Converting To An Individual Plan – Contact PacifiCare Directly

COBRA Eligible

For groups that meet COBRA guidelines, COBRA administration takes place at the Trust level. The Administrative Office is responsible for notifying its employees of COBRA benefits, as well as the administration of the benefits. PacifiCare processes eligibility and changes for COBRA according to the standard contractual guidelines outlined in the contract held with the group.

COBRA Exhaustion

An Individual Conversion Plan is available for PacifiCare members of an active group who become ineligible for coverage due to loss of coverage under active group coverage, after exhaustion of your COBRA or after exhaustion of California continuation benefits after COBRA.  PacifiCare does not automatically initiate the conversion process unless you have exhausted your benefits under California continuation benefits.  Interested members should contact PacifiCare Customer Service 60 days prior to the end of their COBRA coverage.  Prospective applicants should be aware that if they elect Individual Conversion they are waiving their rights to guaranteed issuance under the HIPAA Legislation.  

California Continuation COBRA Benefits

If a member lost active group health plan coverage on or after January 1, 2003 you may be entitled to extend your benefits under California law beyond the 18 or 29 months you are allowed under federal COBRA, up to a combined total of 36 months, at additional cost.  PacifiCare will send you written information on the extension, if any, 60 days prior to your exhaustion of federal COBRA.  If you believe you are entitled to this extended benefit, please contact PacifiCare Customer Service for more information.

To Be Eligible For Individual Conversion

• A member must have had at least three months of continuous coverage by PacifiCare immediately preceding their termination of coverage.
• The member should contact PacifiCare's, Customer Service department directly by calling 1-800-624-8822.  Customer Service will send the member an enrollment packet.
• If a member does not apply for and provide payment of premiums due within 63 days from the date coverage was terminated, they will not be eligible for Individual Conversion.