Cobra vs. Cal-Cobra

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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.
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.

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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:

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.
• 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.

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