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The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified beneficiaries may be required to pay the entire premium for coverage up to 102 percent of the cost of the plan.
The COBRA statute requires employers to offer continuation of group coverage including health, dental, vision, and FlexElect Medical Reimbursement Accounts to covered employees, spouses, domestic partners*, and eligible dependent children who lose group coverage due to a qualifying event. These individuals are known as qualified beneficiaries. The terms and timeframes are set by the Department of Labor and the Internal Revenue Service.
* The state considers a covered domestic partner as a qualified beneficiary who may continue group coverage under COBRA.
The term "qualified beneficiary" means an individual that is eligible to continue group coverage because of a qualifying event. The individual must have been covered under the plan before the qualifying event date. If the individual was not covered, they are not eligible for COBRA.
There is an exception for a newborn child or child placed for adoption who is deemed a qualified beneficiary but was not covered at time of the qualifying event.
A child enrolled in group coverage under a National Medical Support Notice (NMSN) or Qualified Medical Child Support Order (QMCSO) is deemed a qualified beneficiary under COBRA law, regardless of their status as a dependent of the covered employee.
Your personnel office is required to provide you and your eligible dependents with an Initial General COBRA Notice of your rights under COBRA within 90 days after group coverage begins. This notice includes information on COBRA Qualifying Events and your responsibility to report certain events when they occur.
A qualifying event is an event that occurs which results in a loss of group coverage. Here is a list of qualifying events that qualify you for COBRA continuation coverage:
* If the termination from employment is due to "gross misconduct", your department is not required to offer COBRA coverage. When a covered employee is terminated for gross misconduct, there is no qualifying event for the covered employee, spouse, domestic partner, or dependent children. None of these individuals are offered COBRA continuation coverage.
** The state considers a covered domestic partner as a qualified beneficiary who may continue group coverage under COBRA.
Depending on the type of qualifying event you may continue group coverage for the maximum periods shown below.
** Medicare Entitlement is listed as a qualifying event under federal COBRA law, however active state employees do not lose their state-sponsored group dental and vision coverage at age 65 or upon entitlement to Medicare. Therefore, entitlement to Medicare will not impact an active employee's state-sponsored dental and vision coverage and will not be a qualifying event for these benefits. However, if a former state employee becomes covered under Medicare while enrolled in COBRA continuation coverage, then their COBRA coverage will be terminated. COBRA continuation coverage for any covered dependents will not terminate for this reason.
When I retire from state service, CalPERS continues my medical and dental coverage. Are state employees offered vision coverage under COBRA at the time of retirement?
Your departmental personnel office is required to offer you COBRA to continue your active employee vision plan. The COBRA qualifying event is a voluntary or involuntary termination of employment.
The state also offers a Retiree Vision Program to employees that retire from state service. The Retiree Vision Program is fully paid by the retiree and a monthly premium is deducted from your CalPERS retirement warrant.
For more information on retiree vision please visit the VSP State of California Retiree website.
Each covered person has independent election rights. Even if you do not elect COBRA coverage, a spouse, domestic partner or dependent child has independent rights to elect COBRA continuation coverage.
When a covered individual experiences a qualifying event, your departmental personnel office provides you and your eligible dependents a COBRA Election Notice and Election Form. The COBRA Election Notice informs covered individuals of their rights to elect continuation coverage because they are no longer covered under a group plan.
Your departmental personnel office is responsible to monitor timelines for COBRA elections and coverage continuation periods and ensure that eligible employees, spouses, domestic partners, and dependent children are provided the required notices and are advised of their COBRA rights and responsibilities.
Personnel staff are usually notified when a covered employee has died, voluntarily or involuntarily terminated employment, or reduced hours. However, the covered employee, spouse, or domestic partner has responsibility to notify the departmental personnel office of a divorce, termination of domestic partnership, legal separation, or child ceasing to be a dependent (e.g., child turns 26). At the time that one of these qualifying events occurs, the departmental personnel office must receive notification within 60 days from the date of the qualifying event or the date on which coverage is lost.
If the covered individual sends notification timely, then a COBRA Election Notice and Election Form is provided to qualified beneficiaries. This notice is sent to qualified beneficiaries to explain their right to elect COBRA continuation of group coverage. If the covered individual does not send timely notice to the personnel office , the department is not required to offer COBRA continuation of coverage.
Each qualified beneficiary has a maximum 60-day election period to elect continuation coverage. The last date to elect continuation coverage is reflected in the COBRA Election Notice. Each qualified beneficiary has independent election rights.
If COBRA is elected, the cost for coverage is 100 percent of the total premium, plus a 2 percent administration fee which is paid monthly by the enrollee to the plan or its designee. The plan or its designee is not required to send a monthly bill. Your department is not required to pay a share of the COBRA premium. You should contact your departmental personnel office for the applicable premiums, plan names, and addresses to send the monthly premiums.
Once COBRA is elected, the enrollee has 45 calendar days from the date of election to pay all retroactive premiums to the plan or its designee. The retroactive premium payment is the premium to cover the period from the date of loss of coverage to the date of election. All claims occurring during the months of retroactivity are held pending receipt of the premium payment.
Once the retroactive premium is paid, future monthly premiums are due by the first of each following month. While due on the first, the enrollee has a maximum thirty day grace period following the due date in which to make these premium payments. All claims occurring during the month are held pending receipt premium payment. If the applicable payment is not made within the grace period, then coverage is cancelled back to the end of the prior month in which a premium payment was made. Once COBRA coverage is cancelled due to nonpayment of COBRA premiums the enrollee is not reinstated.
If you need more information, check with your departmental personnel office.