Cal-COBRA Administration

“Cal-COBRA” is the California health continuation law that has similar provisions to federal COBRA. Eligibility for Cal-COBRA extends to indemnity policies, PPOs, and HMOs only. Self-insured plans are not eligible.  And unlike COBRA, church plans are eligible under Cal-COBRA. Both COBRA and Cal-COBRA do not apply to individual health insurance.

Cal-COBRA requires that if an employee or other “qualified beneficiary” loses employer-provided health coverage due to termination of employment or another specified “triggering event,” the group health plan must offer continued health care coverage to the qualified beneficiary. The qualified beneficiary may be (and typically is) required to pay the full cost for the coverage.

COBRA coverage has limited duration.  As of January 1, 2003, the extension period for Cal-COBRA has been changed from 18 months to 36 months. If you become eligible for Cal-COBRA after January 1, 2003, you will have the benefit of Cal-COBRA coverage for a full 36 months instead of the prior 18-month coverage extension. California Insurance Code (CIC) Section 10128.59 provides a similar extension under Cal-COBRA for those who have exhausted their 18 months on federal COBRA (or longer in special circumstances) for a total extension that cannot exceed 36 months. For the special COBRA extension to apply, you must have become eligible for COBRA after January 1, 2003.

Senior COBRA:  Under Cal-COBRA special provisions have been made for seniors. These provisions are commonly referred to as Senior COBRA. If you are 60 years or older at the time of your COBRA or Cal-COBRA qualifying event (for example, termination of employment) and have been employed five years or more with the employer sponsoring your group health insurance, then Senior COBRA can extend your coverage up to 5 years or until you reach age 65. Senior COBRA allows you to maintain continuous coverage until you are eligible for Medicare. In order to be eligible for Senior COBRA, you must meet the qualifications for COBRA or Cal-COBRA and elect and exhaust the coverage.

Cal-COBRA affects groups of 2-19 EMPLOYEES.   The group policy must be in force with 2-19 employees currently covered. Employee count includes all full and part time employees on the payroll for the prior payroll quarter.

Cal-COBRA is jointly regulated by the CDI and the DMHC depending upon what type of group coverage you have (indemnity or HMO). These agencies can provide further information on the time frames employers and insurance companies/health plans must follow to Cal-COBRA extension coverage for eligible employees and their dependents. Also, information can be furnished on the actions and responsibilities required by employees to participate and elect continuation of benefits under  Cal-COBRA. When experiencing questions or problems with Cal-COBRA, you can reach the appropriate state agency at:

U. S. Department of Labor
Employee Benefits Security Administration (DOL-EBSA)

Southern California
1055 E. Colorado Blvd., Suite 200
Pasadena, CA 91106-2341
Phone: 626-229-1000

Northern California
71 Stevenson Street, Suite 915
P. O. Box 190250
San Francisco, CA 94199-2050
Phone: 415-975-4600
Web site: www.dol.gov/ebsa
Publication Hotline: 800-998-7542

Department of Managed Health Care (DMHC)
980 Ninth Street, Suite 500
Sacramento, CA 95814
Phone: 888-466-2219
Web site: www.dmhc.ca.gov