Cal COBRA Qualification – Service Area – Provider List – In Network

 

We’ve been getting a LOT of questions about if you can keep your employer’s health plan for Cal COBRA if you’ve moved out of state. 

  • What does Service Area mean?  
  • In Network Provider’s etc.
  • What does your specific Evidence of Coverage say about it?

Steve explains 18 months of Cal COBRA after COBRA expires Steve explains 18 months of Cal COBRA after COBRA expires

Here’s a sample Group policy  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.

Here’s my exact plan with Blue Shield.


Do they have providers in Texas so that I can keep Cal COBRA coverage?

 

Thanks for sending the exact name of your plan. I was able to find the Evidence of Coverage here

I don’t see any restriction about service areas, so you’re good in TX to keep the plan.

Read the information on page 19 about out of area programs Blue Card Program

Here is Blue Shield Provider Finder https://www.blueshieldca.com/fad/home

This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.

It takes some searching, but here’s a readable list of how much better your benefits are when you use in network provider

Blue Card Provider Finder  

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.

In-Network Provider Defintion 

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. https://individuals.healthreformquotes.com/provider-finder/negotiated-rates-itemized-bill/

I don’t know what an “approved” provider means.

Please email a copy of your ID card.

Then we can use the proper “search” terms and find out if there is an In Network Provider for you. https://individuals.healthreformquotes.com/companies/blue-shield/member-portal-easy-pay/provider-finder-instructions/

Please also send a copy of the Evidence of Coverage.

One must read an Insurance Policy or Law THREE times. Then when you think you understand it, read it again.
https://healthlaw.healthreformquotes.com/plain-meaning-rule/

The term is "In-Network Provider"

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.

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.

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,

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.

Employee’s guide to COBRA –
Department of Labor

employees guide to COBRA

*********

Art Gallagher Consulting Guide

COBRA Continuation Coverage?
Who Is Entitled
COBRA Rights and Responsibilities:
Notice and Election Procedures
Benefits
Duration
Summary of Qualifying Events,
Qualified Beneficiaries
Paying for it

Our Webpage on COBRA    *    Cal COBRA 

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