Cal-COBRA
extends COBRA-like benefits (i.e. continuation of coverage) to
employees and dependent spouses and children of firms of less than 20
employees. For more specific information, click on the following:
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What are the differences
between COBRA and CAL-COBRA? |
| COBRA
|
Cal-COBRA |
| Federal Program |
State Program |
|
Applies to Non-Government Employers With 20 or More Employees
who lose health care coverage under a group health plan |
Applies to Non-Government employers of 2-19 Employees who
lose health care coverage under a group health plan |
|
Must be enrolled in an employer's health plan at the time of
a qualifying event |
Must be enrolled in an employer's health plan at the time of
a qualifying event |
|
Qualified Beneficiaries include spouse and dependent children |
Qualified Beneficiaries include spouse and dependent children |
|
Employer must notify employees that benefits are available
within 30 days of a qualifying event |
Employer must notify employees benefits are available within
30 days of a qualifying event |
|
Employee or Qualified Beneficiary must notify the health plan
within 60 days of a Qualifying Event |
Employee or Qualified Beneficiary must notify the health plan
or the employer within 60 days of a Qualifying Event |
|
Cost: No >102% of regular premium for 18 months; No > 150%
for subsequent months |
Cost No > 110% of regular premium for 18 months; No > 150%
for subsequent months |
|
Lasts 18 to 36 months, Depending on Qualifying Event |
Lasts 18 to 29 months, Depending on Qualifying Event |
|
Current COBRA provisions are found in three places: the
Public Health Services Act, 42 U.S.C. §§ 300bb-1 et seq., (group health for
public mployees) and in the Employment Retirement Income Security Act ("ERISA"),
29 U.S.C. §§ 1161 et seq. (group health for private employees), and the Internal
Revenue Code at 26 U.S.C. §§ 4980B |
Cal-COBRA provisions are found at Cal. Health & Safety Code §
1366.20 et seq. |
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The major
difference between Cal-COBRA and COBRA is that the insurance carrier is
responsible for the administration of Cal-COBRA. The employer is responsible
for notifying the carrier of the qualifying event and the carrier takes it from
there. |
Which employees and dependents are eligible?
Employees and their dependent spouses and children of these firms who are
enrolled in the employer’s employee benefit plans at the time of a qualifying
event (defined below) are known as “qualified beneficiaries” and are eligible
for Cal-COBRA, unless the individual:
- becomes covered under another group benefit plan
which does not impose any pre-existing condition limitations affecting the
individual;
- becomes eligible for federal COBRA;
- becomes eligible for Medicare;
- becomes eligible for Medi-Cal;
- fails to notify the health plan of a qualifying
event in the time specified by the law (generally within 60 days); or
- fails to pay their premium on a timely basis
What are “qualifying events”?
- The death of the covered employee;
- The termination or reduction of hours of the
covered employee’s employment for other than gross misconduct;
- Their divorce or legal separation from a covered
employee;
- Their loss of dependent status by a dependent
child; and
- The covered employee becoming eligible for
Medicare.
How long does Cal-COBRA coverage last?
That depends in large part on the qualifying event:
- If the qualifying event is due to termination of
employment or a reduction in hours, the qualified beneficiary can maintain
Cal-COBRA coverage for at least 18 months (assuming the qualified beneficiary
remains eligible by, for example, paying premiums on time). If, within 60 days
of qualifying for Cal-COBRA due to termination or a reduction in hours, the
qualified beneficiary becomes disabled and is subsequently determined by the
Social Security Administration to be totally disabled, Cal-COBRA may be extended
for up to another 11 months (for a total of 29 months).
- If the qualifying event is for a reason other
than for termination of employment or a reduction in hours, the coverage can
last for up to 36 months.
- After January 1, 1999, employees who are 60
years or older when they become eligible for Cal-COBRA and have worked for the
employer for at least five years may continue their coverage even after
Cal-COBRA until they turn 65.
Which benefit plans are covered by Cal-COBRA?
Health, dental and vision plans are covered. However, if a carrier offers a
package of these benefits, it cannot be required to offer only the dental and/or
vision components under Cal-COBRA.
How much do employers pay for Cal-COBRA
coverage?
Under most circumstances, 110 percent of the cost of their group coverage.
However, qualified beneficiaries who are totally disabled as determined by the
Social Security Administration can continue their coverage up to an additional
11 months beyond the initial 18 months by paying 150 percent of the premium for
the additional 11 months.
How do I notify my carrier of a qualifying
event?
Each carrier handles Cal-COBRA notification differently. Most require you to
mail or fax a form to their Cal-COBRA department. Your administration guide
should have the proper forms and information. |
