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 Employer10128.53) 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 

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 deadlineEmails dated 1.21.2015 2:07 PM

Get Covered CA quotes loss of job

 Self-Insured Plans

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)


Westlaw One Day Pass 

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.

Get FREE Instant Individual & Family  California  Quotes - Including Tax Subsidy Calculation - Guaranteed Issue - No Pre-X Claus

Get FREE Instant Quotes - Including Tax Subsidy Calculation - Guaranteed Issue - No Pre-X Clause

Full Instructions to use Individual Quote Engine

how to get quote - full instructions video by steve

Steve's VIDEO introduction to Cal COBRA

cal cobra video by steve

Employee’s guide to COBRA –
Department of Labor

employees guide to COBRA

EmployER's Guide

*********

Art Gallagher Employers Guide to COBRA 

employer 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.

Does the Insurance Company have a manual or is it in my policy Evidence of Coverage  that explains how to do it?
 
 
Is there a Church exclusion (Attorney Interpretation) DOI  in Cal COBRA?

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

Blue Cross Small Group Plan SAMPLE EOC

8.  Do you have an FAQ section for Cal COBRA? What is Gross Misconduct?

9.   What notices must the Employer give the Employee?

19 comments on “Out of State or self insured Employer

  1. 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:

    “xxx does not extend COBRA coverage past the 18 month initial eligibility period, therefore excluding Cal-COBRA. However, losing COBRA coverage is a qualified life event, so the employee can be added onto an eligible dependents plan, or enroll in coverage with the state by visiting the site below. ca.gov/”

    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?

    • 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

  2. 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.

  3. 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.

  4. 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.

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