified Beneficiary? A “Qualified Beneficiary” under COBRA is any par ticipant or eligible dependent who, on the day before the Qualifying Event, has coverage under the Plan, who would otherwise lose such coverage due to the Qualifying Event, and timely elects to receive COBRA Continuation Coverage. The term Qualified Benefi ciary includes any eligible dependent who is born to, or placed for adoption with, you during the period of COBRA Continuation Coverage. Adding a dependent to your coverage may cause an increase in your COBRA premiums. If a Qualified Beneficiary with COBRA Continuation Coverage acquires an eligible dependent, the eligible dependent may be added to the coverage for the remainder of the COBRA Continuation coverage period. If a Qualified Beneficiary has a dependent who was eligible, but not enrolled in the Pla n at the time the Qualified Beneficiary enrolled for COBRA continuation coverage because the dependent had other group health coverage at that time, and the dependent loses the coverage under the other group health plan due to exhaustion of COBRA continuat ion coverage, you may add the dependent to your coverage for the remainder of the COBRA continuation coverage period. The addition must be completed within 30 calendar days after the dependent’ s loss of the other coverage. Who Must Give Notice of the Qual ifying Event? Employer’s Responsibility The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Fund Office has determined, or been notified, that a Qualifying Event has occurred. Your contributing employer must notify the Fund Office if: • You experience a reduction in work hours that causes a loss of eligibility under the Plan; • Your employment ends for any reason other than your gross misconduct; • You die; or • You become entitled to Medicare benefits (Part A, Part B or both). Your Responsibility You are responsible for providing the Fund Office with timely notice of the following Qualifying Events: • You and your Spouse are divorced or are legally separated; • An eligible dependent has ceased to meet the eligibility requirements; • If there is an occurrence of a “second qualifying event” experienced by you or any other qualified beneficiary after you, or the other qualified beneficiary who previously became entitled to COBRA with a maximum duration of 24 (or 35) calendar months. This second qualifying event could include your death, you become entitled to Medicare, your divorce or legal separation, or your dependent losing eligibility status under the Plan. (More information about second qualifying events is provided later in this sec tion.); • If a qualified beneficiary entitled to receive COBRA continuation coverage with a maximum of 24 calendar months has been determined by the Social Security Administration to be disabled. If this determination is made at any time that an individual i s disabled during the first 60 calendar days of COBRA continuation coverage, the qualified beneficiary may be eligible for an 11 - calendar month

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