What if my Employer was out of State or Self Insured,
can I get Cal COBRA, Small Biz Plan or a Individual Plan?
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
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issued outside of California
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to an employer whose principal place of business and
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majority of employees are located outside of California. (§10112.5(b) *
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,
Even if it’s NOT Open Enrollment, there is Special Enrollment. Under Special Enrollment, your coverage is the first of the month after you apply, rather than the crazy 15th and miss a month deadline. Emails dated 1.21.2015 2:07 PM
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.orgMetropolitan 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
Case Law
(Stare Decisis)
Accident policy, applied for and delivered in California where premiums were paid, was California contract, as regards question what law governed. Palmquist v. Standard Acc. Ins. Co., S.D.Cal.1933, 3 F.Supp. 356.
A resident of Missouri signed in that state an application for life insurance. The policy was executed by the insurer at its office in New York, and transmitted to Missouri, where it was delivered to the assured, and where the premiums thereon were paid.
Held, that the policy only became a completed contract on its delivery and the payment of the premium in Missouri, so that it is a Missouri contract, and governed by the laws of that state. Equitable Life Assur. Soc. v. Pettus140 U.S. 226, 11 S.Ct. 822U.S. 1891
This may be in conflict with the US Constitution (State’s Relations) Article 4 Section 1, Full Faith and Credit shall be given in each State to the public Acts, Records, and judicial Proceedings of every other State. And the Congress may by general Laws prescribe the Manner in which such Acts, Records and Proceedings shall be proved, and the Effect thereof. McCarran Ferguson Act? CA Insurance Code §41 All insurance in this State is governed by the provisions of this code.
Part D Rx & B Doctor Visits
Surcharge Chart
We don't always have time to update this chart.
Just click on chart or Medicare Costs Publication #11579 for the latest from Medicare.
Part D
Higher Income Surcharge
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Higher Income Surcharge
Steve's VIDEO introduction to Cal COBRA
- Instant Health Quotes & Enroll
- 15 Reasons to appoint us as your broker - No extra charge
- Department of Labor VIDEO on COBRA and various other rights
Employee’s guide to COBRA –
Department of Labor
*********
Art Gallagher Employers Guide to COBRA
Our Webpage on COBRA * Cal COBRA
Get Individual Guaranteed Issue ACA/Obamacare Quotes -
Subsidies if you make less than 600% of Federal Poverty Level!
No Pre X Clause!
No wait for Open Enrollment as you get Special Enrollment when you lose COBRA or your Employer Group Plan!
COBRA FAQ's
http://www.cvtrust.org/ is one of the state’s largest self-funded PPO public schools’ trust Since they are self funded the trust comes under the “self-funded or insured” exemption in the webpage above.
You can get coverage within 60 days of losing COBRA without having to wait for open enrollment special-enrollment-triggering-events/
Got a notice that I wont be offered Cal-Cobra after my 18 months of Federal Cobra
on my Heath Insurance because of “Health Reform”.
***I’m not aware of any provision of Health Reform that changed the rules of Cal COBRA. I double checked the law on the State’s website leginfo.legislature.ca.gov and don’t see that it’s been repealed.
1. Does the Department of Labor have a FAQ Section or FAQ'?
2. Where can I get more details on MY specific plan and options?
Find your Evidence of Coverage, SAMPLE, and you can get TONS of detail on HIPAA, COBRA & Cal COBRA
8. Do you have an FAQ section for Cal COBRA? What is Gross Misconduct?
9. What notices must the Employer give the Employee?
We live in CA and our family is currently on a health plan with xxx, a large multinational corporation with lots of employees in CA.
My wife worked there until about a year and a half ago and so we have been on their health plan, via COBRA — which expires at the end of this month (October). She just pinged them to extend coverage under Cal-COBRA, and the HR person said:
This is surprising, and we would imagine/hope, not legal.
Do you happen to be able to recommend an attorney who specializes in issues of employer health plan coverage and may be able to write them a stern letter and persuade them to extend Cal-COBRA to us?
xxx (previously known as xxx) is an American Singaporean-domiciled xxx en.wikipedia.org/xxx
See the limitations of CA Insurance Law, above and below
10112.5. (a)
(1) Notwithstanding any other provision of law, every policy or certificate of health insurance marketed, issued, or delivered to a resident of this state, regardless of the situs of the contract or master group policyholder, shall be subject to all provisions of this code.
(2) (A) Paragraph (1) shall not apply to a policy or certificate of health insurance that is
issued outside of California
to an employer whose principal place of business and
majority of employees are located outside of California.
(3) Nothing in subparagraph (A) of paragraph (2) shall be construed to limit the applicability of any other provision of this code to any policy or certificate of health insurance that is issued outside of California to an employer whose principal place of business and majority of employees are located outside of California.
(b) Notwithstanding any other provision of law, every policy or certificate of group health insurance marketed, issued, or delivered to a resident of this state, regardless of the situs of the contract or master group policyholder, shall be subject to Section 10121.7.
https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=INS§ionNum=10112.5.
Does your employer meet the exclusion requirements above.
Please send the Evidence of Coverage.
The HR Department probably meant to send you to Covered CA. I’m an authorized broker for them. You can get instant quotes here http://www.quotit.net/eproIFP/webPages/infoEntry/InfoEntryZip.asp?license_no=0596610
Why would an employee not qualify to enroll in Cal-COBRA?
The employee is enrolled in or eligible for Medicare.
The employee does not enroll within 60 days of receiving the notice of eligibility from the employer.
The employee is covered by another health plan.
The employee is fired for gross misconduct.
If the company closes.
If the company stops offering coverage to current employees.
If the employee is covered by a self-funded plan.
If the employee is covered by an out-of-state plan.
If the employee moves from the Health Plan service area. https://www.dmhc.ca.gov/HealthCareinCalifornia/TypesofPlans/KeepYourHealthCoverage(COBRA).aspx#Can%20I%20get
You might try Westlaw ONE Day Pass
https://legal.thomsonreuters.com/en/support/onepass
Try https://www.legalmatchca.com/
… matching people looking for an attorney to one or more qualified, pre-screened, licensed and insured attorneys without charging a referral fee.
Present your case online in minutes…. Our service makes the accessibility of legal services easier and less intimidating by matching Californians to multiple attorneys simultaneously. Interested attorneys usually respond within hours with detailed information on their affordability, their full profile and specifics on how they can help you resolve your case. All LegalMatch California attorneys are encouraged to provide 30 minute free consultations.
I thought that under ACA/Obamacare no one would want COBRA or Cal COBRA anymore and almost took down these pages. HIPAA after COBRA has gone away.
If your wife G-d forbid is ill and you need her to stay with the same doctors and hospitals you might check into CA law on the continuity of care
https://individuals.healthreformquotes.com/provider-finder/narrow-lists/continuity-of-care-ab-369/
You can check on the providers in an individual plan here.
Does your employer have a benefits site where we can see if they are subject to Cal COBRA or not?
For example:
https://medicare.healthreformquotes.com/seminar/rules-get-part-hospital-medicare-no-charge/lausd-medicare-qualification/
https://medicare.healthreformquotes.com/mapd/regulations/obscure/motion-picture-industry-pension-health-plan/
or check the Q & A here, for how many people we’ve been able to get the forms to keep their disabled child on the coverage
https://medi-cal.healthreformquotes.com/eligibility/aged-and-disabled/ssi/ssi/dac-disabled-adult-child/disabled-children/
Even if they have several offices in CA and hundreds of employees in CA?
It just goes strictly by headquarters?
Along with – Majority of Employees see Insurance Code 10112.5 above and below.
What is the name of the employer? We can then see if they have their COBRA information posted online. Do you have a copy of the Evidence of Coverage? We can then see what their COBRA and Cal COBRA procedures are if any.
Here’s an example from a UHC-United Health Care – CA Issued Policy:
Federal COBRA Continuation Coverage 62
When is COBRA Coverage available? 63
You Must Give Notice of Some Qualifying Events 63
How is COBRA Coverage provided? 63
1401 Extended Continuation Coverage After COBRA 64
Cal-COBRA Continuation Coverage 66
1401 Extended Continuation Coverage After Cal-COBRA 69
If an employer was mandated to provide 18 months of COBRA is NOT a small employer and NOT self insured (plan is Cigna PPO), are they still able to use the out of state provision to refuse to offer Cal COBRA?
See above and CA Insurance Code
10112.5.
(a) (1) Notwithstanding any other provision of law, every policy or certificate of health insurance marketed, issued, or delivered to a resident of this state, regardless of the situs of the contract or master group policyholder, shall be subject to all provisions of this code.
(2) (A) Paragraph (1) shall not apply to a policy or certificate of health insurance that is issued outside of California to an employer whose principal place of business and majority of employees are located outside of California.
(B) Notwithstanding subparagraph (A), no policy or certificate of health insurance marketed, issued, or delivered to a resident of this state shall discriminate in coverage between spouses or domestic partners of a different sex and spouses or domestic partners of the same sex.
(3) Nothing in subparagraph (A) of paragraph (2) shall be construed to limit the applicability of any other provision of this code to any policy or certificate of health insurance that is issued outside of California to an employer whose principal place of business and majority of employees are located outside of California.
(b) Notwithstanding any other provision of law, every policy or certificate of group health insurance marketed, issued, or delivered to a resident of this state, regardless of the situs of the contract or master group policyholder, shall be subject to Section 10121.7.
I notice on your website above that a company headquartered outside of California does not have to participate in, or offer CAL COBRA to their former employees.
Are there any exceptions to the “out of state” “rule” that you are aware of, as my next step is to contact my previous employer’s HR Dept. to request it.
You might go to the law library and read the cases, like I googled above under “Case Law.” In the meantime, why worry, you can get guaranteed issue ACA/Obamacare, no pre x. Get quotes and enroll.
I understand ACA is there for people who cannot otherwise find coverage.
is that correct?
Or is it possible to obtain ACA coverage. If I am currently covered by Medicare (needing only dental coverage,) and my wife needs both medical and dental insurance until she turns 65
ACA is for everyone! It’s the law. Everything is ACA even if Presidents Trump and Obama think it might be only for those who are getting subsidies in Covered CA.
Dental is not mandated to be covered under COBRA… You can shop & enroll in dental here.
Use this link for your wife to shop and enroll in health and dental plans, until she qualifies & enrolls in Medicare.
Employer payments for my Health Care Plan ended when I turned 65.
Under a special enrollment period, we applied for coverage under my husbands government retirement plan.
My original plan covered me, my husband and my disabled dependent daughter age 28.
My spouses group insurance is denying my request to enroll my daughter – citing that she needed to be continuously enrolled (with them) beginning at the age of 26.
This appears to be a discrimination under HIPPA or ERISA.
I am wondering if I should proceed to a fair hearing.
We deal with this issue of changing insurance companies here https://employers.healthreformquotes.com/ab-1083/employer-definition/employee-definition/dependent-definition/disabled-children/rules-insurance-companies-coverage-disabled-children/transfer-rules/
If you have additional questions, please ask there.
I was employed by a 200 person company for 4 years and had Anthem Prudent PPO group insurance. I went on to Cobra after leaving the job, and paid the full premiums. Six months later, the company went to a self-insured plan still offering Anthem Prudent PPO.
1) Is there any grandfather clause or law that would allow me to get CalCobra since I was already on Cobra before the change to self insured was made?
2) Can they simply refuse to offer CalCobra even though I was told in email it would be offered to me because I was already on Cobra before the change?
I’m not aware of any grandfathering provision that would make an Employer Offer Cal COBRA if the employer goes out of business, moves to a self insured plan or simply stops offering Medical Insurance. There has to be an Insurance Plan for the COBRA to “come from.”
Under Health Care Reform, you can get an Individual Policy regardless of your health status – pre-existing conditions, at the same rates as everyone else. You may even qualify for subsidies. Get a FREE quote here.
If you still insist you want Cal COBRA, try following the links above, but I doubt it.