2010 California Code
Health and Safety Code
Article 4.5. California Cobra Program

1366.20.  (a) This article shall be known as the California
Continuation Benefits Replacement Act, or "Cal-COBRA."
   (b) It is the intent of the Legislature that continued access to
health insurance coverage is provided to employees, and their
dependents, of employers with 2 to 19 eligible employees who are not
currently offered continuation coverage under the Consolidated
Omnibus Budget Reconciliation Act of 1985.
   (c) It is the intent of the Legislature that any federal
assistance that is or may become available to qualified beneficiaries
under this article be effectively and promptly implemented by the
department.
   (d) The director, in consultation with the Insurance Commissioner,
may adopt emergency regulations to implement this article in
accordance with Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code by making a finding
of emergency and demonstrating the need for immediate action in the
event that any federal assistance is or becomes available to
qualified beneficiaries under this article. The adoption of these
regulations shall be considered by the Office of Administrative Law
to be necessary to avoid serious harm to the public peace, health,
safety, or general welfare. Any regulations adopted pursuant to this
subdivision shall be substantially similar to those adopted by the
Insurance Commissioner under subdivision (d) of Section 10128.50 of
the Insurance Code.



1366.21.  The definitions contained in this section govern the
construction of this article.
   (a) "Continuation coverage" means extended coverage under the
group benefit plan in which an eligible employee or eligible
dependent is currently enrolled, or, in the case of a termination of
the group benefit plan or an employer open enrollment period,
extended coverage under the group benefit plan currently offered by
the employer.
   (b) "Group benefit plan" means any health care service plan
contract provided pursuant to Article 3.1 (commencing with Section
1357) to an employer with 2 to 19 eligible employees, as defined in
Section 1357, as well as a specialized health care service plan
contract provided to an employer with 2 to 19 eligible employees, as
defined in Section 1357.
   (c) (1) "Qualified beneficiary" means any individual who, on the
day before the qualifying event, is an enrollee in a group benefit
plan offered by a health care service plan pursuant to Article 3.1
(commencing with Section 1357) and has a qualifying event, as defined
in subdivision (d).
   (2) "Qualified beneficiary eligible for premium assistance under
ARRA" means a qualified beneficiary, as defined in paragraph (1), who
(A) was or is eligible for continuation coverage as a result of the
involuntary termination of the covered employee's employment during
the period specified in subparagraph (A) of paragraph (3) of
subdivision (a) of Section 3001 of ARRA, (B) elects continuation
coverage, and (C) meets the definition of "qualified beneficiary" set
forth in paragraph (3) of Section 1167 of Title 29 of the United
States Code, as used in subparagraph (E) of paragraph (10) of
subdivision (a) of Section 3001 of ARRA or any subsequent rules or
regulations issued pursuant to that law.
   (3) "ARRA" means Title III of Division B of the federal American
Recovery and Reinvestment Act of 2009 or any amendment to that
federal law extending federal premium assistance to qualified
beneficiaries.
   (d) "Qualifying event" means any of the following events that, but
for the election of continuation coverage under this article, would
result in a loss of coverage under the group benefit plan to a
qualified beneficiary:
   (1) The death of the covered employee.
   (2) The termination of employment or reduction in hours of the
covered employee's employment, except that termination for gross
misconduct does not constitute a qualifying event.
   (3) The divorce or legal separation of the covered employee from
the covered employee's spouse.
   (4) The loss of dependent status by a dependent enrolled in the
group benefit plan.
   (5) With respect to a covered dependent only, the covered employee'
s entitlement to benefits under Title XVIII of the United States
Social Security Act (Medicare).
   (e) "Employer" means any employer that meets the definition of
"small employer" as set forth in Section 1357 and (1) employed 2 to
19 eligible employees on at least 50 percent of its working days
during the preceding calendar year, or, if the employer was not in
business during any part of the preceding calendar year, employed 2
to 19 eligible employees on at least 50 percent of its working days
during the preceding calendar quarter, (2) has contracted for health
care coverage through a group benefit plan offered by a health care
service plan, and (3) is not subject to Section 4980B of the United
States Internal Revenue Code or Chapter 18 of the Employee Retirement
Income Security Act, 29 U.S.C. Section 1161 et seq.
   (f) "Core coverage" means coverage of basic health care services,
as defined in subdivision (b) of Section 1345, and other hospital,
medical, or surgical benefits provided by the group benefit plan that
a qualified beneficiary was receiving immediately prior to the
qualifying event, other than noncore coverage.
   (g) "Noncore coverage" means coverage for vision and dental care.



1366.22.  The continuation coverage requirements of this article do
not apply to the following individuals:
   (a) Individuals who are entitled to Medicare benefits or become
entitled to Medicare benefits pursuant to Title XVIII of the United
States Social Security Act, as amended or superseded. Entitlement to
Medicare Part A only constitutes entitlement to benefits under
Medicare.
   (b) Individuals who have other hospital, medical, or surgical
coverage or who are covered or become covered under another group
benefit plan, including a self-insured employee welfare benefit plan,
that provides coverage for individuals and that does not impose any
exclusion or limitation with respect to any preexisting condition of
the individual, other than a preexisting condition limitation or
exclusion that does not apply to or is satisfied by the qualified
beneficiary pursuant to Sections 1357 and 1357.06. A group conversion
option under any group benefit plan shall not be considered as an
arrangement under which an individual is or becomes covered.
   (c) Individuals who are covered, become covered, or are eligible
for federal COBRA coverage pursuant to Section 4980B of the United
States Internal Revenue Code or Chapter 18 of the Employee Retirement
Income Security Act, 29 U.S.C. Section 1161 et seq.
   (d) Individuals who are covered, become covered, or are eligible
for coverage pursuant to Chapter 6A of the Public Health Service Act,
42 U.S.C. Section 300bb-1 et seq.
   (e) Qualified beneficiaries who fail to meet the requirements of
subdivision (b) of Section 1366.24 or subdivision (h) of Section
1366.25 regarding notification of a qualifying event or election of
continuation coverage within the specified time limits.
   (f) Except as provided in Section 3001 of ARRA, qualified
beneficiaries who fail to submit the correct premium amount required
by subdivision (b) of Section 1366.24 and Section 1366.26, in
accordance with the terms and conditions of the plan contract, or
fail to satisfy other terms and conditions of the plan contract.



1366.23.  (a) Every health care service plan, including a
specialized health care service plan contract, that provides coverage
under a group benefit plan to an employer, as defined in Section
1366.21, shall offer continuation coverage, pursuant to this section,
to a qualified beneficiary under the contract upon a qualifying
event without evidence of insurability. The qualified beneficiary
shall, upon election, be able to continue his or her coverage under
the group benefit plan, subject to the contract's terms and
conditions, and subject to the requirements of this article. Except
as otherwise provided in this article, continuation coverage shall be
provided under the same terms and conditions that apply to similarly
situated individuals under the group benefit plan.
   (b) Every health care service plan shall also offer the
continuation coverage to a qualified beneficiary who (1) elects
continuation coverage under a group benefit plan, as defined in this
article or in Section 10128.51 of the Insurance Code, but whose
continuation coverage is terminated pursuant to subdivision (b) of
Section 1366.27, prior to any other termination date specified in
Section 1366.27, or (2) who elects coverage through the health care
service plan during any employer open enrollment, and the employer
has contracted with the health care service plan to provide coverage
to the employer's active employees. This continuation coverage shall
be provided only for the balance of the period that the qualified
beneficiary would have remained covered under the prior group benefit
plan had the employer not terminated the group contract with the
previous health care service plan or insurer.
   (c) Every health care service plan or specialized health care
service plan shall offer a qualified beneficiary the ability to elect
the same core, noncore, or core and noncore coverage that the
qualified beneficiary had immediately prior to the qualifying event.
   (d) Any child who is born to a former employee who is a qualified
beneficiary who has elected continuation coverage pursuant to this
article or a child who is placed for adoption with a former employee
who is a qualified beneficiary who has elected continuation coverage
pursuant to this article during the period of continuation coverage
provided by this article shall be considered a qualified beneficiary
entitled to receive benefits pursuant to this article for the
remainder of the period that the former employee is covered pursuant
to this article, if the child is enrolled under a group benefit plan
as a dependent of that former employee who is a qualified beneficiary
within 30 days of the child's birth or placement for adoption.
   (e) An individual who becomes a qualified beneficiary pursuant to
this article shall continue to receive coverage pursuant to this
article until continuation coverage is terminated at the qualified
beneficiary's election or pursuant to Section 1366.27, whichever
comes first, even if the employer that sponsored the group benefit
plan that is continued subsequently becomes subject to Section 4980B
of the United States Internal Revenue Code or Chapter 18 of the
Employee Retirement Income Security Act, 29 U.S.C. Sec. 1161 et seq.
   (f) A qualified beneficiary electing coverage pursuant to this
section shall be considered part of the group contract and treated as
similarly situated employees for contract purposes, unless otherwise
specified in this article.



1366.24.  (a) Every health care service plan evidence of coverage,
provided for group benefit plans subject to this article, that is
issued, amended, or renewed on or after January 1, 1999, shall
disclose to covered employees of group benefit plans subject to this
article the ability to continue coverage pursuant to this article, as
required by this section.
   (b) This disclosure shall state that all enrollees who are
eligible to be qualified beneficiaries, as defined in subdivision (c)
of Section 1366.21, shall be required, as a condition of receiving
benefits pursuant to this article, to notify, in writing, the health
care service plan, or the employer if the employer contracts to
perform the administrative services as provided for in Section
1366.25, of all qualifying events as specified in paragraphs (1),
(3), (4), and (5) of subdivision (d) of Section 1366.21 within 60
days of the date of the qualifying event. This disclosure shall
inform enrollees that failure to make the notification to the health
care service plan, or to the employer when under contract to provide
the administrative services, within the required 60 days will
disqualify the qualified beneficiary from receiving continuation
coverage pursuant to this article. The disclosure shall further state
that a qualified beneficiary who wishes to continue coverage under
the group benefit plan pursuant to this article must request the
continuation in writing and deliver the written request, by
first-class mail, or other reliable means of delivery, including
personal delivery, express mail, or private courier company, to the
health care service plan, or to the employer if the plan has
contracted with the employer for administrative services pursuant to
subdivision (d) of Section 1366.25, within the 60-day period
following the later of (1) the date that the enrollee's coverage
under the group benefit plan terminated or will terminate by reason
of a qualifying event, or (2) the date the enrollee was sent notice
pursuant to subdivision (e) of Section 1366.25 of the ability to
continue coverage under the group benefit plan. The disclosure
required by this section shall also state that a qualified
beneficiary electing continuation shall pay to the health care
service plan, in accordance with the terms and conditions of the plan
contract, which shall be set forth in the notice to the qualified
beneficiary pursuant to subdivision (d) of Section 1366.25, the
amount of the required premium payment, as set forth in Section
1366.26. The disclosure shall further require that the qualified
beneficiary's first premium payment required to establish premium
payment be delivered by first-class mail, certified mail, or other
reliable means of delivery, including personal delivery, express
mail, or private courier company, to the health care service plan, or
to the employer if the employer has contracted with the plan to
perform the administrative services pursuant to subdivision (d) of
Section 1366.25, within 45 days of the date the qualified beneficiary
provided written notice to the health care service plan or the
employer, if the employer has contracted to perform the
administrative services, of the election to continue coverage in
order for coverage to be continued under this article. This
disclosure shall also state that the first premium payment must equal
an amount sufficient to pay any required premiums and all premiums
due, and that failure to submit the correct premium amount within the
45-day period will disqualify the qualified beneficiary from
receiving continuation coverage pursuant to this article.
   (c) The disclosure required by this section shall also describe
separately how qualified beneficiaries whose continuation coverage
terminates under a prior group benefit plan pursuant to subdivision
(b) of Section 1366.27 may continue their coverage for the balance of
the period that the qualified beneficiary would have remained
covered under the prior group benefit plan, including the
requirements for election and payment. The disclosure shall clearly
state that continuation coverage shall terminate if the qualified
beneficiary fails to comply with the requirements pertaining to
enrollment in, and payment of premiums to, the new group benefit plan
within 30 days of receiving notice of the termination of the prior
group benefit plan.
   (d) Prior to August 1, 1998, every health care service plan shall
provide to all covered employees of employers subject to this article
a written notice containing the disclosures required by this
section, or shall provide to all covered employees of employers
subject to this section a new or amended evidence of coverage that
includes the disclosures required by this section. Any specialized
health care service plan that, in the ordinary course of business,
maintains only the addresses of employer group purchasers of benefits
and does not maintain addresses of covered employees, may comply
with the notice requirements of this section through the provision of
the notices to its employer group purchasers of benefits.
   (e) Every plan disclosure form issued, amended, or renewed on and
after January 1, 1999, for a group benefit plan subject to this
article shall provide a notice that, under state law, an enrollee may
be entitled to continuation of group coverage and that additional
information regarding eligibility for this coverage may be found in
the plan's evidence of coverage.
   (f) Every disclosure issued, amended, or renewed on and after July
1, 2006, for a group benefit plan subject to this article shall
include the following notice:
   "Please examine your options carefully before declining this
coverage. You should be aware that companies selling individual
health insurance typically require a review of your medical history
that could result in a higher premium or you could be denied coverage
entirely."


1366.25.  (a) Every group contract between a health care service
plan and an employer subject to this article that is issued, amended,
or renewed on or after July 1, 1998, shall require the employer to
notify the plan, in writing, of any employee who has had a qualifying
event, as defined in paragraph (2) of subdivision (d) of Section
1366.21, within 30 days of the qualifying event. The group contract
shall also require the employer to notify the plan, in writing,
within 30 days of the date, when the employer becomes subject to
Section 4980B of the United States Internal Revenue Code or Chapter
18 of the Employee Retirement Income Security Act, 29 U.S.C. Sec.
1161 et seq.
   (b) Every group contract between a plan and an employer subject to
this article that is issued, amended, or renewed on or after July 1,
1998, shall require the employer to notify qualified beneficiaries
currently receiving continuation coverage, whose continuation
coverage will terminate under one group benefit plan prior to the end
of the period the qualified beneficiary would have remained covered,
as specified in Section 1366.27, of the qualified beneficiary's
ability to continue coverage under a new group benefit plan for the
balance of the period the qualified beneficiary would have remained
covered under the prior group benefit plan. This notice shall be
provided either 30 days prior to the termination or when all enrolled
employees are notified, whichever is later.
   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 notification requirements of this subdivision and
subdivision (c).
   (c) Notwithstanding subdivision (a), the group contract between
the health care service plan and the employer shall require the
employer to notify the successor plan in writing of the qualified
beneficiaries currently receiving continuation coverage so that the
successor plan, or contracting employer or administrator, may provide
those qualified beneficiaries with the necessary premium
information, enrollment forms, and instructions consistent with the
disclosure required by subdivision (c) of Section 1366.24 and
subdivision (e) of this section to allow the qualified beneficiary to
continue coverage. This information shall be sent to all qualified
beneficiaries who are enrolled in the plan and those qualified
beneficiaries who have been notified, pursuant to Section 1366.24, of
their ability to continue their coverage and may still elect
coverage within the specified 60-day period. This information shall
be sent to the qualified beneficiary's last known address, as
provided to the employer by the health care service plan or
disability insurer currently providing continuation coverage to the
qualified beneficiary. The successor plan shall not be obligated to
provide this information to qualified beneficiaries if the employer
or prior plan or insurer fails to comply with this section.
   (d) A health care service plan may contract with an employer, or
an administrator, to perform the administrative obligations of the
plan as required by this article, including required notifications
and collecting and forwarding premiums to the health care service
plan. Except for the requirements of subdivisions (a), (b), and (c),
this subdivision shall not be construed to permit a plan to require
an employer to perform the administrative obligations of the plan as
required by this article as a condition of the issuance or renewal of
coverage.
   (e) Every health care service plan, or employer or administrator
that contracts to perform the notice and administrative services
pursuant to this section, shall, within 14 days of receiving a notice
of a qualifying event, provide to the qualified beneficiary the
necessary benefits information, premium information, enrollment
forms, and disclosures consistent with the notice requirements
contained in subdivisions (b) and (c) of Section 1366.24 to allow the
qualified beneficiary to formally elect continuation coverage. This
information shall be sent to the qualified beneficiary's last known
address.
   (f) Every health care service plan, or employer or administrator
that contracts to perform the notice and administrative services
pursuant to this section, shall, during the 180-day period ending on
the date that continuation coverage is terminated pursuant to
paragraphs (1), (3), and (5) of subdivision (a) of Section 1366.27,
notify a qualified beneficiary who has elected continuation coverage
pursuant to this article of the date that his or her coverage will
terminate, and shall notify the qualified beneficiary of any
conversion coverage available to that qualified beneficiary. This
requirement shall not apply when the continuation coverage is
terminated because the group contract between the plan and the
employer is being terminated.
   (g) (1) A health care service plan shall provide to a qualified
beneficiary who has a qualifying event during the period specified in
subparagraph (A) of paragraph (3) of subdivision (a) of Section 3001
of ARRA, a written notice containing information on the availability
of premium assistance under ARRA. This notice shall be sent to the
qualified beneficiary's last known address. The notice shall include
clear and easily understandable language to inform the qualified
beneficiary that changes in federal law provide a new opportunity to
elect continuation coverage with a 65-percent premium subsidy and
shall include all of the following:
   (A) The amount of the premium the person will pay. For qualified
beneficiaries who had a qualifying event between September 1, 2008,
and May 12, 2009, inclusive, if a health care service plan is unable
to provide the correct premium amount in the notice, the notice may
contain the last known premium amount and an opportunity for the
qualified beneficiary to request, through a toll-free telephone
number, the correct premium that would apply to the beneficiary.
   (B) Enrollment forms and any other information required to be
included pursuant to subdivision (e) to allow the qualified
beneficiary to elect continuation coverage. This information shall
not be included in notices sent to qualified beneficiaries currently
enrolled in continuation coverage.
   (C) A description of the option to enroll in different coverage as
provided in subparagraph (B) of paragraph (1) of subdivision (a) of
Section 3001 of ARRA. This description shall advise the qualified
beneficiary to contact the covered employee's former employer for
prior approval to choose this option.
   (D) The eligibility requirements for premium assistance in the
amount of 65 percent of the premium under Section 3001 of ARRA.
   (E) The duration of premium assistance available under ARRA.
   (F) A statement that a qualified beneficiary eligible for premium
assistance under ARRA may elect continuation coverage no later than
60 days of the date of the notice.
   (G) A statement that a qualified beneficiary eligible for premium
assistance under ARRA who rejected or discontinued continuation
coverage prior to receiving the notice required by this subdivision
has the right to withdraw that rejection and elect continuation
coverage with the premium assistance.
   (H) A statement that reads as follows:

   "IF YOU ARE HAVING ANY DIFFICULTIES READING OR UNDERSTANDING THIS
NOTICE, PLEASE CONTACT Ýname of health plan] at Ýinsert appropriate
telephone number]."

   (2) With respect to qualified beneficiaries who had a qualifying
event between September 1, 2008, and May 12, 2009, inclusive, the
notice described in this subdivision shall be provided by the later
of May 26, 2009, or seven business days after the date the plan
receives notice of the qualifying event.
   (3) With respect to qualified beneficiaries who had or have a
qualifying event between May 13, 2009, and the later date specified
in subparagraph (A) of paragraph (3) of subdivision (a) of Section
3001 of ARRA, inclusive, the notice described in this subdivision
shall be provided within the period of time specified in subdivision
(e).
   (4) Nothing in this section shall be construed to require a health
care service plan to provide the plan's evidence of coverage as a
part of the notice required by this subdivision, and nothing in this
section shall be construed to require a health care service plan to
amend its existing evidence of coverage to comply with the changes
made to this section by the enactment of Assembly Bill 23 of the
2009-10 Regular Session or by the act amending this section during
the second year of the 2009-10 Regular Session.
   (5) The requirement under this subdivision to provide a written
notice to a qualified beneficiary and the requirement under paragraph
(1) of subdivision (h) to provide a new opportunity to a qualified
beneficiary to elect continuation coverage shall be deemed satisfied
if a health care service plan previously provided a written notice
and additional election opportunity under Section 3001 of ARRA to
that qualified beneficiary prior to the effective date of the act
adding this paragraph.
   (h) (1) Notwithstanding any other provision of law, a qualified
beneficiary eligible for premium assistance under ARRA may elect
continuation coverage no later than 60 days after the date of the
notice required by subdivision (g).
   (2) For a qualified beneficiary who elects to continue coverage
pursuant to this subdivision, the period beginning on the date of the
qualifying event and ending on the effective date of the
continuation coverage shall be disregarded for purposes of
calculating a break in coverage in determining whether a preexisting
condition provision applies under subdivision (c) of Section 1357.06
or subdivision (e) of Section 1357.51.
   (3) For a qualified beneficiary who had a qualifying event between
September 1, 2008, and February 16, 2009, inclusive, and who elects
continuation coverage pursuant to paragraph (1), the continuation
coverage shall commence on the first day of the month following the
election.
   (4) For a qualified beneficiary who had a qualifying event between
February 17, 2009, and May 12, 2009, inclusive, and who elects
continuation coverage pursuant to paragraph (1), the effective date
of the continuation coverage shall be either of the following, at the
option of the beneficiary, provided that the beneficiary pays the
applicable premiums:
   (A) The date of the qualifying event.
   (B) The first day of the month following the election.
   (5) Notwithstanding any other provision of law, a qualified
beneficiary who is eligible for the special election opportunity
described in paragraph (17) of subdivision (a) of Section 3001 of
ARRA may elect continuation coverage no later than 60 days after the
date of the notice required under subdivision (j). For a qualified
beneficiary who elects coverage pursuant to this paragraph, the
continuation coverage shall be effective as of the first day of the
first period of coverage after the date of termination of employment,
except, if federal law permits, coverage shall take effect on the
first day of the month following the election. However, for purposes
of calculating the duration of continuation coverage pursuant to
Section 1366.27, the period of that coverage shall be determined as
though the qualifying event was a reduction of hours of the employee.
   (6) Notwithstanding any other provision of law, a qualified
beneficiary who is eligible for any other special election
opportunity under ARRA may elect continuation coverage no later than
60 days after the date of the special election notice required under
ARRA.
   (i) A health care service plan shall provide a qualified
beneficiary eligible for premium assistance under ARRA written notice
of the extension of that premium assistance as required under
Section 3001 of ARRA.
   (j) A health care service plan, or an administrator or employer if
administrative obligations have been assumed by those entities
pursuant to subdivision (d), shall give the qualified beneficiaries
described in subparagraph (C) of paragraph (17) of subdivision (a) of
Section 3001 of ARRA the written notice required by that paragraph
by implementing the following procedures:
   (1) The health care service plan shall, within 14 days of the
effective date of the act adding this subdivision, send a notice to
employers currently contracting with the health care service plan for
a group benefit plan subject to this article. The notice shall do
all of the following:
   (A) Advise the employer that employees whose employment is
terminated on or after March 2, 2010, who were previously enrolled in
any group health care service plan or health insurance policy
offered by the employer may be entitled to special health coverage
rights, including a subsidy paid by the federal government for a
portion of the premium.
   (B) Ask the employer to provide the health care service plan with
the name, address, and date of termination of employment for any
employee whose employment is terminated on or after March 2, 2010,
and who was at any time covered by any health care service plan or
health insurance policy offered to their employees on or after
September 1, 2008.
   (C) Provide employers with a format and instructions for
submitting the information to the health care service plan, or their
administrator or employer who has assumed administrative obligations
pursuant to subdivision (d), by telephone, fax, electronic mail, or
mail.
   (2) Within 14 days of receipt of the information specified in
paragraph (1) from the employer, the health care service plan shall
send the written notice specified in paragraph (17) of subdivision
(a) of Section 3001 of ARRA to those individuals.
   (3) If an individual contacts his or her health care service plan
and indicates that he or she experienced a qualifying event that
entitles him or her to the special election period described in
paragraph (17) of subdivision (a) of Section 3001 of ARRA or any
other special election provision of ARRA, the plan shall provide the
individual with the written notice required under paragraph (17) of
subdivision (a) of Section 3001 of ARRA or any other applicable
provision of ARRA, regardless of whether the plan receives
information from the individual's previous employer regarding that
individual pursuant to Section 24100. The plan shall review the
individual's application for coverage under this special election
notice to determine if the individual qualifies for the special
election period and the premium assistance under ARRA. The plan shall
comply with paragraph (5) if the individual does not qualify for
either the special election period or premium assistance under ARRA.
   (4) The requirement under this subdivision to provide the written
notice described in paragraph (17) of subdivision (a) of Section 3001
of ARRA to a qualified beneficiary and the requirement under
paragraph (5) of subdivision (h) to provide a new opportunity to a
qualified beneficiary to elect continuation coverage shall be deemed
satisfied if a health care service plan previously provided the
written notice and additional election opportunity described in
paragraph (17) of subdivision (a) of Section 3001 of ARRA to that
qualified beneficiary prior to the effective date of the act adding
this paragraph.
   (5) If an individual does not qualify for either a special
election period or the premium assistance under ARRA, the health care
service plan shall provide a written notice to that individual that
shall include information on the right to appeal as set forth in
Section 3001 of ARRA.
   (6) A health care service plan shall provide information on its
publicly accessible Internet Web site regarding the premium
assistance made available under ARRA and any special election period
provided under that law. A plan may fulfill this requirement by
linking or otherwise directing consumers to the information regarding
COBRA continuation coverage premium assistance located on the
Internet Web site of the United States Department of Labor. The
information required by this paragraph shall be located in a section
of the plan's Internet Web site that is readily accessible to
consumers, such as the Web site's Frequently Asked Questions section.
   (k) For purposes of implementing federal premium assistance for
continuation coverage, the department may designate a model notice or
notices that may be used by health care service plans. Use of the
model notice or notices shall not require prior approval of the
department. Any model notice or notices designated by the department
for purposes of this subdivision shall not be subject to the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code).
   (l) Notwithstanding any other provision of law, a qualified
beneficiary eligible for premium assistance under ARRA may elect to
enroll in different coverage subject to the criteria provided under
subparagraph (B) of paragraph (1) of subdivision (a) of Section 3001
of ARRA.
   (m) A qualified beneficiary enrolled in continuation coverage as
of February 17, 2009, who is eligible for premium assistance under
ARRA may request application of the premium assistance as of March 1,
2009, or later, consistent with ARRA.
   (n) A health care service plan that receives an election notice
from a qualified beneficiary eligible for premium assistance under
ARRA, pursuant to subdivision (h), shall be considered a person
entitled to reimbursement, as defined in Section 6432(b)(3) of the
Internal Revenue Code, as amended by paragraph (12) of subdivision
(a) of Section 3001 of ARRA.
   (o) (1) For purposes of compliance with ARRA, in the absence of
guidance from, or if specifically required for state-only
continuation coverage by, the United States Department of Labor, the
Internal Revenue Service, or the Centers for Medicare and Medicaid
Services, a health care service plan may request verification of the
involuntary termination of a covered employee's employment from the
covered employee's former employer or the qualified beneficiary
seeking premium assistance under ARRA.
   (2) A health care service plan that requests verification pursuant
to paragraph (1) directly from a covered employee's former employer
shall do so by providing a written notice to the employer. This
written notice shall be sent by mail or facsimile to the covered
employee's former employer within seven business days from the date
the plan receives the qualified beneficiary's election notice
pursuant to subdivision (h). Within 10 calendar days of receipt of
written notice required by this paragraph, the former employer shall
furnish to the health care service plan written verification as to
whether the covered employee's employment was involuntarily
terminated.
   (3) A qualified beneficiary requesting premium assistance under
ARRA may furnish to the health care service plan a written document
or other information from the covered employee's former employer
indicating that the covered employee's employment was involuntarily
terminated. This document or information shall be deemed sufficient
by the health care service plan to establish that the covered
employee's employment was involuntarily terminated for purposes of
ARRA, unless the plan makes a reasonable and timely determination
that the documents or information provided by the qualified
beneficiary are legally insufficient to establish involuntary
termination of employment.
   (4) If a health care service plan requests verification pursuant
to this subdivision and cannot verify involuntary termination of
employment within 14 business days from the date the employer
receives the verification request or from the date the plan receives
documentation or other information from the qualified beneficiary
pursuant to paragraph (3), the health care service plan shall either
provide continuation coverage with the federal premium assistance to
the qualified beneficiary or send the qualified beneficiary a denial
letter which shall include notice of his or her right to appeal that
determination pursuant to ARRA.
   (5) No person shall intentionally delay verification of
involuntary termination of employment under this subdivision.
   (p) The provision of information and forms related to the premium
assistance available pursuant to ARRA to individuals by a health care
service plan shall not be considered a violation of this chapter
provided that the plan complies with all of the requirements of this
article.


1366.26.  A qualified beneficiary electing continuation coverage
shall pay to the health care service plan, on or before the due date
of each payment but not more frequently than on a monthly basis, not
more than 110 percent of the applicable rate charged for a covered
employee or, in the case of dependent coverage, not more than 110
percent of the applicable rate charged to a similarly situated
individual under the group benefit plan being continued under the
group contract. In the case of a qualified beneficiary who is
determined to be disabled pursuant to Title II or Title XVI of the
United States Social Security Act, the qualified beneficiary shall be
required to pay to the health care service plan an amount no greater
than 150 percent of the group rate after the first 18 months of
continuation coverage provided pursuant to this section. In no case
shall a health care service plan charge an employer an additional fee
for administering Cal-COBRA other than those incorporated in the
risk adjusted employee risk rate as provided for in subdivision (i)
of Section 1357.



1366.27.  (a) The continuation coverage provided pursuant to this
article shall terminate at the first to occur of the following:
   (1) In the case of a qualified beneficiary who is eligible for
continuation coverage pursuant to paragraph (2) of subdivision (d) of
Section 1366.21, the date 36 months after the date the qualified
beneficiary's benefits under the contract would otherwise have
terminated because of a qualifying event.
   (2) Except as provided in Section 3001 of ARRA, the end of the
period for which premium payments were made, if the qualified
beneficiary ceases to make payments or fails to make timely payments
of a required premium, in accordance with the terms and conditions of
the plan contract. In the case of nonpayment of premiums,
reinstatement shall be governed by the terms and conditions of the
plan contract and by Section 3001 of ARRA, if applicable.
   (3) In the case of a qualified beneficiary who is eligible for
continuation coverage pursuant to paragraph (1), (3), (4), or (5) of
subdivision (d) of Section 1366.21, the date 36 months after the date
the qualified beneficiary's benefits under the contract would
otherwise have terminated by reason of a qualifying event.
   (4) The requirements of this article no longer apply to the
qualified beneficiary pursuant to the provisions of Section 1366.22.
   (5) In the case of a qualified beneficiary who is eligible for
continuation coverage pursuant to paragraph (2) of subdivision (d) of
Section 1366.21, and determined, under Title II or Title XVI of the
Social Security Act, to be disabled at any time during the first 60
days of continuation coverage, and the spouse or dependent who has
elected coverage pursuant to this article, the date 36 months after
the date the qualified beneficiary's benefits under the contract
would otherwise have terminated because of a qualifying event. The
qualified beneficiary shall notify the plan, or the employer or
administrator that contracts to perform administrative services, of
the social security determination within 60 days of the date of the
determination letter and prior to the end of the original 36-month
continuation coverage period in order to be eligible for coverage
pursuant to this subdivision. If the qualified beneficiary is no
longer disabled under Title II or Title XVI of the Social Security
Act, the benefits provided in this paragraph shall terminate on the
later of the date provided by paragraph (1), or the month that begins
more than 31 days after the date of the final determination under
Title II or Title XVI of the United States Social Security Act that
the qualified beneficiary is no longer disabled. A qualified
beneficiary eligible for 36 months of continuation coverage as a
result of a disability shall notify the plan, or the employer or
administrator that contracts to perform the notice and administrative
services, within 30 days of a determination that the qualified
beneficiary is no longer disabled.
   (6) In the case of a qualified beneficiary who is initially
eligible for and elects continuation coverage pursuant to paragraph
(2) of subdivision (d) of Section 1366.21, but who has another
qualifying event, as described in paragraph (1), (3), (4), or (5) of
subdivision (d) of Section 1366.21, within 36 months of the date of
the first qualifying event, and the qualified beneficiary has
notified the plan, or the employer or administrator under contract to
provide administrative services, of the second qualifying event
within 60 days of the date of the second qualifying event, the date
36 months after the date of the first qualifying event.
   (7) The employer, or any successor employer or purchaser of the
employer, ceases to provide any group benefit plan to his or her
employees.
   (8) The qualified beneficiary moves out of the plan's service area
or the qualified beneficiary commits fraud or deception in the use
of plan services.
   (b) If the group contract between the plan and the employer is
terminated prior to the date the qualified beneficiary's continuation
coverage would terminate pursuant to this section, coverage under
the prior plan shall terminate and the qualified beneficiary may
elect continuation coverage under the subsequent group benefit plan,
if any, pursuant to the requirements of subdivision (b) of Section
1366.23 and subdivision (c) of Section 1366.24.
   (c) The amendments made to this section by Assembly Bill 1401 of
the 2001-02 Regular Session shall apply to individuals who begin
receiving continuation coverage under this article on or after
January 1, 2003.



1366.28.  A health care service plan subject to this article shall
not be obligated to provide continuation coverage to a qualified
beneficiary pursuant to this article if an enrollee fails to make the
notification required by Section 1366.24, or if the employer of the
enrollee fails to comply with Section 1366.25.



1366.29.  (a) A health care service plan shall offer an enrollee who
has exhausted continuation coverage under COBRA the opportunity to
continue coverage for up to 36 months from the date the enrollee's
continuation coverage began, if the enrollee is entitled to less than
36 months of continuation coverage under COBRA. The health care
service plan shall offer coverage pursuant to the terms of this
article, including the rate limitations contained in Section 1366.26.
   (b) Notification of the coverage available under this section
shall be included in the notice of the pending termination of COBRA
coverage that is required to be provided to COBRA beneficiaries and
that is required to be provided under Section 1366.24.
   (c) For purposes of this section, "COBRA" means Section 4980B of
Title 26 of the United States Code, Sections 1161 et seq. of Title 29
of the United States Code, and Section 300bb of Title 42 of the
United States Code.
   (d) This section shall not apply to specialized health care
service plans providing noncore coverage, as defined in subdivision
(g) of Section 1366.21.
   (e) This section shall become operative on September 1, 2003, and
shall apply to individuals who begin receiving COBRA coverage on or
after January 1, 2003.