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The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, requires that employers with 20 or more employees that maintain group benefit plans (including health, dental, vision, and medical reimbursement accounts), offer continuation of benefit coverage for a specific period of time to covered employees, spouses, domestic partners,* and dependent children who lose group coverage due to a qualifying event. As a state employee enrolled in state-sponsored benefits, you should be aware of your COBRA rights in the event that you lose coverage due to a qualifying event. You also have the responsibility to report certain life events to your departmental personnel office to ensure you and your qualified dependents maintain COBRA eligibility.
*State of California Legislation, not federal law.
Your departmental personnel office will provide the initial general COBRA notice to individuals covered under state-sponsored plans describing their COBRA rights. Your departmental personnel office must provide this notice to covered individuals within the first 90 days of coverage. The notice contains the information that you need to know to protect your COBRA rights while you are covered under the plans. This includes the name of the plan, a general description of the COBRA coverage provided under the plan, departmental personnel office contact information, and an explanation of any notices you must give your departmental personnel office to protect your COBRA rights.
A qualified beneficiary is 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, he or she is not eligible for COBRA.
A child enrolled in group coverage when ordered by a National Medical Support
Notice (NMSN) or Qualified Medical Child Support Order (QMCSO) is deemed a qualified
beneficiary under COBRA law, regardless of thier status as a dependent of the
covered employee. Please note COBRA will only be offered to dependents
considered eligible based on the Public Employee Medical and Hospital Care Act
Group coverage may be continued under COBRA for up to 18 months if you lose coverage based on one of the following qualifying events:
While you are still employed, group coverage for your dependents can continue under COBRA for up to 36 months if the loss of coverage is based on one of the following qualifying events:
Under certain conditions, California law permits an extension of COBRA coverage for an enrollee, who has exhausted their initital 18 month continuation coverage periso for up to 36 months from the date that converage began. This extension is managed by the health plan carrier, and you must inquire with the health plan carrier administering the COBRA coverage.
Before the end of the original 18 months of COBRA coverage, you may extend COBRA coverage for eligible dependents to 36 months from the original date of loss of coverage if one of the following events occurs:
It is the qualified beneficiary's responsibility to notify the plan carrier in writing within 60 days of a second COBRA qualifying event and within the original 18-month COBRA timeline.
Under no circumstances will continuation of coverage last beyond 36 months from the original date of loss of coverage.
The 18 months of COBRA coverage can be extended for an additional 11 months of coverage, to a maximum of 29 months for all qualified beneficiaries if the Social Security Administration determines a qualified beneficiary was disabled according to Title II or XVI of the Social Security Act at the time of the qualifying event or any time during the first 60 days of COBRA coverage. This extended period allows disabled persons continued coverage for the period of time that it normally takes to become eligible for Medicare. Premiums for coverage beyond the initial 18 months will be calculated at 150 percent of the State's group coverage premium rate and will continue to be paid monthly directly to the plan carrier or its designee.
It is the qualified beneficiary's responsibility to obtain this disability determination from the Social Security Administration and provide a copy of the determination to the appropriate plan within 60 days after the date of determination and before the original 18-month COBRA eligibility period expires. It is also the qualified beneficiary's responsibility to notify the plan carrier within 30 days if a final determination has been made that they are no longer disabled.
Once a COBRA qualifying event occurs or is reported to your departmental personnel office, they will send the qualified beneficiary or beneficiaries a COBRA election notice and form. The COBRA election notice informs the qualified beneficiary of their rights under COBRA law and the form allows the qualified beneficiary to elect COBRA coverage to continue enrollment in benefits. Qualified beneficiaries have 60 calendar days from the date of loss of coverage or from the date of receiving the COBRA election notice to elect COBRA coverage, whichever date is later. If a qualified beneficiary does not enroll during this window, they forfeit their right to COBRA coverage.
As of April 28, 2020, there is an extension that allows employees longer than 60 days to elect COBRA coverage; however, please note there is no coverage during the election period. All retroactive premiums will be required to be paid. This extension will remain in place until further notice.
If a qualified beneficiary elects COBRA coverage, they will be responsible for 100 percent of the total premium, plus a 2 percent administration fee, which they will pay monthly to the plan carrier or its designee. The plan carrier or its designee is not required to send a monthly bill. The department does not pay a share of the COBRA premium. Once a qualified beneficiary elects COBRA coverage, they have 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 the plan receiving the premium payment. Once the enrollee pays the retroactive premium, 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 until the plan carrier or its designee receives the premium payment. If the applicable payment is not made within the grace period, the plan will cancel coverage back to the end of the prior month in which they had received a premium payment. Once COBRA coverage is cancelled due to nonpayment of COBRA premiums the enrollee will not be reinstated. For information on where to send payments, please see the “Carrier Contact Information" below.
As of April 28, 2020, there is an extension that allows employees a longer period of time to pay COBRA premiums; however, please note there is no coverage during a period of non-payment. All retroactive premiums will be required to be paid. This extension will remain in place until further notice.
The Health Insurance Premium Payment (HIPP) Program may pay COBRA premiums in certain cases for persons eligible for Medi-Cal. You may inquire about this program by emailing the Department of Health Care Services at: HIPP@dhcs.ca.gov.
Under the Comprehensive AIDS Resources Emergency (CARE) Act of 1990, the Health Insurance Premium Payment (HIPP) Program may pay COBRA premiums for persons unable to work because of a disability due to HIV/AIDS. You may inquire about this program by emailing the Department of Health Care Services at: HIPP@dhcs.ca.gov.
COBRA coverage remains in effect for the specified time or until one of the following events terminates the coverage:
The plan provides all termination of COBRA coverage notices to the enrollee.
If you fail to notify your departmental personnel office within 60 days of a divorce, termination of domestic partnership, legal separation or a child ceasing to be a dependent, then you and any dependents will not be eligible for COBRA coverage and the departmental personnel office will send you a letter of unavailability of coverage. You and your dependents will not be offered COBRA coverage if you are terminated for gross misconduct.
Please visit our
COBRA Frequently Asked Questions
For Delta Dental PPO, Delta Dental PPO plus Premier Basic, and Delta Dental PPO plus Premier Enhanced:
Delta Dental of California:
Send COBRA enrollment forms (STD. 692) to:
P.O. Box 537011
Sacramento, CA 95853-7011
Support for COBRA enrolled members:
For DeltaCare USA:
For MetLife* Standard Plan and MetLife* Enhanced Plan:
Attn: COBRA Billing
P.O. Box 13724
Philadelphia, PA 19101
Benefits Questions 1-800-880-1800
Billing Questions - (949) 471-2222
*Benefits provided by SafeGuard Health Plans, Inc., a MetLife company.
For Premier Access:
Attn: COBRA Unit
8890 Cal Center Drive
Sacramento, CA 95826
For Western Dental:
Western DentalAttn: COBRA UNIT
530 South Main Street, 6th FloorOrange, CA 92868(866) 859-7525
For Bargaining Unit 6 - CCPOA/Primary Dental (R06), CCPOA/Western Dental (R06), and CCPOA/Primary Dental (S06, M06, E06, C06):
CCPOA Benefit Trust Fund2515 Venture Oaks Way, Suite 200Sacramento, CA 95833(800) 468-6486
For Bargaining Unit 5 (Dental enrollments only) - CAHP (R05) CAHP Dental Trust2030 V StreetSacramento, CA 95818(800) 734-2247
Vision Service PlanAttn: COBRA UNIT - Mailstop 229P.O. Box 997100Sacramento, CA 95899-7100You may also fax the STD. 700 to (916) 463-9031 Ext.4636(800) 852-7600