California Cobra Program

Cal. HSC § 1366.21

California Statutes

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 to eligible employees, as defined in

Section 1357, as well as a specialized health care service plan contract provided to an employer with to 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 of ARRA, (

B) elects continuation coverage, and (

C) meets the definition of “qualified beneficiary” set forth in paragraph (3) of

Section of Title of the United States Code, as used in subparagraph (

E) of paragraph (10) of subdivision (

a) of

Section 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 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 and (1) employed to eligible employees on at least 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 to eligible employees on at least 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 of the Employee Retirement Income Security Act, 29 U.S.C.

Section 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.

Document details

CollectionCalifornia Statutes
CitationCal. HSC § 1366.21
Date2010-06-03
Typestatute
Languageen
SourceCA_STAT
IdentifierHSC1366.21.2010241

California Cobra Program

Cal. HSC § 1366.21

California Statutes

California Cobra Program

Cal. HSC § 1366.21

California Statutes

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 to eligible employees, as defined in

Section 1357, as well as a specialized health care service plan contract provided to an employer with to 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 of ARRA, (

B) elects continuation coverage, and (

C) meets the definition of “qualified beneficiary” set forth in paragraph (3) of

Section of Title of the United States Code, as used in subparagraph (

E) of paragraph (10) of subdivision (

a) of

Section 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 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 and (1) employed to eligible employees on at least 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 to eligible employees on at least 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 of the Employee Retirement Income Security Act, 29 U.S.C.

Section 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.

Document details

CollectionCalifornia Statutes
CitationCal. HSC § 1366.21
Date2010-06-03
Typestatute
Languageen
SourceCA_STAT
IdentifierHSC1366.21.2010241
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