Extension of Benefits

Note: PacifiCare changed its name to UHC of California and will do business as (dba) UnitedHealthcare of California, effective May 2011. (See the March 25, 2011 announcement.)

Our extension of benefits policy is based on both California state law and federal law.  Federal law mandates that a replacement carrier provide coverage beginning on the effective date, to all members, even those who are disabled.  In most cases, even if there is a pre-existing clause, coverage is provided.  In those rare cases where the member would meet criteria for extension of benefits under federal law, we would extend coverage for up to six months, less the amount of coverage the member had prior to the termination date.  

If there is no replacement carrier, our policy reverts to state law and we will cover disabled enrollees meeting the criteria for up to twelve months for the disabling condition only.