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COBRA Eligibility in California

California's COBRA program is similar to the federal program but applies to employers who have between two and 19 employees on their payroll, instead of 20 and more. "Cal-COBRA" allows employees to keep their family health coverage benefits for up to 36 months, instead of 18, as required under the federal COBRA. It also helps employees who work for large employers with over 19 employees to extend their federal benefits.

  1. Federal COBRA

    • Employers who have at least 20 employees must provide their employees with the option to continue coverage for themselves and dependents upon qualifying events. Qualifying events include job loss, reduced employment hours, divorce and separation, loss of dependent status, death or enrollment in the Medicare program. Under the federal COBRA regulations, employers must provide their employees with a written COBRA benefits notice at discharge. For the other qualifying events, employees must notify their employers of their change in circumstances to receive continuing coverage.

    California COBRA (Cal-COBRA)

    • In California, employees who do not qualify for the federal benefits because they work for smaller employers can sign up for extended state health benefits coverage through Cal-COBRA. Cal-COBRA allows employees to keep their health coverage for 18 months if they did not qualify for federal COBRA benefits. If they qualified for federal COBRA coverage, they may extend coverage to 36 months--18 months of federal COBRA and 18 months of state COBRA. However, under legislation that ended in 2010, Congress gave some employees extended federal coverage through the American Recovery Reinvestment Act. In this case, benefits under both Cal-COBRA and federal COBRA cannot exceed 36 months. The longest recipients can receive benefits for under either plan is 36 months.

    COBRA Benefits

    • Under both Cal-COBRA and federal COBRA, employees have the same options as all other employees have in the group health plan. This includes the ability to change plans during open enrollment periods and no restrictions for any preexisting diseases or illnesses. Employees must have the option to purchase any other specialized medical benefit plans, such as dental, vision and prescription coverage. Employees may have to pay for the entire premium costs under both plans unless they qualified for the congressional legislation benefits in 2009 and 2010.

    Limitations and Exclusions

    • Benefits under both plans end after 18 months of coverage (or 36 months). Additionally, benefits end when employees do not pay the cost of their premiums, when their employer become bankrupt or when the employer no longer maintains group health coverage for its employees. Benefits also may end when employees move outside of the health insurance carrier's servicing area or when employees enroll in a different group health plan.

    Considerations

    • Since employment laws can frequently change, do not use this information as a substitute for legal advice. Seek advice through an attorney licensed to practice law in your jurisdiction.

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