DOCUMENTS AND FORMS

   Separation of Employment



This page includes the post-termination process for all Company benefits.  Please note that some sections may not be relevant to all employees.  Applicability of each section is dependent on the terminating employee’s eligibility if currently enrolled in the relevant Company benefit.  If you have any questions, please contact benefits@cei.com

Health Insurance - COBRA                                                                                                                                                      

You will receive correspondence from Igoe Administrative Services, our COBRA administrator, regarding continuation of benefits.  If you have any questions or if you wish to contact them immediately you can call:

Igoe Administrative Services

Monday – Friday, 8:00 am – 5:00pm PST

Call: 1-800-633-8818    Website: www.goigoe.com    Email: COBRA@goigoe.com          

If applicable, your Health Benefits Continuation Plan allows you to continue health benefits for yourself and your covered dependents.  Your coverage can commence on the first day after your coverage under the regular group health benefits ends.  The monthly costs to continue your medical, dental and/or vision insurance through COBRA can be found here - COBRA Rate Sheet.

When your active health coverage ends due to the termination of your employment, you will have a limited period of time during which you will have the right to elect COBRA continuation coverage, Marketplace coverage (or perhaps coverage through your spouse’s or other plan).  It is important to note that if you choose to elect COBRA continuation coverage after the termination of your employment and then later decide to voluntarily terminate COBRA coverage, the loss of COBRA coverage will not be a qualifying event that would allow you to enroll in Marketplace coverage (or your spouse’s or other plan coverage) right away.  You must wait until the next open enrollment period for the Marketplace (or your spouse’s or other plan) in order to enroll for such coverage.  Please review your post-termination coverage options and notices carefully.

Notice to California residents or participants under plans issued in California:  Under California law, you may be eligible for a state mandated continuation of medical coverage (Cal-COBRA) after your federally mandated COBRA period expires.  This law allows certain participants covered under insurance contracts issued in California to continue coverage for a total of 36 months from the time your COBRA coverage began.  If you think you may be eligible for this continuation, please contact your current insurance carrier for more information.

If you decide to waive your Health Benefits continuation rights, your group coverage plan with Cupertino Electric, Inc. will end on the last day of the month in which your employment ends.

Expense Reimbursement                                                                                                                                         

You will have 30 days following your date of termination to submit any outstanding business expenses that you incurred up to your termination date. Please complete the enclosed expense reimbursement form, attach the supporting documentation, and submit to HRBP@cei.com for approval and processing.

Group Term Life Insurance

Your coverage will cease on the date of your termination. You may convert your insurance to an individual policy with Guardian Life Insurance Company by sending the completed Election of Portability Coverage form within 31 days after your termination date.

Portability Form
Conversion Form

Voluntary Life Insurance

Your coverage will cease on the date of your termination. You may convert or port your insurance to an individual policy with Guardian Life Insurance Company by sending the completed “Optional Insurance Election of Portability Coverage” form within 31 days after your termination date.

Portability Form
Conversion Form

Long Term Care Insurance                                                                                                                                     

Your coverage will cease on the date of your termination. You may convert your insurance to an individual policy by completing the election form section marked “To Be Completed by the Employee” and mailing the completed form to Unum Life Insurance Company of America LTC Customer Services 2211 Congress Street Portland, Maine 04122. The Basic Care package consists of a $1,000 monthly facility benefit (maximum of three (3) years).  In addition to the Basic Care package, eligible employees have the option to buy additional coverage for a spouse, parent, grandparent (employee and spouse), and in-laws. Please note no payment is necessary at the time of enrollment. 

Portability Form

Critical Illness Insurance

Your coverage will cease on the date of your termination. You may convert your insurance to an individual policy with Guardian by sending the completed “Election of Portability Coverage” form within 31 days after your termination date.

Portability Form

Hospital Indemnity Insurance

Your coverage will cease on the date of your termination. You may convert your insurance to an individual policy with Guardian by sending the completed “Election of Portability Coverage” form within 31 days after your termination date.

Portability Form

Accident Insurance

Your coverage will cease on the date of your termination. You may convert your insurance to an individual policy with Guardian by sending the completed “Election of Portability Coverage” form within 31 days after your termination date.

Portability Form

ARAG Legal

Your coverage will cease on the date of your termination. You may convert your plan to an individual policy within 90 days after your termination date.   If you have any questions, you may contact ARAG’s Customer Care Center:

Available M – F, 7am – 7pm CST

800.247.4184

Service@ARAGlegal.com

HSA Bank Account                                                                       

If you currently have an H.S.A. account, you will be responsible for a monthly service fee in the amount of $2.25 after your employment ends. This fee will be deducted from your account on the last day of each month. If your balance is $3,000 or greater, the monthly fee will be waived.  Visit www.hsa.bank for more information.

Flexible Spending Plan       
                                                                                                                                          

If you are enrolled in the Company’s Healthcare Flexible Spending account, you will have 60 days following your termination date to submit any covered expenses for reimbursement. You may only submit expenses that you incurred prior to your termination date.  If you have a positive FSA account balance, you may elect COBRA continuation coverage. Any contributions made after your employment ends will be on an after-tax basis.  COBRA continuation will allow you to continue to incur expenses beyond your termination date through the end of the current plan year.

If you are enrolled in the Company’s Dependent Care Flexible Spending account you will have 90 days following the close of the plan year to submit reimbursements for any eligible expenses incurred during the plan year; even after your termination date with the Company.  Visit www.goigoe.com for more information.

FSA Plan Highlights
Reimbursement Request Form

401(k) Plan                                                                                                                                                           

If applicable, contributions to your 401K plan will cease on your termination date. If your account balance is less than $1,000, your account will be closed out by the end of the current quarter and you will receive a refund check via U.S. mail directly from Empower, our 401(k) administrator.  Account balances greater than $1,000 will be automatically rolled over to an IRA with Millennium Trust Company if no distribution or rollover has been made by the end of the current quarter. Please note, if you have an outstanding loan(s) you will need to contact Empower at 1-888-411-4015 to obtain a payoff quote.  Loan payments are required to be paid in full within 60 days of termination.

Distribution Options 401(k)
Withdrawal Request Form

 Job Search Resources

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