Employee's guide to COBRA - Department of Labor
Employee’s guide to COBRA – Department of Labor

California Cal-Cobra (Insurance Code §10128.50   Our site with annotations) 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:

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.

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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.

Send us your question?

Consumer Links

Department of Managed Health Care on COBRA & Cal COBRA

Employee Guide to Cal Cobra (20 Pages)

Disability Benefits 101 FAQ’s Cal COBRA

Pit Falls of Cal COBRA – DI 101

DOL (Dept. of Labor) More Info – Job Loss

DMHC Laws relating to Health Care Plans in CA

 Other pages in this section

Evidence of Coverage

Insurance Company WebPages, then look for Administration Page to find
EmployER Administrative Manuals

Senior COBRA

Technical & Research Links

Actual Text of Cal COBRA Law 

California Continuation Benefits Replacement Act,

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

 

Changing to Different COBRA plans?

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.

 

19 comments on “California Cal-COBRA

  1. My son worked for a California based employer, Trader Joes, (but he lives in Maryland) and when he voluntarily terminated, he kept their employer insurance through COBRA and that 18 months is about to expire.

    He got an Evidence of Coverage [sic] COBRA Termination letter and assumed he had to buy on the individual market in Maryland.

    We were surprised to get a letter from Anthem Blue Cross saying he is now eligible for an additional 18 months of Cal Cobra.

    The premium is no higher than an individual market policy in Maryland and the insurance is superior.

    We were just surprised he would be eligible living in Maryland.

    1. Is this correct as you understand it?

    2. When the Cal Cobra ends will he qualify for the “special enrollment” period option to buy guaranteed insurance on the individual market in Maryland just like he would have at the end of this 18 month COBRA period? or does that guaranteed issue only apply to California individual insurance?

    3. Can he drop it anytime he wants for any reason? (like gets a job with employer insurance)

    4. I am very nervous about the waves in D.C. to drop all the Obamacare guarantees and if he gets insurance on the individual market right now in Maryland he would have the insurance in place before they drop the preexisting conditions guarantees.

    5. if he wait to buy it in Feb 2020 when his Cal Cobra runs out then I am afraid they could reject him or charge him more if he had preexisting conditions at that time.

    • First off, we do not normally deal with competent adults through 3rd parties. Any further questions must come directly from your son.

      1. Yes, he’s eligible as long as Blue Cross has Maryland in their service area. See the Q & A below with Fran where it gets discussed ad nauseam.

      To give you a true authoritative answer, we would need to see the exact evidence of coverage for his plan and then we could check the Blue Cross provider finder. trader joes benefits.com https://www11.anthem.com/traderjoes/ If your son logs into the website, he can send us the information for review.

      2. Yes, when COBRA ends he would have a Special Enrollment.

      3. He can drop COBRA coverage anytime. The question is, when does he qualify for other coverage.

      4. I don’t have a crystal ball. I don’t know that if he has coverage now under ACA, if it will be grandfathered. Here’s where we are monitoring the Texas v USA case to declare the Pre X clause of ACA is unconstitutional as the mandate won’t produce any tax revenue.

      5. First, let’s see if he’s in Blue Cross of CA’s Service Area. Then we will have to watch and see what happens with Pre X in any of the future plans that might come out.

  2. My paperwork from my former employer says my coverage ended on March 10. How am I supposed to get coverage before the 1st of the next month? Is there a law somewhere that says coverage goes through the end of the month?

  3. I know it will be expensive whichever [ACA Obamacare] plan I choose, but I have drug coverage with my Cobra plan for $535/month.

    I’m hoping to find something more reasonable if possible.

    Any suggestions?

      • Basically, I have great coverage from Wells Fargo, but was hoping to pay less than $535/month for coverage.

        There doesn’t appear to be an option that will provide the level of coverage I have for much less than I’d be paying via COBRA.

        I can’t see researching doctors, meds, etc. to get comparable coverage for perhaps a few dollars less.

        Am I missing something, Steve?

        I guess I thought bidding this would give me some more affordable options, but I’m not seeing anything less than $500 (right?).

        • Right, in your case at age 59 and Wells Fargo must be funding your COBRA program, you’ve got a great plan. President Obama’s promise of saving $2,500/family didn’t happen.

          Check with us in 18 or 36 months depending on if Wells Fargo is subject to Cal COBRA or Federal COBRA. Here’s Wells Fargo Websites on their Health Coverage.

          https://teamworks.wellsfargo.com/index.html

          https://teamworks.wellsfargo.com/handbook/HB_Online.pdf

          https://cobra.ehr.com.

          https://cobra.ehr.com/ESS/FAQ/FAQsESS.pdf

          Do the Marketplace health plans cost less than my COBRA coverage?

          Since the COBRA premium is the full cost [Then you are getting a great deal – Maybe Wells Fargo doesn’t age rate and the rate for a 20 year old is the same as an older person?] of your former employer group health plan plus a 2% administrative fee, it is possible that one or more of the Marketplace plans will be less expensive than COBRA coverage.

          Our Quote Engine includes Covered CA. Rates are the same in and out of Covered CA. This year though, Silver is less outside of Covered CA. If you are low income and get subsidies, that might be a wash.

  4. I will be exhausting my COBRA coverage within 6 months & am counting on CAL-COBRA for additional coverage.

    Immediately after retirement I moved out of California.

    Will this affect CAL-COBRA coverage?

    • Here’s a sample Group policy from Blue Cross, see page 128 for Cal COBRA rules. See # 8 on page 130, once you move out of the service area, you wouldn’t be able to continue cobra. On page 151 Service Area is defined as The geographical area where you can get Covered Services from an In-Network Provider.

      Here’s confirmation from the DMHC.CA.Gov website:

      When do Federal COBRA and Cal-COBRA end?

      They end when:

      You move outside the health plan’s service area.

      The ACA – Obamacare is all guaranteed issue. Check with a local agent.

      • I need some clarification on moving outside of the “coverage area” to elect Cal COBRA coverage after federal COBRA expires.

        I moved out of California right after retirement, and I could not continue with my HMO plan because the “in network” doctors were all in California, so was required right away to change to a PPO plan. The employer offered, and still offers, a PPO plan.

        Why would I not be able to continue in that PPO plan under Cal COBRA after federal COBRA expires?

        I’m already living outside California and have a California PPO plan, the same PPO plan that my former employer offers.

        Can you clarify that please?

        Cal COBRA, even at 110% of the premiums, is cheaper and better than an individual policy in North Carolina, and would almost get me through to my eligibility for Medicare.

        • I don’t see any reason why you can’t continue with Cal cobra for 18 months

          Where are you getting these doubts from?

          do you have any kind of citation to back the negative opinion your from?

          • Your response to Fran D concerning moving outside of the coverage area. If Fran D is on a PPO plan, the coverage area is any approved provider outside the network area (for an HMO). I guess I’m confused how, if you’re on a PPO plan, you can move outside of the coverage area.

            Originally when I planned and executed my retirement, I thought I’d be able to get an ACA policy if I couldn’t continue with my employer’s PPO plan. That seems really expensive and a terrible plan since this administration has been trying everything in its power to destroy the ACA. The language of the state regulation seems clear about continuing under Cal COBRA as long as the employer still maintains the plan, but I wanted to ask someone who might have experience with this. My employer has farmed their COBRA duties out to a third party, and they are none too bright so I can’t ask them. Just planning ahead, I still have about a year before federal COBRA expires. Anyway, thanks for your help.

            • See our other pages on out of network coverage and providers:

              Out of Network Problems

              See the reply to Fran about the definition of Service area.

              PPO has much better coverage if you use an in-network provider. See pages 39 & 40 of the sample EOC for a detailed explanation, of how it works. See the Schedule of Benefits starting on page 13 for a matrix of how much better the coverage is, when you use in-network providers.

              Check the provider finder, for your plan and see if there are in-network providers in your area.

              Is it Blue Cross or Shield? Maybe the Blue Card will suffice? I doubt it though.

              • I’m sorry to belabor this, but your response to Dana confused me.

                She (or he) has been living out of state on a PPO plan since moving out of state right after retirement.

                This is exactly my situation. You told her she could lose Cal COBRA coverage if she moved out of the coverage area.

                I understand that under a PPO, you should contact Blue Shield and get an approved provider out of California, no question about that.

                That’s exactly what I did, I was given a list of approved providers in North Carolina and I chose one of them to provide my medical care under my California Blue Shield PPO plan. So I am confused about how someone could move out of the coverage area of a PPO plan (as opposed to an HMO plan, at which point you’d switch to a PPO like Dana and I had to) thereby losing coverage. I have read the language of the regulation. I believe the “move out” language would apply to a person in an HMO who moves outside of the HMO coverage area if the employer does NOT offer a PPO plan. Then the person would lose coverage because they could not switch to a PPO because the employer does not offer a PPO plan.

                Your response to Dana thus made me question if you know something I don’t know. That’s all. Thanks,

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