Disclosure of Continuation Coverage  (For California Residents Only)

You may be eligible to continue coverage under the current SafeGuard plan upon a qualifying event as defined under the California Continuation of Benefits Replacement Act ("Cal-COBRA").  A qualifying event is defined as any of the following events that, but for the election of continuation coverage, would result in a loss of coverage under your SafeGuard plan:

1. the death of the covered employee or subscriber;
2. the termination or reduction of hours of the covered employee’s or subscriber’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; and
4. the loss of dependent status by dependent enrolled in the group benefit plan.

Upon election, you will be able to continue your SafeGuard plan, subject to the terms and conditions of the group contract and the requirements of Cal-COBRA.  

The continuation of your coverage will only be provided for the balance of the period that you would have remained covered under your prior SafeGuard plan and group contract, had your employer not terminated the group contract or the contract with your previous group benefit plan.  To be eligible for such continuation of benefits, you must notify SafeGuard or your employer if the employer has contracted to perform the administrative services, within sixty (60) days of the date of your qualifying event.  Failure to make such notification within your required sixty (60) days, will disqualify you from receiving continuation coverage.  If you wish to continue coverage, you must request such continuation of coverage in writing and deliver it via first class mail, or other reliable means of delivery, to SafeGuard or to your employer, within the sixty (60) day period following the latter of  (1) the date of the qualifying event; (2) the date you are given notice of the ability to continue coverage by SafeGuard or your employer; or (3) the date coverage under your employer’s plan terminates.  Within fourteen (14) days of receiving your notice of a qualifying event, SafeGuard or your employer that contracts to perform the notice and administrative services, will provide you with the necessary benefits information, premium information, enrollment forms, and instructions.  At such time, you will be required to pay the amount of premium that is set forth in your notice.  Your first premium payment for the initial three (3) months of coverage will be delivered by certified mail or other reliable means of delivery to SafeGuard or your employer within forty-five (45) days of the date you provided written notice to SafeGuard or your employer of your election to continue coverage.  Failure to submit the correct premium amount within such forty-five (45) day period, will disqualify you from receiving continuation coverage.  Quarterly payments will be due thereafter in accordance with a billing from SafeGuard.

If you had continuation coverage that has been terminated under a prior group benefit plan, you may continue such coverage for the balance of the period if you would have remained covered under the prior group benefit plan.  The requirements for your election to continue coverage and payment of the required premiums are the same as described above.  However, your continuation coverage shall terminate if you fail to comply with the requirements pertaining to enrollment in, and payment of premiums to your new plan within thirty (30) days of receiving notice of the termination of your prior group benefit plan.