CA Insurance Code 10128

CA Insurance Code  10128.50  
    (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.(COBRA)

10128.51.  (a) "Continuation coverage" means extended coverage under
the group benefit plan under which an eligible employee or eligible
dependent is currently covered, 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" has the same meaning as "health benefit
plan" defined in Section 10700, including group policies of
vision-only and dental-only coverage, provided pursuant to Chapter 8
(commencing with Section 10700) to an employer with 2 to 19 eligible
employees, as defined in Section 10700.
   (c) "Qualified beneficiary" means any individual who, on the day
before the qualifying event, is covered under a group benefit plan
offered by a disability insurer pursuant to Article 1 (commencing
with Section 10700) of Chapter 8, and has a qualifying event, as
defined in subdivision (d).
   (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 10700 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 disability
insurer, 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 for hospital, medical, or
surgical benefits provided under 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.




10128.52.  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 10198.6 and 10198.7.  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 10128.55 regarding notification of a
qualifying event or election of continuation coverage within the
specified time limits.
   (f) Qualified beneficiaries who fail to submit the correct premium
amount required by subdivision (b) of Section 10128.55 and Section
10128.57, in accordance with the terms and conditions of the policy
or contract, or fail to satisfy other terms and conditions of the
policy or contract.



AB 112  10128.53.  
(a) Every disability insurer, that provides coverage
under a group benefit plan to an employer, including those policies
and contracts that provide vision-only and dental-only benefits, as
defined in Section 10128.51, 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 section.  Except as otherwise provided in this section,
continuation coverage shall be provided under the same terms and
conditions that apply to similarly situated individuals under the
group benefit plan.


   (b) Every disability insurer 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 1366.21 of the Health and Safety Code, but whose continuation
coverage is terminated under the group benefit plan pursuant to
subdivision (b) of Section 10128.57, prior to any other termination
date specified in Section 10128.57, or (2) who elects coverage
through the disability insurer during any employer open enrollment,
and the employer has contracted with the disability insurer 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 contract with the previous insurer or health care service plan.
   (c) Every disability insurer 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
section, 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 10128.57, 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 of 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 benefit plan and
treated as similarly situated employees for contract purposes, unless
otherwise specified in this article.