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.
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, as you have just lost coverage MEC Minimum Essential Coverage. 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
If you have problems obtaining your COBRA, or CAL COBRA coverage, we can lead you in the right direction. It’s basically though something that you arrange directly through your Former Employer’s HR Department or Insurance Company.
We suggest that you get Quotes for the Healthy Members of your Family 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 or not taking maternity-pre ACA ObamaCare, dental, life or vision to save $$$.
Department of Managed Health Care on COBRA & Cal COBRA
Keep your Prior Employer Coverage
Cal COBRA allows you, the employee and spouse or child to keep your prior Employer Group Medical Insurance Coverage when you lose your job or have another qualifying event. Some examples are:
losing your job, regardless of if you were laid off, fired or passed away.
Divorce or a spiteful spouse who took you or children off the policy… even though CA Divorce Law Financial Automatic Restraining Orders FL 110 prohibiting that.
If you worked for a Small Employer, under 20 employees, Cal COBRA provides the entire 36 months of coverage.
When Cal COBRA ends, we can help you obtain, buy Coverage, coverage for your new business or an Individual & Family Plan. (SB 719, California Continuation Benefits Replacement Act §10128.50 et seq. , §1366.2, AB 1401 )
On the other hand, with Guaranteed Issue Health Care Reform, we don’t think COBRA or Cal COBRA carries the tremendous value that it did in the past.
When must you be notified of your right to get COBRA?
When there occurs a “qualifying event” 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)
Q-1: What is a qualifying event?
A-1: (a) A qualifying event is an event that satisfies paragraphs (b)…
(b) An event satisfies this paragraph (b) if the event is any of the following—
(3) The divorce or legal separation of a covered employee from the employee’s spouse;
(c) An event satisfies this paragraph (c) if, under the terms of the group health plan, the event causes the covered employee, or the spouse or a dependent child of the covered employee, to lose coverage under the plan. For this purpose, to lose coverage means to cease to be covered under the same terms and conditions as in effect immediately before the qualifying event. … If coverage is reduced or eliminated in anticipation of an event (for example,… an employee’s eliminating the coverage of the employee’s spouse in anticipation of a divorce or legal separation), the reduction or elimination is disregarded in determining whether the event causes a loss of coverage. 26 CFR 54.4980B-4 Qualifying Events
Gross Misconduct? Might prevent you from getting COBRA
Call us to discuss 310.519.1335. We will open up Tax Facts with details we can’t post due to copyright.
When can COBRA rates to go up?
The applicable premium must be fixed for a 12-month “determination period.” ERISA § 604 (3); Treas. Reg. § 54.4980B-8, Q/A-2(a) §1164 (3). Therefore, a mid-period increase in insurance rates will not permit a mid-period increase in the COBRA premium charged to QBs. Heart of Matters.com benefitslink.com/
The law limits the conditions when the applicable premium may be increased during a determination period.
A determination period is any 12-month period selected by the plan that is applied consistently from year to year. During a determination period, a plan can increase the premium only in the following three cases:
- (1) The plan has previously charged less than the maximum amount permitted and the increased amount required to be paid does not exceed the maximum amount permitted; or
- (2) The increase occurs during a disability extension and the increased amount required to be paid does not exceed the maximum amount permitted; or
- (3) A qualified beneficiary changes the coverage being received. Because the law is clear in its guidance for premium increases, it is advisable to consult your benefits professional or legal counsel when passing on rate increases to COBRA participants for reasons not stated above. (cobrapoint.com)
Legal Separation? Unofficial Separation?
When your COBRA rates change, you can get a special enrollment into an individual plan.
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/)
Art Gallagher Employers Guide to COBRA
Department of Managed Health Care on COBRA & Cal COBRA
Art Gallagher Employer Guide to COBRA
Disability Benefits 101 FAQ’s Cal COBRA
Pit Falls of Cal COBRA – DI 101
DOL (Dept. of Labor) More Info – Job Loss
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.
2. Where can I get more details on MY specific plan and options?
8. Do you have an FAQ section for Cal COBRA? What is Gross Misconduct?
9. What notices must the Employer give the Employee?
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
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.
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 (pdf) with our markup and annotations.
Don’t pick up COBRA (pdf)
Blue Shield Procedures to change EmployER name or ownership
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
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
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.
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H.R.1319 – American #Rescue Plan Act of 2021
FREE COBRA for Six Months!
Subtitle F–Preserving Health Benefits for Workers
Under section 9501, qualifying COBRA enrollees would be required to pay 15 percent
Note – all the interpretations say nothing
of the total COBRA and Cal COBRA premium from the first of the month following the date of enactment through September 30, 2021. The federal government would provide a subsidy on behalf of the individual for the remainder.
People would be eligible for premiums to be paid on their behalf [So, as I understand it, the employer pays the premium and gets a credit on their payroll taxes] if they are enrolled in, or are eligible to enroll in, COBRA or Cal COBRA coverage because of an involuntary termination or reduction of hours at the time of enactment. Section 9501 would permit eligible people who did not previously elect COBRA coverage and eligible people who discontinued COBRA coverage prior to enact CBO *
(A) Reduction of premiums payable.–In the case of any premium for a period of coverage during the period beginning on the first day of the first month beginning after the date of the enactment of this Act, [April 1st 2021] and ending on September 30, 2021, for COBRA continuation coverage with respect to any assistance eligible individual described in paragraph (3), such individual shall be treated for purposes of any COBRA continuation provision as having paid in full the amount of such premium.
(B) Plan enrollment option.–
(i) In general.–Solely for purposes of this subsection, the COBRA continuation provisions shall be applied such that any assistance eligible individual who is enrolled in a group health plan offered by a plan sponsor may, not later than 90 days after the date of notice of the
plan enrollment option described in this subparagraph, elect to enroll in coverage under a plan offered by such plan sponsor that is different than coverage under the plan in which such individual was enrolled at the time, in the case of any assistance eligible individual described in paragraph (3), the qualifying event specified in section 603(2) of the Employee Retirement Income Security Act of 1974, section 4980B(f)(3)(B) of the Internal Revenue Code of 1986, or section 2203(2) of the Public Health Service Act, except for the voluntary termination
***See our Q & A on definition of voluntary termination
of such individual’s employment by such individual, occurred, and such coverage shall be treated as COBRA continuation
coverage for purposes of the applicable COBRA continuation coverage provision.
(3) Assistance eligible individual.–For purposes of this section, the term “assistance eligible individual” means, with respect to a period of coverage during the period beginning on the first day of the first month beginning after the date of the enactment of this Act, and ending on September 30, 2021, any individual that is a qualified beneficiary who–
(A) is eligible for COBRA continuation coverage by reason of a qualifying event specified in section 603(2) of the Employee Retirement Income Security Act of 1974, section 4980B(f)(3)(B) of the Internal Revenue Code of 1986, or section 2203(2) of the Public Health Service Act, except for the voluntary termination of such individual’s employment by such individual; and
(A) In general.–The Secretary of Labor, in consultation with the Secretary of the Treasury and the Secretary of Health and Human Services, shall provide outreach consisting of public education and enrollment assistance relating to premium assistance provided under this subsection. Such outreach shall target employers, group health plan administrators, public assistance programs, States, insurers, and other entities as determined appropriate by such Secretaries. Such outreach shall include an initial focus on those individuals electing
continuation coverage who are referred to in paragraph (5)(C). Information on such premium assistance, including enrollment,
shall also be made available on websites of the Departments of Labor, Treasury, and Health and Human Services.
(B) Enrollment under medicare.–The Secretary of Health and Human Services shall provide outreach consisting of public education. Such outreach shall target individuals who lose health insurance coverage. Such outreach shall include information regarding enrollment for Medicare benefits for purposes of preventing mistaken delays of such enrollment by such individuals, including lifetime penalties for failure of timely enrollment.
(9) Definitions.–For purposes of this section:
(B) Cobra continuation coverage.–The term “COBRA continuation coverage” #means continuation coverage provided pursuant to part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (other than under section 609), title XXII of the Public Health Service Act, or section 4980B of the Internal Revenue Code of 1986 (other than subsection (f)(1) of such section insofar as it relates to pediatric vaccines), or under a State program that provides comparable continuation coverage. Such term does not include coverage under a health flexible spending arrangement under a cafeteria plan within the meaning of section 125 of the Internal Revenue Code of 1986.
“(a) In General.–The person to whom premiums are payable for continuation coverage under section 9501(a)(1) of the American Rescue
Plan Act of 2021 shall be allowed as a credit against the tax imposed by section 3111(b), [Employment Taxes] or so much of the taxes imposed under section 3221(a) as are attributable to the rate in effect under section 3111(b), for each calendar quarter an amount equal to the premiums not paid by assistance eligible individuals for such coverage by reason of such section 9501(a)(1) with respect to such calendar quarter.
“(3) in the case of any group health plan not described in paragraph (1) or (2), the insurer providing the coverage under the group health plan. Congress.Gov *
Resources & Links
Cobra Information Department of Labor Website
3rd Party Administrators & Reference Services
Ceridian COBRA Compliance Services
Employee Benefits Institute of America
§54.4980B-0 Table of contents.
§54.4980B-1 COBRA in general.
§54.4980B-2 Plans that must comply.
§54.4980B-3 Qualified beneficiaries.
§54.4980B-4 Qualifying events.
§54.4980B-5 COBRA continuation coverage.
§54.4980B-6 Electing COBRA continuation coverage.
§54.4980B-7 Duration of COBRA continuation coverage.
§54.4980B-8 Paying for COBRA continuation coverage.
§54.4980B-9 Business reorganizations and employer withdrawals from multiemployer plans.
§54.4980B-10 Interaction of FMLA and COBRA.
§54.4980D-1 Requirement of return and time for filing of the excise tax under section 4980D.
§54.4980E-1 Requirement of return and time for filing of the excise tax under section 4980E.
§54.4980F-1 Notice requirements for certain pension plan amendments significantly reducing the rate of future benefit accrual.
ERISA & US Code Links
Tax Facts Requires Subscription Email us to discuss
COBRA & Cal COBRA Rights & Procedures
from SAMPLE Blue Cross EOC – Evidence of Coverage
Continuation of Coverage Under Federal Law (COBRA)
The following applies if you are covered by a Group that is subject to the requirements of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, as amended.
COBRA continuation coverage can become available to you when you would otherwise lose coverage under your Group’s health Plan. It can also become available to your Dependents, who are covered under the Group’s health Plan, when they would otherwise lose their health coverage. For additional information about your rights and duties under federal law, you should contact the Group.
Qualifying events for Continuation Coverage under Federal Law (COBRA)
COBRA continuation coverage is available when your coverage would otherwise end because of certain “qualifying events.” After a qualifying event, COBRA continuation coverage must be offered to each person who is a “qualified beneficiary.” You, your spouse and your Dependent children could become qualified beneficiaries if you were covered on the day before the qualifying event and your coverage would be lost because of the qualifying event. Qualified beneficiaries who elect COBRA must pay for this COBRA continuation coverage.
This benefit entitles you and any Dependents who are enrolled in the Plan to elect continuation independently. Each qualified beneficiary has the right to make independent benefit elections at the time of annual enrollment. Covered Subscribers may elect COBRA continuation coverage on behalf of their spouses, and parents or legal guardians may elect COBRA continuation coverage on behalf of their children. A child born to, or placed for adoption with, a covered Subscriber during the period
of continuation coverage is also eligible for election of continuation coverage.
|Qualifying Event||Length of Availability of Coverage|
Voluntary or Involuntary Termination (other than gross misconduct) or Loss of Coverage Under an Employer’s Health Plan Due to Reduction In Hours Worked
A Covered Subscriber’s Voluntary or Involuntary Termination (other than gross misconduct) or Loss of Coverage Under an
Employer’s Health Plan Due to Reduction In Hours Worked
|Covered Subscriber’s Entitlement to Medicare
Divorce or Legal Separation
Death of a Covered Subscriber
|For Dependent Children:
Loss of Dependent Child Status
COBRA coverage will end before the end of the maximum continuation period listed above if you become entitled to Medicare benefits. In that case a qualified beneficiary – other than the Medicare beneficiary – is entitled to continuation coverage for no more than a total of 36 months. (For example, if you become entitled to Medicare prior to termination of employment or reduction in hours, COBRA continuation coverage for your spouse and children can last up to 36 months after the date of Medicare entitlement.)
If Your Group Offers Retirement Coverage
If you are a retiree under this Plan, filing a proceeding in bankruptcy under Title 11 of the United States Code may be a qualifying event. If a proceeding in bankruptcy is filed with respect to your Group, and that bankruptcy results in the loss of coverage, you will become a qualified beneficiary with respect to the bankruptcy. Your Dependents will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under this Plan. If COBRA coverage becomes available to a retiree and his or her covered Dependents as a result of a bankruptcy filing, the retiree may continue coverage for life and his or her Dependents may also continue coverage for a maximum of up to 36 months following the date of the retiree’s death.
Second qualifying event
If your family has another qualifying event (such as a legal separation, divorce, etc.) during the initial 18 months of COBRA continuation coverage, your Dependents can receive up to 18 additional months of COBRA continuation coverage, for a maximum of 36 months from the original qualifying event. Such additional coverage is only available if the second qualifying event would have caused your Dependents to lose coverage under the Plan had the first qualifying event not occurred.
The Group will offer COBRA continuation coverage to qualified beneficiaries only after the Group has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment, death of the Subscriber, commencement of a proceeding in bankruptcy with respect to the employer, or the Subscriber’s becoming entitled to Medicare benefits (under Part A, Part B, or both), the Group will notify the COBRA Administrator (e.g., Human Resources or their external vendor) of the qualifying event.
You Must Give Notice of Some Qualifying Events
For other qualifying events (e.g., divorce or legal separation of the Subscriber and spouse or a Dependent child’s losing eligibility for coverage as a Dependent child), you must notify the Group within 60 days after the qualifying event occurs.
Electing COBRA Continuation Coverage
To continue your coverage, you or an eligible Dependent must make an election within 60 days of the date your coverage would otherwise end, or the date the company’s benefit Plan Administrator notifies you or your Dependent of this right, whichever is later. You must pay the total Premium appropriate for the type of benefit coverage you choose to continue. If the Premium rate changes for active associates, your monthly Premium will also change. The Premium you must pay cannot be more than 102% of the Premium charged for Employees with similar coverage, and it must be paid to the company’s benefit plan administrator within 30 days of the date due, except that the initial Premium payment must be made before 45 days after the initial election for continuation coverage, or your continuation rights will be forfeited.
Disability extension of 18-month period of continuation coverage
For Subscribers who are determined, at the time of the qualifying event, to be disabled under Title II (OASDI) or Title XVI (SSI) of the Social Security Act, and Subscribers who become disabled during the first 60 days of COBRA continuation coverage, coverage may continue from 18 to 29 months.
These Subscribers’ Dependents are also eligible for the 18- to 29-month disability extension. (This also applies if any covered Dependent is found to be disabled.) This would only apply if the qualified beneficiary gives notice of disability status within 60 days of the disabling determination. In these cases, the employer can charge 150% of Premium for months 19 through 29. This would allow health coverage to be provided in the period between the end of 18 months and the time that Medicare begins coverage for the disabled at 29 months. (If a qualified beneficiary is determined by the Social Security Administration to no longer be disabled, such qualified beneficiary must notify the Plan Administrator of that fact in writing within 30 days after the Social Security Administration’s determination.)
Trade Adjustment Act Eligible Individual
If you don’t initially elect COBRA coverage and later become eligible for trade adjustment assistance under the U.S. Trade Act of 1974 due to the same event which caused you to be eligible initially for COBRA coverage under this Plan, you will be entitled to another 60-day period in which to elect COBRA coverage. This second 60-day period will commence on the first day of the month on which you become eligible for trade adjustment assistance. COBRA coverage elected during this second election period will be effective on the first day of the election period.
When COBRA Coverage Ends
COBRA benefits are available without proof of insurability and coverage will end on the earliest of the following:
· A covered individual reaches the end of the maximum coverage period;
· A covered individual fails to pay a required Premium on time;
· A covered individual becomes covered under any other group health plan after electing COBRA. If the other group health plan contains any exclusion or limitation on a pre-existing condition that applies to you, you may continue COBRA coverage only until these limitations cease;
· A covered individual becomes entitled to Medicare after electing COBRA; or
· The Group terminates all of its group welfare benefit plans.
Other Coverage Options Besides COBRA Continuation Coverage
Instead of enrolling in COBRA continuation coverage, there may be other coverage options for you and your Dependents through the Health Insurance Marketplace, Medicaid, or other group health plan coverage options (such as a spouse’s plan) through what is called a “special enrollment period.” Some of these options may cost less than COBRA continuation coverage. You can learn more about many of these options at www.healthcare.gov. or better yet, on our website!
Get INSTANT Quote for CA.
If You Have Questions
Questions concerning your Group’s health Plan and your COBRA continuation coverage rights should be addressed to the Group. For more information about your rights under ERISA, including COBRA and other laws affecting group health plans, contact the nearest Regional or District Office of the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at www.dol.gov/ebsa. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.)
If the Group is an employer with two (2) to nineteen (19) full-time, permanent, active employees on a typical business day, you may be entitled, in accordance with the provisions of this Part, to continue for a limited period of time coverage that would otherwise end. In order to continue coverage, you must qualify as described below, and you and the Group must also satisfy the requirements set out below.
The meanings of key terms used in this section are shown below. Whenever any of the key terms shown below appears in these provisions, the first letter of each word will appear in capital letters. When you see these capitalized words, you should refer to this “Definitions” provision.
Initial Enrollment Period is the period of time following the original Qualifying Event, as indicated in the “Terms of Cal-COBRA Continuation” provisions that follow.
Qualified Beneficiary means:
(a) a person enrolled for this Cal-COBRA continuation coverage who, on the day before the Qualifying Event, was covered under the Agreement as either a Subscriber or Dependent,
(b) a child who is born to or placed for adoption with the Subscriber during the CalCOBRA continuation period, or (c) a child for whom the Subscriber or spouse has been appointed permanent legal guardian by final court decree or order during the Cal-COBRA continuation period.
Qualified Beneficiary does not include any person who was not enrolled during the Initial Enrollment Period, including any Dependents acquired during the Cal-COBRA continuation period, with the exception of newborns, adoptees, and children of permanent legal guardians as specified above.
Qualifying Event means any one of the following circumstances which would otherwise result in the termination of your coverage under the Agreement. The event will be referred to throughout this section by letter/number.
A. For Subscriber and Dependents:
1. The Subscriber’s termination of employment, for any reason other than gross misconduct; or
2. A reduction in the Subscriber’s work hours.
B. For Dependents:
1. The death of the Subscriber;
2. The spouse’s divorce or legal separation from the Subscriber;
3. The end of a child’s status as a Dependent child, as defined by the Agreement;
4. The Subscriber’s entitlement to Medicare; or
5. The loss of eligible status by an enrolled Dependent.
ELIGIBILITY FOR CAL-COBRA CONTINUATION
A Subscriber or Dependent may choose to continue coverage under the Agreement if his or her coverage would otherwise end due to a Qualifying Event.
Exception: A Member is not entitled to continue coverage if, at any time of the Qualifying Event:
(1) the Member is entitled to Medicare;
(2) the Member is covered under any other group health plan, unless the other group health plan contains an exclusion or limitation relating to a preexisting condition of the Member;
(3) we fail to receive timely notice of the Qualifying Event or election, as set out below, of a Cal-COBRA continuation;
(4) the Member fails to submit the required Premium charge as set out below;
(5) the Member is covered, becomes covered, or is eligible for federal COBRA; or
(6) the Member is covered, becomes covered, or is eligible for coverage pursuant to Chapter 6A of the Public Health Service Act, 29 U.S.C. Section 1161 et seq. If one Member is unable to continue coverage for these reasons, other entitled Members may still choose to continue their coverage.
TERMS OF CAL-COBRA CONTINUATION
1. For Qualifying Event A., above, the Group must notify the Subscriber and us within thirty (30) days of the Qualifying Event of the right to continue coverage. We in turn must within fourteen (14) days give you official notice of the Cal-COBRA continuation right.
2. You must inform us within sixty (60) days of Qualifying Event B., above, if you wish to continue coverage. We in turn must within fourteen (14) days give you official notice of the Cal-COBRA continuation right.
If you choose to continue coverage, you must notify us within sixty (60) days of the later of:
(i) the date your coverage under the Agreement terminates by reason of a Qualifying Event, or
(ii) the date you were sent notice of your Cal-COBRA continuation right. The Cal-COBRA continuation coverage may be chosen for all Members within a covered family, or only for selected Members.
Please examine your options carefully before declining this coverage. You should be aware that companies selling individual health insurance typically require a review of your medical history that could result in higher cost or you could be denied coverage entirely.
****Nope, this no longer applies under ACA/Obamacare! Get instant quotes here.
This is why it’s VERY important to get your actual EOC Evidence of coverage. This evidence was coverage was written in 2017. After ACA…. maybe they are warning you about Health Sharing Ministries, Short Term Plans or a lot of the Mickey Mouse plans that allege they are really true insurance, but are not.
If you fail to elect the Cal-COBRA continuation during the Initial Enrollment Period, you may not elect the Cal-COBRA continuation at a later date.
The initial Premium must be delivered to us within forty-five (45) days after you elect Cal-COBRA continuation coverage.
An election of continuation coverage must be in writing and delivered to us by first class mail or other reliable means of delivery, including personal delivery, express mail or private courier company. The initial Premium must be delivered to us at Anthem, P.O. Box 9062, Oxnard, CA 93031-9062 by first class mail, certified mail or other reliable means of delivery, including personal delivery, express mail or private courier company, and must be in an amount sufficient to pay all Premium due. A failure to properly give notice of an election of continuation coverage or a failure to properly and timely pay Premium due will disqualify you from continuing coverage under this Part.
If you have Cal-COBRA continuation coverage under a prior plan that terminates because the agreement between the employer and the prior plan terminates, you may elect continuation coverage under the Agreement, which will continue for the balance of the period under which you would have remained covered under the prior plan. To do so, you must make the election and pay all Premium on the terms described above and below. Such continuation coverage will terminate if you fail to comply with the requirements for enrolling in and paying Premiums to us within thirty (30) days of receiving notice of the termination of the prior plan.
Additional Dependents. A child acquired during the Cal-COBRA continuation period is eligible to be enrolled as a Dependent and has separate rights as a Qualified Beneficiary. The standard enrollment provisions of the Agreement apply to enrollees during the Cal-COBRA continuation period. A Dependent acquired and enrolled after the effective date of continuation coverage resulting from the original Qualifying Event is not eligible for a separate continuation if a subsequent Qualifying Event results in the person’s loss of coverage.
Cost of Coverage. You must pay us the Premium required under the Agreement for your CalCOBRA continuation coverage, and the notice of your Cal-COBRA continuation right, which you will receive from us, will include the amount of the required Premium payment. This Premium, also sometimes called the “Premium,” must be remitted to us by the first of each month during the CalCOBRA continuation period and shall be 110% of the rate applicable to a Member for whom a Qualifying Event has not occurred. The first payment of the Premium is due within forty-five (45) days after you elect Cal-COBRA. We must receive subsequent payments of the Premium from you by the first of each month in order to maintain the coverage in force.
Besides applying to the Subscriber, the Subscriber’s rate also applies to:
1. A spouse whose Cal-COBRA continuation began due to divorce, separation or death of the Subscriber;
2. A child if neither the Subscriber nor the spouse has enrolled for this Cal-COBRA continuation coverage (if more than one child is so enrolled, the Premium will be based on the two-party or three-party rate depending on the number of children enrolled); and
3. A child whose Cal-COBRA continuation began due to the person no longer meeting the Dependent child definition.
Subsequent Qualifying Events. Once covered under the Cal-COBRA continuation, it is possible for a second Qualifying Event to occur. If that happens, a Member who is a Qualified Beneficiary may be entitled to an extended Cal-COBRA continuation period. This period will in no event continue beyond thirty-six (36) months from the date of the first Qualifying Event.
For example, a child may have been originally eligible for Cal-COBRA continuation due to termination of the Subscriber employment, and enrolled for this Cal-COBRA continuation as a Qualified Beneficiary. If, during the Cal-COBRA continuation period, the child reaches the upper age limit of the plan, the child is eligible to remain covered for the balance of the continuation period, which would end no later than thirty-six (36) months from the date of the original Qualifying Event (the termination of employment).
When Cal-COBRA Continuation Coverage Begins. When Cal-COBRA continuation coverage is elected during the Initial Enrollment Period and the Premium is paid, coverage is reinstated back to the date of the original Qualifying Event, so that no break in coverage occurs.
For Dependents properly enrolled during the Cal-COBRA continuation, coverage begins according to the enrollment provisions of the Agreement.
When Cal-COBRA Continuation Ends.
The continuation will end on the earliest of:
1. The end of thirty-six (36) months from the Qualifying Event;*
2. The date the Agreement terminates;
3. The end of the period for which Premium are last paid;
4. The date the Member becomes covered under any other group health plan, unless the other group health plan contains an exclusion or limitation relating to a preexisting condition of the Member, in which case this Cal-COBRA continuation will end at the end of the period for which the preexisting condition exclusion or limitation applied;
5. In the case of
(a) a Subscriber who is eligible for continuation coverage because of the termination of employment or reduction in hours of the Subscriber’s employment (except for gross misconduct) and determined, under Title II or Title XVI of the Social Security Act, to be disabled at any time during the first sixty (60) days of continuation coverage and
(b) his or her spouse or Dependent child who has elected Cal-COBRA coverage, the end of thirty-six (36) months from the Qualifying Event. If the Subscriber is no longer disabled under Title II or Title XVI, benefits shall terminate on the later of thirty-six (36) months from the Qualifying Event or the month that begins more than thirty-one (31) days after the date of the final determination under Title II or Title XVI that the Subscriber is no longer disabled;
6. The date the Member becomes entitled to Medicare;
7. The date the employer, or any successor employer or purchaser of the employer, ceases to provide any group benefit plan to his or her employees; or
8. The date the Member moves out of the Plan’s Service Area or commits fraud or deception in the use of services.
*For a Member whose Cal-COBRA continuation coverage began under a prior plan, this term will be dated from the time of the Qualifying Event under that prior plan.
If your Cal-COBRA continuation coverage under this Plan ends because the Group replaces our coverage with coverage from another company, the Group must notify you at least thirty (30) days in advance and let you know what you have to do to enroll for coverage under the new plan for the balance of your Cal-COBRA continuation period. Sample Group Employer Policy *