Continuation of Group Coverage under Federal or State Law

COBRA

You may be able to continue your coverage under this Evidence of Coverage (EOC) for a limited time after you would otherwise lose eligibility, if required by the federal COBRA law. COBRA applies to employees (and their covered family Dependents) of most employers with 20 or more employees. Members are not ineligible for COBRA continuation coverage solely because they live in the service area of a Region outside California.

You must submit a COBRA election form to your Group within the COBRA election period. Please ask your Group’s benefits administrator for the details about COBRA continuation coverage, such as how to elect coverage and how much you must pay your Group.

If you choose not to apply for COBRA continuation coverage through your Group, you may be able to convert to a non-group Plan as described in "Conversion of Group Membership to an Individual Plan" below. If you do enroll in COBRA, when you lose your COBRA eligibility, you may be able to continue coverage under state law as described in "State Continuation Coverage after COBRA coverage" below. Also, you may be able to convert to a non-group Plan as described in "Conversion of Group Membership to an Individual Plan" below.

State Continuation Coverage After COBRA Coverage

If you lose eligibility for COBRA coverage because you exhaust the length of time allowed for COBRA coverage, you may be eligible to continue your Group coverage under state law (State Continuation Coverage) if required by Section 1373.621 of the California Health and Safety Code. To continue your Group coverage under state law, you must call our Member Service Call Center toll free at 1-800-464-4000 (TTY 1-800-777-1370), 7 a.m. to 7 p.m., seven days a week, to request enrollment within 30 days before the date COBRA continuation coverage is scheduled to end and pay applicable dues to us. In addition, you must meet one of the following requirements:

• You are a Subscriber who was 60 years of age or older and were employed by your Group for at least five years before the date employment with your Group terminated
• You are the Spouse of a Subscriber who dies, divorces, legally separates, or becomes entitled to Medicare
• You are a former Spouse of a Subscriber

Termination of State Continuation Coverage

Coverage continues only upon payment of applicable monthly dues to us at the time we specify, and terminates on the earliest of:

• The date your Group’s Agreement with us terminates
• The date you obtain coverage under any other group health plan not maintained by your Group, regardless of whether that coverage is less valuable
• The date you become entitled to Medicare
• Your 65th birthday
• Five years from the date your COBRA coverage was scheduled to end, if you are a Subscriber’s Spouse or former Spouse
• When you fail to make payments to us when due

Uniformed Services Employment and Reemployment Rights Act (USERRA)

If you are called to active duty in the uniformed services, you may be able to continue your coverage under this EOC for a limited time after you would otherwise lose eligibility, if required by the federal USERRA law. Members are not ineligible for USERRA continuation coverage solely because they live in the service area of a Region outside California. You must submit an USERRA election form to your Group within 60 days after your call to active duty.  Please contact your Group if you want to know how to elect USERRA coverage and how much you must pay your Group.

Conversion of Group Membership to an Individual Plan

You may be eligible to convert to a non-group plan (Individual Plan) if you no longer meet the eligibility requirements described under "Who Is Eligible" in the "Dues, Eligibility, and Enrollment" section, or if you enroll in COBRA or USERRA continuation coverage and then lose eligibility for that coverage. However, you may not convert to this non-group plan if any of the following is true:

• You continue to be eligible for coverage through your Group
• Your membership ends because our Agreement with your Group terminates
• We terminated your membership under "Termination for Cause" or "Nonpayment of any other charges"
• You live in the service area of a Region outside California, except that the Subscriber’s or the Subscriber’s Spouse’s otherwise eligible children are not ineligible to be covered Dependents solely because they live in a non-California Region if:
  1. They are attending an accredited college or vocational school
  2. The Subscriber or Subscriber’s Spouse is required to cover them pursuant to a Qualified Medical Child Support Order

You must apply to convert your membership within 31 days after your Group coverage ends. During this period, no medical review is required, and your individual coverage begins when your Group coverage ends. You will have to pay Dues, and the benefits and Copayments under the new coverage may differ from those under this EOC.

For information about converting your membership or about other individual plans, call our Member Service Call Center toll free at 1-800-464-4000 (TTY 1-800-777-1370), 7 a.m. to 7 p.m., seven days a week.

Certificates of Creditable Coverage

The Health Insurance Portability and Accountability Act requires employers or health plans to issue "Certificates of Creditable Coverage" to terminated Members. The certificate documents healthcare membership and is used to prove prior creditable coverage when a terminated Member seeks new coverage. When your membership terminates, we will mail the certificate to the Subscriber unless your Group has an agreement with us to mail the certificates. If you have any questions, please contact your Group’s benefits administrator.