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|LegalCornerTM - Cal Cobra Health Insurance F.A.Q.'s|
Q.What is COBRA and Cal-COBRA?
Federal COBRA is a U.S. law that provides health insurance coverage protection to employees who work for employers with group health plans that cover 20 or more employees. Under COBRA, employees who are terminated, quit, or are laid off and spouses and dependants that lose their coverage are allowed to retain their health insurance benefits for up to 18 months so long as the formerly covered employee pays the premium. Under federal COBRA, if the employer's group health plan offers not only medical health insurance, but also vision and/or dental plans those plans must likewise be offered under COBRA. However, if you only qualify for Cal-COBRA (discussed next), or opt for Cal-COBRA coverage after your Federal COBRA benefit expires, Cal-COBRA does not require the health insurance provider to offer you vision and dental insurance.
Cal-COBRA is a California health coverage insurance protection program that requires California employers with 2 to 19 employees to provide their employees (and their spouses and dependants) with the right to obtain continuing health insurance coverage for up to 36 months after a qualifying event occurs.
A qualifying event occurs when: (1) an employee quits or is terminated for any reason other than gross misconduct (e.g. arson) or (2) there is a reduction in work hours. As stated above, Cal-COBRA also applies to individuals who have exhausted their 18 months of Federal COBRA. When a formerly covered employee’s 18 months of Federal COBRA ends, Cal-COBRA permits the individual to buy up to 18 more months of medical health insurance under Cal-COBRA. Cal-COBRA does not require the health insurance provider to offer vision or dental insurance.
COBRA and Cal-COBRA Time Sensitive Deadlines
The formerly covered individual only has 60 days to elect COBRA/Cal-COBRA coverage. If the individual misses the deadline, he or she may have permanently lost the right to COBRA/Cal-COBRA benefits.
If, for any reason, the former employer, or health provider fails to provide the forms to elect COBRA/Cal-COBRA within 30 days of a qualifying event, make a written demand for the forms from your prior employer and the health plan. If you still do not receive the forms, call California's Help Center.
What benefits are provided under Federal COBRA and Cal-COBRA?
Under both COBRA and Cal-COBRA, you have the same medical health insurance benefits provided to the employer's other employee's under the same plan. Thus, if your former employer's employees have an open enrollment period each year when they can change from one plan to another, you can too. If, on the other hand, the employer changes the health insurance plan offered to his/her/it's employees, your plan will likewise change. However, under both COBRA and Cal-COBRA restrictions due to pre-existing conditions are NOT permitted.
Is Anyone Prohibited From Enrolling in Federal COBRA or Cal-COBRA?
YES. The following individuals are prohibited from participating in COBRA and/or Cal-COBRA:
Can I Continue My Insurance Coverage After Federal COBRA or Cal-COBRA ends?
In California, YES. In fact, California residents have several options including:
HIPAA stands for the Health Insurance Portability and Accountability Act. HIPPA allows people to buy individual health insurance when they lose their group health insurance, even if they have a pre-existing health condition. If you qualify for HIPPA, all health plans that sell individual plans must offer you health insurance. You cannot be denied insurance because of your medical history, but your benefits and premiums may change.
Anyone starting COBRA or Cal-COBRA after January 1, 2003 must use all 36 months of eligibility to qualify for HIPAA Guaranteed-Issue or Conversion coverage.