1373.621
. (a) Except for a specialized health care service plan,
every health care service plan contract that is issued, amended,
delivered, or renewed in this state on or after January 1, 1999, that
provides hospital, medical, or surgical expense coverage under an
employer-sponsored group plan for an employer subject to COBRA, as
defined in subdivision (e), or an employer group for which the plan
is required to offer Cal-COBRA coverage, as defined in subdivision
(f), including a carrier providing replacement coverage under Section
1399.63, shall further offer the former employee the opportunity to
continue benefits as required under subdivision (b), and shall
further offer the former spouse of an employee or former employee the
opportunity to continue benefits as required under subdivision (c).
(b) (1) In the event a former employee who worked for the employer
for at least five years prior to the date of termination of
employment and who is 60 years of age or older on the date employment
ends is entitled to and so elects to continue benefits under COBRA
or Cal-COBRA for himself or herself and for any spouse, the employee
or spouse may further continue benefits beyond the date coverage
under COBRA or Cal-COBRA ends, as set forth in paragraph (2). Except
as otherwise specified, continuation coverage shall be under the same
benefit terms and conditions as if the continuation coverage under
COBRA or Cal-COBRA had remained in force. For the employee or spouse,
continuation coverage following the end of COBRA or Cal-COBRA is
subject to payment of premiums to the health care service plan.
Individuals ineligible for COBRA or Cal-COBRA, or who are eligible
but have not elected or exhausted continuation coverage under federal
COBRA or Cal-COBRA, are not entitled to continuation coverage under
this section. Premiums for continuation coverage under this section
shall be billed by, and remitted to, the health care service plan in
accordance with subdivision (d). Failure to pay the requisite
premiums may result in termination of the continuation coverage in
accordance with the applicable provisions in the plan's group
subscriber agreement with the former employer.
(2) The employer shall notify the former employee or spouse or
both, or the former spouse of the employee or former employee, of the
availability of the continuation benefits under this section in
accordance with Section 2800.2 of the Labor Code. To continue health
care coverage pursuant to this section, the individual shall elect to
do so by notifying the plan in writing within 30 calendar days prior
to the date continuation coverage under COBRA or Cal-COBRA is
scheduled to end. Every health care service plan and specialized
health care service plan shall provide to the employer replacing a
health care service plan contract issued by the plan, or to the
employer's agent or broker representative, within 15 days of any
written request, information in possession of the plan reasonably
required to administer the requirements of Section 2800.2 of the
Labor Code.
(3) The continuation coverage shall end automatically on the
earlier of (A) the date the individual reaches age 65, (B) the date
the individual is covered under any group health plan not maintained
by the employer or any other health plan, regardless of whether that
coverage is less valuable, (C) the date the individual becomes
entitled to Medicare under Title XVIII of the Social Security Act,
(D) for a spouse, five years from the date on which continuation
coverage under COBRA or Cal-COBRA was scheduled to end for the
spouse, or (E) the date on which the employer terminates its group
subscriber agreement with the health care service plan and ceases to
provide coverage for any active employees through that plan, in which
case the health care service plan shall notify the former employee
or spouse or both of the right to a conversion plan in accordance
with Section 1373.6.
(c) (1) If a former spouse of an employee or former employee was
covered as a qualified beneficiary under COBRA or Cal-COBRA, the
former spouse may further continue benefits beyond the date coverage
under COBRA or Cal-COBRA ends, as set forth in paragraph (2) of
subdivision (b). Except as otherwise specified in this section,
continuation coverage shall be under the same benefit terms and
conditions as if the continuation coverage under COBRA or Cal-COBRA
had remained in force. Continuation coverage following the end of
COBRA or Cal-COBRA is subject to payment of premiums to the health
care service plan. Premiums for continuation coverage under this
section shall be billed by, and remitted to, the health care service
plan in accordance with subdivision (d). Failure to pay the requisite
premiums may result in termination of the continuation coverage in
accordance with the applicable provisions in the plan's group
subscriber agreement with the employer or former employer.
(2) The continuation coverage for the former spouse shall end
automatically on the earlier of (A) the date the individual reaches
65 years of age, (B) the date the individual is covered under any
group health plan not maintained by the employer or any other health
plan, regardless of whether that coverage is less valuable, (C) the
date the individual becomes entitled to Medicare under Title XVIII of
the Social Security Act, (D) five years from the date on which
continuation coverage under COBRA or Cal-COBRA was scheduled to end
for the former spouse, or (E) the date on which the employer or
former employer terminates its group subscriber agreement with the
health care service plan and ceases to provide coverage for any
active employees through that plan.
(d) (1) If the premium charged to the employer for a specific
employee or dependent eligible under this section is adjusted for the
age of the specific employee, or eligible dependent, on other than a
composite basis, the rate for continuation coverage under this
section shall not exceed 102 percent of the premium charged by the
plan to the employer for an employee of the same age as the former
employee electing continuation coverage in the case of an individual
who was eligible for COBRA, and 110 percent in the case of an
individual who was eligible for Cal-COBRA. If the coverage continued
is that of a former spouse, the premium charged shall not exceed 102
percent of the premium charged by the plan to the employer for an
employee of the same age as the former spouse selecting continuation
coverage in the case of an individual who was eligible for COBRA, and
110 percent in the case of an individual who was eligible for
Cal-COBRA.
(2) If the premium charged to the employer for a specific employee
or dependent eligible under this section is not adjusted for age of
the specific employee, or eligible dependent, then the rate for
continuation coverage under this section shall not exceed 213 percent
of the applicable current group rate. For purposes of this section,
the "applicable current group rate" means the total premiums charged
by the health care service plan for coverage for the group, divided
by the relevant number of covered persons.
(3) However, in computing the premiums charged to the specific
employer group, the health care service plan shall not include
consideration of the specific medical care expenditures for
beneficiaries receiving continuation coverage pursuant to this
section.
(e) For purposes of this section, "COBRA" means Section 4980B of
Title 26 of the United States Code, Section 1161 et seq. of Title 29
of the United States Code, and Section 300bb of Title 42 of the
United States Code, as added by the Consolidated Omnibus Budget
Reconciliation Act of 1985 (Public Law 99-272), and as amended.
(f) For purposes of this section, "Cal-COBRA" means the
continuation coverage that must be offered pursuant to Article 4.5
(commencing with Section 1366.20), or Article 1.7 (commencing with
Section 10128.50) of Chapter 1 of Part 2 of Division 2 of the
Insurance Code.
(g) For the purposes of this section, "former spouse" means either
an individual who is divorced from an employee or former employee or
an individual who was married to an employee or former employee at
the time of the death of the employee or former employee.
(h) Every plan evidence of coverage that is issued, amended, or
renewed after July 1, 1999, shall contain a description of the
provisions and eligibility requirements for the continuation coverage
offered pursuant to this section.
(i) This section does not apply to any individual who is not
eligible for its continuation coverage prior to January 1, 2005.