FAQs

What is Cobra or Cal-Cobra, HIPPA, and how does it affect me?

Federal COBRA and Cal-COBRA


Federal COBRA and Cal-COBRA
http://www.hmohelp.ca.gov/dmhc_consumer/hp/hp_cobra.aspx 

Federal COBRA is a U.S. law that applies to employers and group health plans that cover 20 or more employees. It lets you keep your group health insurance when your job ends or your hours are cut. You have to pay the premium but you can keep your insurance for at least 18 months.

Find out about The American Recovery and Reinvestment Act of 2009 (ARRA) which reduces COBRA premiums up to 65% for up to 9 months for certain individuals terminated between September 1, 2008 and December 31, 2009, and their qualified dependents. Also, eligible individuals may be able to change to less costly coverage, if the employer allows. There is also a special election period for people who did not sign up for COBRA when they first became eligible.

Cal-COBRA is a California law that is like Federal COBRA. Cal-COBRA applies to employers and group health plans that cover from 2 to 19 employees. It lets you keep your insurance for up to a total of 36 months.

A reduction in premium is also available to people eligible for Cal-COBRA under the ARRA. Eligible individuals may be able to change to less costly coverage, if the employer allows. At this time, there is no special election period for people who did not sign up for Cal-COBRA when they first became eligible. Contact your health plan for more information.

Cal-COBRA is also for people who use up their Federal COBRA. When your 18 months of Federal COBRA ends, you can buy 18 more months of health insurance under Cal-COBRA.

Small Employer (2 to 19 employees)Large Employer (20 or more employees)

Cal-COBRA — up to 36 months

Federal COBRA — 18 or 36 months
(depends on the qualifying event)

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

Meet the Deadlines

  • You have 60 days after being notified of your Federal COBRA/Cal-COBRA rights to sign up.
  • If you do not get notification in the mail, call your last employer or health plan.
  • Call the Help Center if you are having problems getting the forms you need.
  • If you miss the deadline, you may lose the chance to sign up for Federal COBRA/Cal-COBRA.

Questions and Answers

Who can enroll in Federal COBRA or Cal-COBRA?

  • You may be able to get Federal COBRA if you have health insurance through an employer who has 20 or more employees and there is a qualifying event described below.
  • You may be able to get Cal-COBRA if you have health insurance through an employer who has 2 to 19 employees and there is a qualifying event described below.

A qualifying event means that you lose your health insurance because:

  •  
    • The employee's job ends.
    • The employee's hours are cut.
    • You divorce or legally separate from the employee.
    • You are no longer a dependent of the employee.
    • The employee enrolls in Medicare.
    • The employee dies.

How do I sign up for Federal COBRA or Cal-COBRA?

  • If you leave your job or your hours are cut, you should receive a notice that says you can enroll in Federal COBRA or Cal-COBRA. Within 60 days of the date of the notice, you must tell the health plan in writing that you want to sign up.
  • If you divorce, legally separate, or you can no longer be considered a dependent, you should tell the employer and the health plan to send you the forms you need. Within 60 days of being notified of your right to Federal COBRA or Cal-COBRA, you must tell the health plan in writing that you want to sign up.
  • The health plan must then send you a notice that tells you how much the premium is and how to sign up.
  • Make sure you:
    • Send in the application form before the deadline.
    • Send it to the right place.
    • Send the right premium amount.
    • Meet the deadline for paying your premium.

Can I get Cal-COBRA after I use up my Federal COBRA?

You may be able to. If your Federal COBRA lasted 18 months, you may be able to keep your health insurance under Cal-COBRA for 18 more months, for a total of 36 months. If your Federal COBRA lasted 36 months, you cannot get more Cal-COBRA.

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What are my benefits under Federal COBRA and Cal-COBRA?

  • You have the same benefits as other employees in the same plan.
  • If other employees have open enrollment periods when they can change from one plan to another, you can too.
  • If the employer changes the employees from one plan to another, you change too.
  • You have no restrictions because of pre-existing conditions.
  • If the group plan offers specialized plans, such as dental or vision plans, they must be offered to you also. However, if you change to Cal-COBRA from Federal COBRA, these specialized plans do not have to be offered to you.

When do Federal COBRA and Cal-COBRA end?

They end when:

  • The time period ends (up to 18 months of Federal COBRA followed by up to 18 months of Cal-COBRA (36 months total), or 36 months if you only have Cal-COBRA).
  • You do not pay your premiums on time.
  • The employer no longer offers any health insurance.
  • You move outside the health plan's service area.
  • You enroll in, or become eligible to enroll in Medicare.
  • You enroll in another health plan.

Who cannot enroll in Federal COBRA or Cal-COBRA?

You cannot enroll in Federal COBRA or Cal-COBRA if you:

  • Are enrolled in, or become eligible to enroll in Medicare.
  • Are fired for gross misconduct.
  • Did not enroll in the time limit.
  • Do not pay your premiums on time.
  • Are covered or become covered by another health plan.

Can I continue my insurance after Federal COBRA or Cal-COBRA ends?

Yes. You have several choices, including:

Resources

California Department of Insurance (CDI)
State agency with information on COBRA
1-800-927-4357 (many languages)
1-800-482-4833 (TTY)
www.insurance.ca.gov (Spanish)

U.S. Department of Labor COBRA
Information on the Federal COBRA program to help you keep group health insurance if you lose your job or your hours are cut
1-866-444-3272 (Spanish, Chinese)
1-877-889-5627 (TTY)
www.dol.gov/dol/topic/health-plans/cobra.htm (Spanish)
www.dol.gov/ebsa

Major Risk Medical Insurance Program (MRMIP)
Provides Health insurance if you are unable to get coverage because of your pre-existing conditions. To get a program handbook or application
1-800-289-6574
www.mrmib.ca.gov/MRMIB/MRMIP.html

 

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How can I save money on group health insurance in California?

The number one goal is to ensure your employee are getting the enough benefits to keep them healthy and at work. Employers pay so much for employee's health insurance but see little in return. Insurance is very intangible and can only be appreciated if something bad happens. Even then there are complications and a lot of follow up. Lets find a few ways were its not so difficult to provide group health insurance for your employees.

1.) Find plans with higher deductibles or fewer benefits. There are three levels of paying for services within insurance plans. The first of course is the insurance premium that the employer and

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I've just been let go from work and I want to know my California health insurance options...

What are my options when I’m no longer employed or cant get individual health insurance?

If you have left your job and are concerned about the price of insurance we can help. If you lost a job by a layoff or the company went out of business it will affect the way you can continue getting healthcare.

Scenario #1: Layoff and former employer continues group health insurance

Time line for coverage:  If the company has 20 or more employees, you can elect to go on COBRA at 102% of group health premium for 18 months, then Cal-COBRA for another 18 months at approximately 117% of group premium.(link bold text to Cobra text down below) So for a total of three years you can continue to get guaranteed issue health insurance. If the company has 2-19 employees then you go straight to Cal-COBRA. After the 18 months to 36 months of cobra you are elible for a HIPAA conversion plan (link to HIPAA text down below). This is also a guaranteed issue insurance.

For further details and eligibility please see Cobra and HIPAA description down below.

This is where California Well Being Insurance Agency can help maximize your dollars for your situation. We can quote you individual insurance which is almost always less expensive than the COBRA premiums. Individual policies (link to Individual Insurance down below) are medically underwritten so we can review you medical past and see if you qualify. Take a look at all the underwriting requirements for the various carriers.  Anthem Bluecross, Blueshield, Health Net, Aetna, Pacificare (link the .pdfs to each of these). We will work together to best fit your medical conditions to your budget.

 

Scenario #2: Layoff and my former employer has gone out of business or no longer offers health insurance its current employees.

This means you cannot elect to go onto COBRA and Cal-COBRA because the group’s policy is canceled.  You are immediately forced to make a decision between no insurance, guaranteed issue insurance HIPAA conversion(link to HIPAA Conversion down below), and medically underwritten individual plan.

Scenario #3: Layoff and my former employer never offered group health insurance.

 

The options are considerable less. You are not eligible for COBRA or HIPPA. The only options are to have individual coverage that is medically underwritten or no insurance. If you believe that you are not eligible for insurance because of medical conditions you have one last option with Major Risk Medical Insurance Program ( MRMIP ) .(link to text below starting with “ I have been declined…”)

Scenario #4:  Im an individual looking for coverage for myself or my family and what to know more.

California Well Being Insurance Agency is dedicated to finding the right plan, for the right person, at the right time. This industry is extremely dynamic help make that snap shot decision you are looking for. Lets review your budget and what types of plans you are looking for. Individual plan pricing is the same no matter what agent you go to. All plans are based on only two things, your age and the zip code where you live. Its not cheaper if you go directly to the carrier, its not cheaper if you go to a different agent. The carrier plans are open book to all agents and individuals at the same rate. The key in quoting is listening to your concerns and finding the point where necessity meets reality. This is where we live.

 

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I've been declined for individual California health insurance, now what?

If you have been declined by one Health Insurance Carrier it probably means you will be declined by the remainder of the carriers. In fact on almost all applications it specifically asks “Have you or your dependents been declined or rated up for medical insurance?”. This is a problem. There are a few ways you can go to find coverage.  First is MRMIP a government program that helps insure the uninsurable with slightly higher premiums with slightly lower benefits.  It definitely helps.

 The Major Risk Medical Insurance Program (MRMIP) provides health insurance for Californians unable to obtain coverage in the individual health insurance market because of their pre-existing conditions. Californians qualifying for the program participate in the cost of their coverage by paying premiums. The State of California supplements those premiums to cover the cost of care in MRMIP. Tobacco tax funds currently subsidize the MRMIP. Qualifications:1.)   California resident.2.)   Cannot be eligible for both Part A and Part B of Medicare, unless eligible solely because of end-stage renal disease.3.)   Cannot be eligible to purchase any health insurance for continuation of benefits under Cobra or CalCobra4.)   Unable to secure adequate coverageBecause of funding limitations, MRMIP does sometimes have a wait list. For information on whether there is a wait list or a copy of the MRMIP Handbook & application, please call toll free 1-800-289-6574.MRMIP Handbook & Application can also be downloaded at MRMIP Handbook and Application.  HIPAA Conversion Plans Please include the link as well http://www.hmohelp.ca.gov/dmhc_consumer/hp/hp_hipaacp.aspx#hipaa



HIPAA

If you have had health insurance for the last 18 months without a gap of more than 63 days, you may have the right to buy a HIPAA individual plan. However, you must first use up Federal COBRA/Cal-COBRA if you qualified for it.

Conversion Coverage

When your group health insurance ends, your health plan may have to offer you an individual plan. This is called a conversion plan because you convert from the group to an individual plan. If you qualify for a conversion plan, you cannot be denied insurance because of your medical history. If you buy a conversion plan, you have to pay the premiums. However, you must first use up Federal COBRA/Cal-COBRA if you qualified for it.

HIPAA and Conversion Plan Benefits and Rates

You can see summaries of the benefits and how much a HIPAA plan or Individual Conversion plan will cost. The California Department of Insurance (www.insurance.ca.gov) also oversees some HIPAA and Individual Conversion plans. You may visit their web site at or call 1-800-927-4357 for information on these plans.

 

Questions and Answers

What is HIPAA?

HIPAA stands for the Health Insurance Portability and Accountability Act. It allows people to buy individual health insurance when they lose their group health insurance, even if they have a pre-existing health condition. If you qualify, all health plans that sell individual plans must offer you health insurance. You cannot be denied insurance because of your medical history.

Who can enroll in a HIPAA plan?

  • You must have had health insurance for the last 18 months.
  • Your most recent insurance must have been in an employer-sponsored group health plan.
  • You must first use up all your Federal COBRA/Cal-COBRA if you qualify for it.
  • You do not have other health insurance, such as a group health insurance, Medi-Cal, or Medicare.
  • Finally you did not lose your most recent health insurance because you failed to pay the premiums or because you tried to deceive the health insurance company.

How do I apply for a HIPAA plan?

You have 63 days from the date your group health insurance ends or, if you qualify, your Federal COBRA or Cal-COBRA ends, to apply for HIPAA. When you apply for a HIPAA plan, you should provide a Certificate of Creditable Coverage from your last health plan. This is a letter that says how long you have been covered and helps to prove that you have had at least 18 months of coverage.

If you are unable to provide a Certificate of Creditable Coverage, you may wish to talk to the health plan about other ways you can prove that you had a least 18 months of coverage.

How do I find a HIPAA plan?

All health plans that sell individual plans must offer their two most popular individual plans to people who qualify for HIPAA.

Can I apply for a HIPAA plan if I have a conversion plan?

No. If you accept a conversion plan or any other individual plan after you use up your Federal COBRA or Cal-COBRA, you cannot apply for a HIPAA plan.

What are my benefits in a HIPAA plan?

You may not have the same benefits or the same premiums that you had with your group health plan. You should compare the benefits and premiums in a HIPAA plan with the benefits and premiums of a conversion plan, if you qualify for one.

Who can enroll in a conversion plan?

You can enroll in a conversion plan if your employer is ending your group health insurance and you were in this group plan for at least 3 continuous months before your health insurance ended. However, you must first use up Federal COBRA/Cal-COBRA if you qualified for it.

You cannot enroll in a conversion plan if the health plan cancelled your insurance because you did not pay your premiums or because you were not honest with the health plan.

You cannot enroll in a conversion plan if the health plan cancelled your insurance because you did not pay your premiums or because you committed fraud against the health plan.

How do I sign up for a conversion plan?

Your employer must notify you within 15 days after your group health plan ends that you qualify for a conversion plan. Your health plan must receive your application and first premium payment within 63 days after your group health insurance ends.

What are my benefits in a conversion plan?

You may not have the same benefits or the same premiums that you had with your group health plan. You should compare the benefits and premiums in a conversion plan with the benefits and premiums in a HIPAA plan, if you qualify for one.

Resources

Consumer Guide to Getting and Keeping Health Insurance in California
Information on COBRA and HIPAA
www.healthinsuranceinfo.net

U.S. Department of Labor COBRA
Information on Federal COBRA and HIPAA
1-866-444-3272 (Spanish, Chinese)
1-877-889-5627 (TTY)
http://www.dol.gov/ebsa

 

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