Continuing coverage with COBRA and Cal-COBRA

An overview for employers

 

Cal-COBRA

Cal-COBRA applies to employers with 2 – 19 employees*, as well as employers with 20+ employees who have exhausted their federal COBRA.

California law requires that insurers and HMOs provide continuation coverage known as Cal-COBRA.

Employers with 2 to 19 employees* Employers with 20+ employees
Cal-COBRA — up to 36 months COBRA — 18 or 36 months
(depends on the qualifying event)

Cal-COBRA — If COBRA was 18 months, 18 more months of Cal-COBRA is available.

At a glance

Cal-COBRA AB1401 Cal-COBRA
  • State requirement placed on health plan
  • 2-19 employees
  • Benefit plan mirrors employer plan
  • Administered by the Plan
  • State requirement placed on health plan
  • 20+ employees
  • Benefit plan mirrors employer plan
  • Administered by the Plan

Your obligations

Notify Sharp Health Plan of Certain Qualifying Events: You must notify Sharp Health Plan in writing within thirty (30) days of an Enrolled Employee’s Cal-COBRA Qualifying Event. Qualifying events include:

  • Termination of employment
  • Reduction in hours worked

If the Member fails to apply for Cal-COBRA within sixty (60) days of the event, that Member will be disqualified from receiving Cal-COBRA Continuation Coverage.

Who may choose Cal-COBRA

A Member may choose Cal-COBRA for one or all of the family members who were enrolled at the time of the qualifying event. In other words, the Member can elect coverage for the spouse or one or more Dependent children without being covered under the Cal-COBRA continuation coverage as a Member.

If a child is born or placed for adoption with the former Member during the period of Cal-COBRA coverage, the child would be a Qualified Beneficiary and could be added to the Cal-COBRA policy.

Qualifying events and subsequent eligible period of coverage

Termination of employment 18 months^
Reduction in hours 18 months^
Transfer to ineligible class 18 months^
Death of the employee 36 months
Divorce or legal separation 36 months
Employee becomes eligible for Medicare 36 months
Dependent child becomes ineligible 36 months

Payment for Cal-COBRA

The Member must pay Sharp Health Plan 110% of the applicable group rate charged for employees and their Dependents.

The Member must remit the first payment within forty-five (45) days of submitting the completed enrollment form to Sharp Health Plan. The first payment must cover the period from the last day of prior coverage to the present. There can be no gap between prior coverage and Cal-COBRA continuation Coverage.

All subsequent payments must be made on the first day of each month. If payment is not received by the first of the month, Sharp Health Plan will send a letter warning that coverage may terminate if payment is not received by the Plan.

Changes in benefits under Cal-COBRA coverage

If a Member or any Dependents elect Cal-COBRA coverage, benefits will remain the same as the benefits for active Members of your current Group policy. If you change the benefits provided to active Members enrolled in your current Group policy, benefits will also change for Members and Dependents on COBRA.

 

* You employed fewer than 20 eligible employees on at least 50% of its working days during the previous calendar year.

^ If COBRA coverage was initially effective on or after January 1, 2003, and the eligible period of coverage is less than 36 months, members may elect to continue coverage through Cal-COBRA for a period up to 36 months from the date that COBRA coverage was originally effective.

COBRA

Federal COBRA applies to employers that cover 20 or more employees.

COBRA (the Consolidated Omnibus Budget Reconciliation Act) is a United States federal law that, among other things, requires employers of 20 or more employees to offer continuation of coverage to employees and their dependents when a qualifying event that results in the loss of group eligibility occurs.

At a glance

COBRA AB1401 Cal-COBRA
  • Federal requirement placed on employer
  • 20+ employees
  • Benefit plan mirrors employer plan
  • Administered by the employer (or the employer’s COBRA administrator)*
  • State requirement placed on health plan
  • 20+ employees
  • Benefit plan mirrors employer plan
  • Administered by the Plan

Key facts

Eligibility

Employers must notify employees about the right to continue coverage when a qualifying event that results in the loss of group eligibility occurs.

Duration

Depending on the qualifying event, COBRA and/or Cal-COBRA may last for up to 36 months.

Administration

Sharp Health Plan neither provides nor administers federal COBRA services. All employers are responsible for administering their own federal COBRA program. Sharp Health Plan administers Cal-COBRA when an employer is subject to it under state law.

Groups have the option to self-administer their federal COBRA benefits or choose a third-party COBRA administrator.

Deadline

Employees must sign up with the health plan within 60 days of receiving notice of eligibility for federal COBRA or Cal-COBRA.

Cost

For COBRA, employees are responsible for the entire cost, up to 102% of the group rate.

Common questions about COBRA

What can I do when COBRA has been exhausted?

Anyone whose COBRA coverage runs out can apply for individual coverage. Email us at ifpsales@sharp.com to explore your options or call us at 1-858-499-8211.


How long do I have to decide on COBRA?

If you are entitled to elect COBRA coverage, you must be given an election period of at least 60 days to choose whether or not to elect continuation coverage. This would start either on the date you are furnished the election notice or the date you would lose coverage, whichever is later.


Who do I contact with questions about COBRA?

COBRA Enrollment

Employers Your designated account manager
Members Benefit administrator at your employer
Brokers Your designated account manager

COBRA Billing

Employers Call our Billing Employer Line at 1-858-499-8023
Members Call Customer Care at 1-800-359-2002