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What happens if you lose your coverage?

Here is some information on available options in the event a government employee loses health care insurance coverage. For more information, go to the CalPERS web site at www.calpers.ca.gov

Disabled Employees

If you qualify for Social Security Disability (SSD) or the Supplemental Security Income (SSI) program, you may continue coverage for up to 29 months. The cost to you cannot exceed 102 percent of the premium for the first 18 months, and 150 percent of the premium for months 19 to 29. This COBRA coverage applies to you and any dependents currently enrolled under your eligibility.

Dependents
Dependents may also enroll in COBRA for up to 36 months as a result of any of the following:

–Death of the member under which they were dependents. Eligibility applies whether the member was working orretired at the time of death (dependent must have been enrolled in the health plan at the time of member’s death).

–Divorce/registered domestic partnership termination or legal separation.

–Enrolled child marries or reaches age 23.

Cancellation of COBRA Coverage

COBRA coverage for you or your dependents remains in effect until one of the following events occurs:
–Failure to pay the premium.
–You receive coverage through another group health plan.

–You become entitled to Medicare Coverage.

–Time limit ends.

–You request cancellation.

Extension of COBRA Coverage

Under certain conditions, California law permits an extension of COBRA benefits. This extension does not apply to out-of-state COBRA enrollees. If you exhaust your federal COBRA benefit, and have had less than 36 months of COBRA coverage, Cal-COBRA may extend the benefit up to a total of 36 months. This Cal-COBRA extension premium cannot exceed 110 percent of the current group rate. If you lose your CalPERS coverage, you have two options to continue your health benefits: COBRA Continuation Coverage or an Individual Conversion Policy.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) Continuation Coverage allows you to continue health coverage for yourself or your dependents if you involuntarily lose your health benefits. If you are eligible for COBRA, you will be automatically notified by your employer (or by CalPERS if retired). You must complete and return a Group Continuation Coverage form within 60 days of notification. If you are an active employee, return the form to your former employer, and if you are a retiree, return the form to CalPERS. If you or your dependents are eligible for Medicare prior to involuntarily losing CalPERS benefits, you or your dependents are eligible for COBRA. Medicare would be your primary health insurer, and your Medicare-coordinated group health plan would be secondary. Your premium cannot exceed 102 percent of the group monthly premium rate. Coverage must be continuous, and you must pay premiums from the date your CalPERS coverage ended. You should send your premium payments directly to the health plan, not to CalPERS.

Here are some guidelines for COBRA Continuation Coverage.

Active Employees
You may continue COBRA coverage for 18 months if either of the following applies:
–You separate from employment for reasons other than dismissal due to gross misconduct.

–You have a reduction in work hours to less than half-time (or less than 480 hours in a control period for State Permanent-Intermittent employees).

Coverage for either of the above reasons applies to you and any dependents currently enrolled under your eligibility.

An Individual Conversion Policy is an alternative to COBRA or can follow COBRA coverage. If you lose your CalPERS health benefits or COBRA coverage, you can request an Individual Conversion Policy through your prior health plan. You must request this new policy within 30 days of losing coverage. All CalPERS health plans offer this Individual Conversion Policy option, but your cost and benefits will differ from your previous coverage.


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