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 

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!

What if my Employer was out of State or Self Insured,
can I get Cal COBRA, HIPAA, Small Biz Plan or a Individual Plan?

If you worked for an non CA Employer headquartered Out of State, they do not have to offer you the additional 18 months of Cal Cobra coverage after COBRA or the original 36 months, if they are a small employer. 10128.53) and not subject to Federal COBRA.  Nor if your former employer was self insured.  If this happens you can go straight to HIPAA (in the past  AB 1180 ends HIPAA for new enrollees) or try for a preferred GUARANTEED ISSUE ObamaCare Individual plan.

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,

GET FREE ObamaCare Guaranteed Issue QUOTES

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

 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)

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.

Steve's introduction to 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! 

Get FREE Instant 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

 FAQs / Ask Us a Question

http://www.cvtrust.org/ 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. My guess would be that they were just being nice to you, giving you the additional 18 months of coverage. Under Health Care Reform – Covered CA wants everyone to be covered under the new plans, so that they get everyone, not just those who need subsidies or guaranteed issue. Thousands of policies were cancelled!!! healthreformquotes.com healthreformquotes.com Page 14 of Covered CA Contract with Insurance Companies steveshorr.com/

I’m still recovering as an agent, as many of my policy holders still are not getting their premium noticies correctly. Covered CA and the Government think they know what is best for you. Essential Benefits healthreformquotes.com Limited exceptions for plans that don’t have Essential Benefits – Grand Fathering – If you like your plan, you can keep it.

grandfathering/ New Obamacare being guaranteed issue – no medical questions asked end-stage-renal/ (Scroll to the bottom of the page for citations)

Individual Quotes & Enrollment outside of Covered CA are available at quotit.net If you need subsidies you can authorize us to help you with Covered CA by jumping these hoops. Otherwise, Covered CA wants to destroy the independent insurance agent

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.

Please send a copy of the letter, either by scanning to pdf, using your smartphone and sending a jpg or fax to 310.519.1359 Last year I was told I would be given 36 months of Cobra both Feds and Ca.

***That’s my understanding of the law, if your employer is subject to cal cobra. Please read the three criteria above. I am currently receiving better health insurance at a cheaper price than Covered Ca. can give me.

***You can double check the rates at quotit.net I was hoping to ride this Cobra Train until Medicare at 65. /medicare/ I am almost 63.

COBRA FAQ's

What if my Employer doesn't know anything about my right to have,  buy coverage for 36 months? Does the Insurance Company have a manual or is it in my policy that explains how to do it? Employee's Guide to Federal COBRA
Does my policy or Evidence of Coverage give me specific Information on the COBRA & Cal COBRA procedures on how do I sign up for Cal COBRA?
What if my employer was out of state, self insured, went out of business or sold to another company?
What happens when I use up my COBRA or Cal COBRA benefits, or I want to compare pricing & benefits, can I get HIPAA or FREE, No Obligation Quotes for a standard plan?
What if I'm late on a payment is there a grace period?
Where can I find actual text of the Cal COBRA law?
I would like to see a Sample Employee Notification Letter
I cannot afford the premiums...does the Government have any programs that I can look into?
The Senior COBRA program where one could  keep coverage to 65, was eliminated by AB 254 - 2005 Montaz  *  FAQ's?
What if it's a very short time, till I get onto another Group Employer Plan or Medicare?

Are short term plans available?

Does Cal COBRA qualify for the Stimulus Credit?
Is there a Church exclusion (Attorney Interpretation) DOI  in Cal COBRA?

What is Senior COBRA

Can I Change to a 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.

Ask a new question

FAQ's

Ask New Questions?

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.

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?

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?

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

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?

12 comments on “Out of State Employer

    • 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

  1. 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.

  2. 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.

  3. 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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