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
Technical & Research Links
10128.51. (a) "Continuation coverage" means (b) "Group benefit plan" has the same meaning (d) "Qualifying event" (e) "Employer" means (f) "Core coverage" means (g) "Noncore coverage" 10128.52. AB 112 10128.53. (a) Every disability insurer (c) Every disability insurer
10128.54. (a) 10128.55. (a)10128.56. 10128.57. (a) (7) The employer, or any successor employer or purchaser of the employer, ceases to provide 10128.59. (a) (d) This section shall not apply toKnox Keene Heath Care Act
Cal COBRA allows one, be they the employee, spouse or child to keep their 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 prohibit that.
Cal COBRA coverage extends for 18 months after Federal COBRA which covers employers of 20 or more, expires, even if you were an owner or partner of the company. 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, (HIPAA is no longer available) 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. Covered CA explanation of Cobra vs ObamaCare.
Are short term plans available?
When you have COBRA or Cal COBRA, you have the same rights as other employees. You may change plans at Plan Anniversary - Open Enrollment, otherwise everything is the same as when you were an employee, other than you are paying all the premium and a 2% surcharge for the extraexpense of an individual vs group employER invoice.
Since COBRA has been made pretty much obsolete under Health Care Reform... not all the links work... Try scrolling the entire page or just Email us.
2. Where can I get more details on MY specific plan and options?
KQED story about a reporter taking five weeks to get coverage with Covered CA. Part of the problem was answering the question about if you have COBRA coverage. We can help you with this, no extra charge. First, get a instant quote and we will contact you.
3. What happens if your Employer changes coverage from one Insurance Company to another?
4. What if my COBRA gets cancelled?
5. What if I'm separated and my spouse cancels my coverage, is that a Qualifying event?
6. Where can I get more information on Cal COBRA?
Blue Cross Small Group Plan SAMPLE EOC
Kaiser COBRA Specialist # 866-429-0142
7. How much notice must one receive, before COBRA rates can go up?
8. Do you have an FAQ section for Cal COBRA? What is Gross Misconduct?
9. What notices must the Employer give the Employee?
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
|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.
Art Gallagher Consulting Guide
COBRA Continuation Coverage?
Who Is Entitled
COBRA Rights and Responsibilities:
Notice and Election Procedures
Summary of Qualifying Events,
Paying for it
No Pre X Clause!
Covered CA Appointment Instructions
Click here for instructions to appoint us as your agent for FREE year around support. There is no more pre-exisiting condition clause and even though it's not Open Enrollment, when you lose group coverage is a Qualifying Event that gives you 60 days to enroll in an Individual Plan.
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