Overview
The Consolidated Omnibus
Budget Reconciliation Act
(COBRA) was enacted in 1986
to offer employees and their
covered dependents the
opportunity to elect a
temporary extension of their
plan coverage in certain
instances where coverage
would otherwise end. The
employee or qualified
beneficiary is responsible
for the full applicable
premium plus an
administration fee of up to
2%.
You will also be able to
elect COBRA Continuation
Coverage if your spouse was
covered but you are widowed
or divorced. If you were
covered under your parents’
group plan while you were in
school but have since lost
eligibility due to age or
student status, you will
also be eligible to elect
coverage
If you have any questions
regarding COBRA Continuation
Coverage or COBRA Open
Enrollment, please contact
Employee Benefits at (909)
387-5552.
COBRA Qualifying Events
If you are an employee of
the County and are covered
by the group health and
welfare plans maintained by
the County, you have the
right to elect continuation
coverage if you lose
coverage under the plans due
to any one of the following
"qualifying events:"
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Termination of your
employment (for
reasons other than
your gross
misconduct). |
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Reduction in the
hours of your
employment. |
If you are the spouse of an
employee and are covered by
the group health and welfare
plans maintained by the
County, you have the right
to elect continuation
coverage if you lose
coverage under the plans due
to any of the following
"qualifying events":
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The death of your
spouse. |
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A termination of
your spouse's
employment (for
reasons other than
gross misconduct) or
reduction in your
spouse's hours of
employment with the
County. |
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Divorce or legal
separation from your
spouse. |
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Your spouse becomes
entitled to Medicare
benefits. |
In the case of an employee's
dependent child who is
covered by the group health
and welfare plans maintained
by the County, he or she has
the right to elect
continuation coverage if
group health coverage under
the plans is lost due to any
of the following "qualifying
events":
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The death of the
employee parent. |
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The termination of
the employee
parent's employment
(for reasons other
than gross
misconduct) or
reduction in the
employee parent's
hours of employment
with the County. |
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The employee
parent's divorce or
legal separation. |
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The employee parent
becomes entitled to
Medicare benefits. |
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The dependent child
ceases to be a
"dependent child"
under the plans. |
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Notices and Elections
Under the COBRA statute, you
(the employee) or a family
member has the
responsibility to notify the
Employee Benefits and
Services Division of a
divorce, legal separation or
a child losing dependent
status under the group
health and welfare plans
maintained by the County.
This notification must be
made within 60 days from
whichever date is later:
the date of the event or the
date which health and
welfare plan coverage would
be lost under the terms of
the applicable insurance
contracts because of the
event. If you or a family
member fails to provide this
notice to the Employee
Benefits and Services
Division during this 60-day
notice period, then rights
to continuation coverage
will be forfeited.
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COBRA Rights and Obligations
Individual Election Rights
and Eligibility
Each individual who was
covered under the group
health and welfare plans
maintained by the County of
San Bernardino on the day
before the qualifying event
is a "qualified beneficiary"
and has independent election
rights to continuation
coverage. This means that
each dependent who was
covered can elect
independently to continue
coverage, even if the
covered employee chooses not
to continue coverage.
However, continuation
coverage is available to
qualified beneficiaries
subject to their continued
eligibility. The Human
Resources Division Chief,
Employee Benefits and
Services Division of the
County of San Bernardino, or
designee, reserves the right
to verify eligibility status
and terminate continuation
coverage back to the
original COBRA effective
date, if it is determined
that an individual is
ineligible or coverage was
obtained through a material
misrepresentation of the
facts.
Under the provisions of
COBRA, each qualified
beneficiary can elect to
continue all health and
welfare plan coverage or any
combination of coverage in
which they were enrolled in
the day before the event.
For instance, a
qualified beneficiary could
elect to continue their
group medical coverage and
waive the continuation of
their group dental
coverage. The applicable
premiums will vary depending
on the coverage elected. If
you are covered by a region
specific HMO and are moving
outside of the HMO service
area, additional rights may
be available to you at the
time of the event. Please
call the Employee Benefits
and Services Division for
additional information.
Once an election of
continuation coverage is
made, the coverage may
change if modifications are
made to the coverage
provided to similarly
situated non-COBRA plan
participants or if an Open
Enrollment period occurs.
Once enrolled, if your
marital status changes, if a
covered dependent ceases to
be eligible for coverage, or
if the address of you or
your spouse changes, you
must notify the Employee
Benefits and Services
Division immediately.
No Coverage During Election
Period
You will not be covered
under the plan(s) during the
election period. However,
if a COBRA election is made
as described in the
Notice of Right to Elect
Continuation of Group Health
and Welfare Plan (COBRA)
Coverage and all
applicable premiums are paid
as detailed in the following
section, then your health
and welfare plan coverage
selected will be reactivated
back to your loss of
coverage date in accordance
with federal law.
Premium Payments
For all plans EXCEPT Kaiser
Permanente: If you elect to
continue your health and
welfare plan coverage, as a
qualified beneficiary you
are responsible for the full
applicable premium payment
for the coverage selected,
which will include a 2%
administration fee. After
your election form is
received by the Employee
Benefits and Services
Division, you will be sent a
payment schedule.
For Kaiser Permanente
Coverage: If you elect to
continue your Kaiser
Permanente coverage, as a
qualified beneficiary you
are responsible for the full
applicable premium payment
for the coverage selected,
which will include a
2%administration fee.
Kaiser Permanente will mail
you a monthly billing
statement. To elect
continuation of your Kaiser
coverage, you must complete
the COBRA Medical Plan
Enrollment/Change Form
that will be sent to you and
mail it to the address
below:
Kaiser Permanente Medical
Care Program
California
Service Center
P.O. Box 23127
San Diego,
California 92193-9918
Phone: (888) 236-4490
Fax: (858) 614-3345
For Health Net Coverage: If
you elect to continue your
Health Net coverage, you are
responsible for the full
applicable premium for the
coverage selected, which
will include a 2%
administration fee. To elect
continuation of your Health
Net coverage, you must
complete the COBRA
Medical Plan
Enrollment/Change Form
and mail it to the address
below:
Health Net DP COBRA
11971 Foundation Place
Rancho Cordova, CA 95670
Phone: (800) 977-2207
Fax: (916) 935-3801
For ALL plans: COBRA
premiums must be paid on a
monthly basis. In order to
ensure that you receive both
continuous coverage and the
exact length of coverage as
provided for by law, a daily
rate will be used to
determine premiums for any
partial months of coverage.
This daily rate will
typically be used to
determine the premium for
your first and last months
of coverage. For example,
if due to your qualifying
event, your health and
welfare plan coverage ended
on July 21, your COBRA
coverage would begin on July
22. The premium for your
first month of COBRA
coverage would be for 10
days of coverage and would
be calculated by multiplying
the daily rate by 10.
All premiums, except those
amounts for Kaiser
Permanente and Health Net
coverage, must be paid by
check or money order payable
to the County of San
Bernardino. Premiums for
Kaiser Permanente coverage
must be paid by check or
money order payable to
Kaiser Permanente. Premiums
for Health Net may be paid
by credit card. Any person
or entity can pay COBRA
premiums for a qualified
beneficiary; however it is
the qualified beneficiary’s
responsibility to insure
that the payment is made on
a timely basis.
The first payment can be
made in small partial
payments or in one payment;
however the balance of the
first payment must be
received within 45 days of
your election. This first
payment due will include all
applicable premiums for
coverage back to the loss of
coverage date and those
premiums that become due
during this 45-day period.
After the first payment, you
are responsible for insuring
your premiums are paid in
accordance with the premium
schedule. You will not
receive any further
reminders or bills. No
partial or late payments
will be accepted after the
first payment, which is due
45 days following the
election of benefits.
For all plans EXCEPT Kaiser
Permanente: The premium
payment schedule will
reflect that the premium due
date for COBRA coverage is
the first (1st) day of the
month prior to each monthly
coverage period. A grace
period of thirty (30) days
is provided to ensure that
premiums are received. If
payment for a specified
monthly period is not
received within this thirty
(30) day grace period,
coverage will be
retroactively cancelled back
to the date for which
coverage was paid.
COBRA premium payments can
either be hand-delivered or
mailed. If hand-delivered,
it must be delivered to the
Employee Benefits and
Services Division. If
mailed, document the date
the premium is sent and call
within 10 days to insure the
premium is received. If
premiums are not received
or, if mailed, not
postmarked within the
required periods as
described in the premium
payment schedule, then COBRA
rights and protections will
be forfeited.
For Kaiser Permanente
coverage: The premium
payment schedule will
reflect that the premiums
for Kaiser Permanente COBRA
coverage are due on or
before the first day of the
coverage month. A grace
period of not more than
thirty (30) days is provided
to ensure that premiums are
received. If payment for a
specific monthly period is
not received within this
thirty (30) day grace
period, coverage will be
retroactively cancelled back
to the date for which
coverage was paid.
Kaiser Permanente COBRA
premium payments must be
mailed to the address on the
billing statement that will
be provided by Kaiser
Permanente. Document the
date the premium is sent and
call within 10 days to
insure the premium is
received. If premiums are
not postmarked within the
required premium periods as
described in the premium
payment schedule, then COBRA
rights and protections will
be forfeited.
For ALL plans:
If any payment is not
received in accordance with
the timeframes described
above, your coverage will be
immediately terminated and
may not be reinstated. Your
COBRA rights will be
forfeited as a result of
failure to pay premiums
timely.
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Length of Continuation
Coverage
18 Months
If the event causing the
loss of coverage is a
termination of employment
(other than for reasons of
gross misconduct) or a
reduction in work hours,
then each qualified
beneficiary will have the
opportunity to continue
coverage for 18 months from
the date of the qualifying
event. A qualified
beneficiary is any
individual who, on the day
before a qualifying event,
is covered under the group
health and welfare plans
maintained by the County of
San Bernardino by virtue of
being on that day either a
covered employee, the spouse
of a covered employee, or a
dependent child of the
covered employee.
Social Security Disability -
The 18 months of
continuation 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 on the date of
the qualifying event or at
any time during the first 60
days of continuation
coverage. 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 Employee Benefits and
Services Division within 60
days after the date of the
disability determination and
before the original 18
months of COBRA continuation
coverage expire. This
notice can be made by any of
the qualified
beneficiaries. If the
qualified beneficiary is a
newborn or adopted child who
is added to a covered
employee's COBRA coverage,
then the first 60 days of
continuation coverage for
the newborn or adopted child
is measured from the date of
the birth or the date of the
adoption. If a copy of the
disability determination is
not provided to the Employee
Benefits and Services
Division within this
timeframe, then the
additional 11-month
extension of COBRA coverage
will not be provided.
Each qualified beneficiary
has independent election
rights to this extension.
If the disabled qualified
beneficiary chooses not to
continue coverage, all other
qualified beneficiaries are
still eligible for the
extension. If coverage is
extended and the disabled
qualified beneficiary has
elected the extension, then
the applicable premium rate
is 150% of the premium
rate. If only the
non-disabled qualified
beneficiaries extend
coverage, the premium rate
will remain at the 102%
level. It is also the
responsibility of each
qualified beneficiary to
ensure that the Employee
Benefits and Services
Division is notified within
30 days if a final
determination is made that
the individual is no longer
disabled.
Secondary Events - Another
extension of the above
mentioned 18 or 29 months
continuation period can
occur, if during the 18 or
29 months of continuation
coverage a second qualifying
event takes place (for
example a death or
divorce). If a second event
occurs, then the original 18
or 29 months of continuation
coverage can be extended to
36 months from the date of
the original qualifying
event date for those
individuals who were
qualified beneficiaries
under the health and welfare
plans in connection with the
first qualifying event and
who are still qualified
beneficiaries at the time of
the second qualifying
event. If a second event
occurs, it is the
qualified beneficiary's
responsibility to notify the
Employee Benefits and
Services Division in writing
within 60 days of the second
event and within the
applicable 18 or 29 months
of original coverage. In no
event, however, will
continuation of coverage
last beyond 36 months from
the date of the event that
originally made the
qualified beneficiary
eligible for COBRA
coverage. Effective January
1, 2000, a reduction in
hours followed by a
termination of employment
will not be considered a
second event for COBRA
purposes.
36 Months
If the original event
causing the loss of coverage
was the death of the
employee, divorce, legal
separation, or a dependant
child ceasing to be a
dependent child under the
group health plans
maintained by the County,
then each
qualified beneficiary will
have the opportunity to
continue coverage for 36
months from the date of the
qualifying event.
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New Dependents and Open
Enrollments
If, during the applicable
period of COBRA coverage, an
employee who elected
continuation coverage
acquires new dependents
(such as through marriage),
the new dependents may be
added to the coverage
according to the rules of
the plan. However, the new
dependents do not gain the
status of a qualified
beneficiary and will lose
coverage if the qualified
beneficiary who added them
to the plan loses coverage.
An exception to this is if a
child is born to or if a
child is placed or adoption
with an employee who has
elected continuation
coverage. If the newborn or
adopted child is added to
the covered employee's COBRA
continuation coverage, then
unlike a spouse or
stepchildren, the newborn or
adopted child will gain the
rights of all other
"qualified beneficiaries."
The addition of a newborn or
adopted child does not
extend the 18 or 29 months
coverage period. Plan
procedures for adding new
dependents are available by
calling the Employee
Benefits and Services
Division. Premium rates
will be adjusted at that
time to the applicable
rates.
In addition, should an Open
Enrollment period occur
during your COBRA
continuation period, we will
notify you of your Open
Enrollment rights as well.
If an Open Enrollment period
occurs, each qualified
beneficiary will continue to
have independent election
rights to select any of the
options or plans that are
available to similarly
situated non-COBRA plan
participants.
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California Continuation
Rights
Coverage may be continued
past the date when your
federal (18 months) COBRA
Continuation Coverage ends.
Health plans must offer
individuals who have
exhausted their initial 18
months (or 29 months for a
disability extension) an
extension under California
law (called Cal-COBRA).
This extension is available
for up to a total of 36
months (when combined with
your 18 months of federal
COBRA). The extension
applies to medical plans
only (not dental or
vision). To obtain the
extended coverage, you must
notify your health plan in
writing no later than 30
days before the end of the
initial 18 month (or 29
month) period. If you elect
this extension, you will
notice an increase in the
premium. Under Cal-COBRA, a
health plan may charge up to
a 10% administration fee.
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Cancellation of Continuation
Coverage
COBRA continuation coverage
will end prior to the
expiration of the applicable
18, 29, 36, or 60 (in the
case of a spouse covered
under California
Continuation Rights
extension) months of
continuation coverage for
any of the following
reasons:
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The County ceases to
provide any group
health plan to any
of its active
employees; |
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Any required premium
for continuation
coverage is not paid
in a timely manner; |
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A qualified
beneficiary becomes,
after the effective
date of election,
covered under
another group health
plan that does not
contain any
exclusion or
limitation with
respect to any
pre-existing
condition of such
beneficiary other
than such an
exclusion or
limitation which
does
not apply to (or is
satisfied by) such
beneficiary be
reason of the Health
insurance
Portability and
Accountability Act (HIPPA)
of 1996; |
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A qualified
beneficiary becomes,
after the date of
the election,
entitled to
Medicare; |
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A qualified
beneficiary extended
continuation
coverage to 29
months due to a
Social Security
disability and a
final determination
has been made
finding that the
qualified
beneficiary is no
longer disabled
(first day of the
month after 30 days
from the final
determination); |
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A qualified
beneficiary notifies
the County they wish
to cancel
continuation
coverage; |
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For cause, on the
same basis that the
plan terminates for
cause the coverage
of similarly
situated non-COBRA
participants. |
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Certificate of Health
Insurance Portability
Your Certificate of Health
Insurance Portability will
be mailed separately to your
home address. It will
detail the amount of time
you have been covered under
the County's group health
insurance plan(s).
Under the Health
Insurance Portability and
Accountability Act (HIPPA)
of 1996, the time covered
under the County's group
health plan (including COBRA
coverage, if elected) may be
used to reduce a new health
plan's pre-existing
condition period. For
example, if you were covered
under the County's health
plan for 10 months,
including COBRA coverage,
and your new health plan has
a 12 month pre-existing
condition clause for new
enrollees, the new plan
would subtract 10 months
from the 12 month
pre-existing condition
period. However, for your
coverage under the County's
plan to be counted under a
new health plan, there must
not be a break in coverage
for more than 63 days from
the time coverage under the
County's plan (including
COBRA coverage, if elected)
ceases to the date of
enrollment in your new plan.
Questions regarding a new
health plan's pre-existing
condition period and the
impact HIPPA will have
should be directed to your
new health plan. If you
obtain other insurance,
present the Certificate of
Health Insurance Portability
to your new health insurance
plan and they will determine
if any benefits are
available to you in this
matter.
If you elect COBRA coverage,
an updated Certificate of
Health Insurance Portability
will be sent to you when
your COBRA coverage ceases.
Is you lose or do not
receive the above mentioned
certificate, one can be
requested up to 24 months
from the date coverage (or
COBRA coverage) ceases by
calling (909) 387-5552.
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Plan Administrator
The Plan Administrator for
all Plans except
Kaiser Permanente and Health
net is:
County of San Bernardino
Human Resources Department
Employee Benefits and
Services Division
157 W. Fifth Street, First
Floor
San Bernardino, CA
92415-0440
Phone: (909) 387-5552
Fax: (909) 387-5566
The Plan Administrator for
Kaiser Permanente is:
Kaiser Permanente Medical
Care Program
California Service Center
P.O. Box 23127
San Diego, CA 92193-9918
Phone: (888) 236-4490
Fax: (858) 614-3345
The Plan Administrator for
Health Net is:
Health Net DP COBRA
11971 Foundation Place
Rancho Cordova, CA 95670
Phone: (800) 977-2207
Fax: (916) 935-3801
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How to Get in Touch with a
COBRA Representative
Call the Human Resources
Department, Employee
Benefits and Services
Division at 1-909-387-5552.
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