COBRA & California Cal-Cobra
Federal & Cal COBRA
- Federal COBRA and California Cal-COBRA basically provide that if you are no longer covered under your Employer’s group health plan, you can keep the group coverage regardless of your health and with no pre-existing condition clause for 18 (Federal) or 36 months (California) at 2 to 10% more premium than your employer was being billed from the Insurance Company.
- When you lose group coverage, that is a Qualifying event, which allows you to get other coverage, without waiting for Open Enrollment, examples:
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losing your job, regardless of if you were laid off, fired or passed away.
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your child lost his student status, gets married, no longer a dependent or reached age 26
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Divorce or a spiteful spouse who took you or children off the policy… even though CA Divorce Law Financial Automatic Restraining Orders FL 110 prohibits financial changes. 26 CFR 54.4980B-4 Qualifying Events *
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- Since everything now is Guaranteed Issue with No Pre-X under Health Care Reform, consider going on an Individual Plan (Get Quotes). Even if it’s NOT Open Enrollment, there is Special Enrollment, as you have just lost coverage MEC Minimum Essential Coverage. Under Special Enrollment, your coverage is the first of the month after you apply.
- If you have problems obtaining your COBRA, or CAL COBRA coverage, we can lead you in the right direction. There is no such place as Cal COBRA. It’s a law that guarantees you can keep your employer’s group plan when you terminate employment. It’s basically though something that you arrange directly through your Former Employer’s HR Department or Insurance Company. (SB 719, California Continuation Benefits Replacement Act §10128.50 et seq. , §1366.2, AB 1401 )
- We suggest that you get Quotes and see if you can get a better alternative than COBRA. Not all members of the family have to take COBRA for one member to get coverage. With your own Individual coverage you have the option of taking a higher deductible, HSA Health Savings Account get quotes on dental, life or vision to save $$$.
#Options for getting coverage when you lose your job?
- Cal Cobra & Cobra
- Don’t worry about getting notified… You will and you will have time to make a decision!
- Private Coverage – Direct or Covered CA with Subsidies – NO Medical Questions – No Pre X
- Medi – Cal Medi Cal does monthly qualification too!
Learn More – Links & References
- FAQ’s on right to keep Employer Plan
- VIDEO Losing Job-Based Coverage
- Continuity of Care same doctor even if no longer in network
- Department of Managed Health Care on COBRA & Cal COBRA
- Check out your Evidence of Coverage – Actual Policy for rules & procedures
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DOL (Dept. of Labor) More Info – Job Loss
- Our webpage on Continuity of Care
- Our webpage on Registered Domestic Partners – Spousal Health Coverage?
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F. Medicare And Other Health Insurance Coverage Hi Cap CA Health Care Advocates
- Medicare & Other Insurance HI Cap
- F-002-People with Medicare and TriCare for Life – 12-16-13
- F-003-Medicare and Veterans Administration Medical Benefits Package – 04-01-22
- F-004 COBRA and Medicare – 05-11-20
Employee’s guide to #COBRA –
Department of Labor
- EmployER’s Guide to COBRA
- DOL on Health & Retirement benefits after job loss
- DOL on COBRA
- FAQ CA Department of Insurance
- CA Department of Managed Health Care FAQ’s
- Retirement and Health Care Coverage… Questions and Answers for Dislocated Workers
- Federal workers hit by layoffs have their own version of COBRA
Here’s what private-sector benefits specialists should know about new hires coming in with “temporary continuation of coverage” benefits. - Navigating COBRA Continuation Coverage: What Employers and Brokers Need to Know
- Your Employer’s Bankruptcy – How Will It Affect Your Employee Benefits?
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Art Gallagher Employers Guide to COBRA
- Our Webpage on COBRA & Cal COBRA
- Get Individual Guaranteed Issue ACA/Obamacare Quotes –
- No Pre X Clause!
- No wait for Open Enrollment as you get Special Enrollment when you lose COBRA or your Employer Group Plan!
Dental & Vision
- Dental & Vision Benefits are protected under the CA Cal COBRA program Insurance Code §10128.52 (a)
Steve’s VIDEO introduction to Cal COBRA
- Instant Health Quotes & Enroll
- 15 Reasons to appoint us as your broker – No extra charge
- VIDEO – Moving from Employer Plan to Individual Plan
- Department of Labor VIDEO on COBRA and various other rights
Contact Us - Ask Questions - Get More Information
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All our Health plans are Guaranteed Issue with No Pre X Clause
Quote & Subsidy #Calculation
There is No charge for our complementary services, we are paid by the Insurance Company.
- We are authorized Brokers for Dental, Vision & Covered CA get instant quotes direct and in Covered CA with subsidy calculation for:
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that explains everything about getting a quote
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- Our Quote Engine Takes all the complexity out of using pencil and paper to figure out the premiums per the Obamacare/ACA rules under CFR §1.36B-3 *
FAQ’s
- COBRA doesn’t count as Active Employer Coverage to give you a special enrollment period to Medicare A & B.
- FAQ’s Queens Employment Attorney.com
- What if you have a plan that can’t pay benefits, like if they went bankrupt?
- DOL.gov Fact Sheet
FAQ’s
Mandatory #Notification of COBRA & Cal Cobra Rights
- When there occurs a “qualifying event” like losing coverage, that entitles persons covered by an employer group health plan to elect continuation coverage, such as the employee’s termination of employment or death, the divorce of the employee and his or her spouse, or a dependent child’s ceasing to qualify for dependent coverage under the plan, a notice of the right to elect continuation coverage generally must be sent to each person (termed in the COBRA law a “qualified beneficiary”) who has that right.
- If the “qualifying event” is the employee’s termination, reduction of hours or death, the employer has 30 days after the event (or, if later, 30 days after the date coverage is lost) to notify the plan administrator, which in turn must give the notice of COBRA rights within 14 days to persons entitled to elect coverage. (If the employer and the plan administrator are the same, it has the full 44 days to give the notice.)
- How soon the notice is provided affects how long eligible persons have to elect continuation coverage because they must be given at least 60 days from the date of the notice. Wilcox & Savage Esq. * Reporting & Disclosure Guide (DOL) California Cobra Program [10128.50 – 10128.59]
- Get more detail in the Employees Guide to COBRA page 5
- Blue Cross Employer Administrative Manual
Lapse? Re-Instatement? Grace Period? COBRA
- There is a minimum 30-day grace period for each successive payment due date. Payment is considered made on the date it is postmarked (if it is mailed), not the date of the check or the date the payment is physically received by the Plan. (cms.gov Page 15 Section V # 4, dol.gov, vantaggiohr.com Treasury Regulation §54.4980b-8 Question # 5)
- Under the new regulations, qualified beneficiaries must receive what is called an “Early Termination Notice” if they lose coverage due to failure to make payment by the due date or within the grace period. (dol.gov/)
Gross Misconduct?
- Gross Misconduct Might prevent you from getting COBRA. It’s not defined in the code, thus
- Courts that have faced the gross misconduct case generally refer to the two questions below when deciding if the conduct is truly gross misconduct.
- Was the conduct intentional, willful, deliberate or reckless, and was that conduct performed with a conscious or reckless disregard of the consequences of one’s acts for the very purpose of causing harm or with knowledge that harm would result in the employer’s best interest?
- Did the conduct have a connection or series of connections or physical presence linking the gross misconduct or performance directly to the employer, a co-worker or a current or former client or customer? East Coast Risk Management * HR Service Inc *
Out of State? #Self Insurance?
- If you worked for an Employer who was headquartered Out of State, they do not have to offer you the additional 18 months of Cal Cobra coverage after COBRA or even the original 36 months, of Cal COBRA, if they are a small employer. CA Law Definition Employer * (§10128.53) and not subject to Federal COBRA. That’s a mouthful isn’t it. Please double check it, before relying on it.
- The CA Insurance Code shall not apply to a policy… that covers hospital, medical, or surgical expenses and that is issued outside of California
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to an employer whose principal place of business
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U.S. Supreme Court has held that, absent unusual circumstances, a corporation’s principal place of business is its nerve center, i.e., the place where its officers direct, control, and coordinate the corporation’s activities Cornell Law * Nixon Peabody and
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majority of employees are located outside of California. (§10112.5(b) *
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- It’s possible that your Employer might be in CA, but is owned by a larger company, headquartered out of CA and thus they may not have to offer Cal COBRA.
- Since everything now is Guaranteed Issue with No Pre-X under Health Care Reform, consider going on an Individual Plan,
- The CA Insurance Code shall not apply to a policy… that covers hospital, medical, or surgical expenses and that is issued outside of California
- Even if it’s NOT Open Enrollment, there is Special Enrollment. Get Quotes
- The 36 months of Cal COBRA coverage does not apply to self insured health care plans that are covered by the Employee Retirement Income Security Act (ERISA).disability benefits 101.org Metropolitan Life Insurance Company v. Massachusetts, 471 U.S. 724 (1985), the U.S. Supreme Court ruled that state laws governing self-insured benefit plans are subject to ERISA preemption. Foley & Lardner Attorney Analysis
What happens if my EmployER sells the business?
Does the NEW owner have to cover my COBRA?
Simply put, the answer is YES, even if it’s just a sale of assets. See details and examples in the Code of Federal Regulations § 54.4980B-9
See our webpages on:
Service Area – Network
#Service In Network Area
- Once you move out of the service area, the geographical area where you can get Covered Services from an In-Network Provider, CA Law Website * double check your evidence of coverage for exact rules in Plain English, you wouldn’t be able to continue COBRA or Cal COBRA dmhc.ca.gov *
- When Cal-COBRA Continuation Ends.
- The date the Insured moves out of the plan’s service area or commits fraud or deception in the use of services. eoc.hospital.plus.
****************- (k) “Service area” means a geographical area designated by the plan within which a plan shall provide health care services. leginfo.legislature.ca.gov
**** - A geographic area where a health insurance plan accepts members if it limits membership based on where people live.
For plans that limit which doctors and hospitals you may use, it’s also generally the area where you can get routine (non-emergency) services. The plan may end your coverage if you move out of the plan’s service area. .healthcare.gov/
*********** - A coverage area (also called service area) is a specific region where a health insurer’s members can get covered care under their plan. The insurance company contracts with doctors, medical groups, pharmacies, and hospitals in this area to guarantee in-network rates for its members. For EPO or HMO plans, you have to live within a coverage area in order to sign up for an insurance policy. hioscar.com/service-area
********* - Service Area: The geographic area served by an insurer or healthcare provider. glossary
- (k) “Service area” means a geographical area designated by the plan within which a plan shall provide health care services. leginfo.legislature.ca.gov
- In-Network Provider Definition
- A Provider that has a contract, either directly or indirectly, with us, or another organization, to give Covered Services to Members through negotiated payment arrangements under this Plan.
- FAQ’s
3rd Party Administrators & Reference Services
- Employee Benefits Institute of America
- UnitedHealthcare Administration – COBRA
- ERISA & US Code Links
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Steve,
Your professional advice and suggestion are really appreciated.
Thanks!