BILL NUMBER: SB 838 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 29, 2010
AMENDED IN SENATE APRIL 6, 2010
AMENDED IN SENATE FEBRUARY 16, 2010
INTRODUCED BY Senator Strickland
(Coauthor: Senator Alquist)
(Coauthors: Assembly Members Fletcher and Monning)
JANUARY 5, 2010
An act to amend Sections 1366.21, 1366.22, 1366.25, and 1366.27 of
, and to add Chapter 1.1 (commencing with Section 24100) to
Division 20 of, the Health and Safety Code, and to
amend Sections 10128.51, 10128.52, 10128.55, and 10128.57 of the
Insurance Code, and to add Section 2800.4 to the Labor
Code, relating to health care coverage, and declaring the
urgency thereof, to take effect immediately.
LEGISLATIVE COUNSEL'S DIGEST
SB 838, as amended, Strickland. Cal-COBRA: premium assistance.
Existing federal law, the Consolidated Omnibus Budget
Reconciliation Act of 1985 (COBRA), requires group health plans
providing coverage to employers of 20 or more employees to provide
former employees with continuation of benefits, as specified. The
federal American Recovery and Reinvestment Act of 2009 (ARRA)
provides up to 9 months of premium assistance under COBRA and
comparable state continuation coverage programs for certain eligible
individuals whose employment was involuntarily terminated between
September 1, 2008, and December 31, 2009, as specified. Subsequent
federal legislation extends that premium assistance and also
for a specified period of time, makes the
assistance available to certain eligible individuals whose employment
is involuntarily terminated on or after January 1, 2010 , and
provides a special election opportunity for certain eligible
individuals who experience a reduction in hours followed by an
involuntary termination of employment, as specified . Existing
federal law requires a plan administrator or other entity involved to
provide notices regarding that assistance to certain qualified
beneficiaries within specified periods of time.
The Knox-Keene Health Care Service Plan Act of 1975 provides for
the licensure and regulation of health care service plans by the
Department of Managed Health Care and makes a willful violation of
the act a crime. Existing law also provides for regulation of health
insurers by the Department of Insurance. The California Continuation
Benefits Replacement Act (Cal-COBRA) requires health care service
plans and health insurers providing group coverage to employers of 2
to 19 employees to offer continuation of that coverage for a
specified period of time to certain qualified beneficiaries, as
specified. Existing law requires Cal-COBRA plans and insurers to
provide notice of the availability of premium assistance under ARRA
to qualified beneficiaries who experience a qualifying event between
September 1, 2008, and December 31, 2009, as specified.
This bill would require those plans and insurers to also provide
notice of the availability of premium assistance to qualified
beneficiaries who experience a qualifying event between January 1,
2010, and specified dates under federal law. The bill
law and would additionally require plans and
insurers to notify qualified beneficiaries eligible for premium
assistance of the extension of premium assistance made available by
federal law consistent with the notice requirements imposed under
that law, and law. The bill would require
plans and insurers to give certain qualified beneficiaries whose
employment is terminated on or after March 1, 2010, written notice
regarding the availability of premium assistance and the special
election opportunity provided under ARRA and would allow
beneficiaries eligible for special election opportunity to elect
continuation coverage within 60 days of the notice. The bill would
also require plans and insurers to provide information regarding the
federal premium assistance and any special election periods under
ARRA on their Internet Web sites, as specified, and would apply
certain notice requirements to employers of employees whose
employment has been terminated on or after March 2, 2010 .
The bill would authorize the Department of Managed Health Care to
designate model notices for purposes of implementing federal premium
assistance, as specified, and would make other conforming changes.
Because a willful violation of these requirements by a health care
service plan would be a crime, the bill would impose a
state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
This bill would declare that it is to take effect immediately as
an urgency statute.
Vote: 2/3. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1366.21 of the Health and Safety Code is
amended to read:
1366.21. The definitions contained in this section govern the
construction of this article.
(a) "Continuation coverage" means extended coverage under the
group benefit plan in which an eligible employee or eligible
dependent is currently enrolled, or, in the case of a termination of
the group benefit plan or an employer open enrollment period,
extended coverage under the group benefit plan currently offered by
the employer.
(b) "Group benefit plan" means any health care service plan
contract provided pursuant to Article 3.1 (commencing with Section
1357) to an employer with 2 to 19 eligible employees, as defined in
Section 1357, as well as a specialized health care service plan
contract provided to an employer with 2 to 19 eligible employees, as
defined in Section 1357.
(c) (1) "Qualified beneficiary" means any individual who, on the
day before the qualifying event, is an enrollee in a group benefit
plan offered by a health care service plan pursuant to Article 3.1
(commencing with Section 1357) and has a qualifying event, as defined
in subdivision (d).
(2) "Qualified beneficiary eligible for premium assistance under
ARRA" means a qualified beneficiary, as defined in paragraph (1), who
(A) was or is eligible for continuation coverage as a result of the
involuntary termination of the covered employee's employment during
the period specified in subparagraph (A) of paragraph (3) of
subdivision (a) of Section 3001 of ARRA, (B) elects continuation
coverage, and (C) meets the definition of "qualified beneficiary" set
forth in paragraph (3) of Section 1167 of Title 29 of the United
States Code, as used in subparagraph (E) of paragraph (10) of
subdivision (a) of Section 3001 of ARRA or any subsequent rules or
regulations issued pursuant to that law.
(3) "ARRA" means Title III of Division B of the federal American
Recovery and Reinvestment Act of 2009 or any amendment to that
federal law extending federal premium assistance to qualified
beneficiaries.
(d) "Qualifying event" means any of the following events that, but
for the election of continuation coverage under this article, would
result in a loss of coverage under the group benefit plan to a
qualified beneficiary:
(1) The death of the covered employee.
(2) The termination of employment or reduction in hours of the
covered employee'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.
(4) The loss of dependent status by a dependent enrolled in the
group benefit plan.
(5) With respect to a covered dependent only, the covered employee'
s entitlement to benefits under Title XVIII of the United States
Social Security Act (Medicare).
(e) "Employer" means any employer that meets the definition of
"small employer" as set forth in Section 1357 and (1) employed 2 to
19 eligible employees on at least 50 percent of its working days
during the preceding calendar year, or, if the employer was not in
business during any part of the preceding calendar year, employed 2
to 19 eligible employees on at least 50 percent of its working days
during the preceding calendar quarter, (2) has contracted for health
care coverage through a group benefit plan offered by a health care
service plan, and (3) is not subject to Section 4980B of the United
States Internal Revenue Code or Chapter 18 of the Employee Retirement
Income Security Act, 29 U.S.C. Section 1161 et seq.
(f) "Core coverage" means coverage of basic health care services,
as defined in subdivision (b) of Section 1345, and other hospital,
medical, or surgical benefits provided by the group benefit plan that
a qualified beneficiary was receiving immediately prior to the
qualifying event, other than noncore coverage.
(g) "Noncore coverage" means coverage for vision and dental care.
SEC. 2. Section 1366.22 of the Health and Safety Code is amended
to read:
1366.22. The continuation coverage requirements of this article
do not apply to the following individuals:
(a) Individuals who are entitled to Medicare benefits or become
entitled to Medicare benefits pursuant to Title XVIII of the United
States Social Security Act, as amended or superseded. Entitlement to
Medicare Part A only constitutes entitlement to benefits under
Medicare.
(b) Individuals who have other hospital, medical, or surgical
coverage or who are covered or become covered under another group
benefit plan, including a self-insured employee welfare benefit plan,
that provides coverage for individuals and that does not impose any
exclusion or limitation with respect to any preexisting condition of
the individual, other than a preexisting condition limitation or
exclusion that does not apply to or is satisfied by the qualified
beneficiary pursuant to Sections 1357 and 1357.06. A group conversion
option under any group benefit plan shall not be considered as an
arrangement under which an individual is or becomes covered.
(c) Individuals who are covered, become covered, or are eligible
for federal COBRA coverage pursuant to Section 4980B of the United
States Internal Revenue Code or Chapter 18 of the Employee Retirement
Income Security Act, 29 U.S.C. Section 1161 et seq.
(d) Individuals who are covered, become covered, or are eligible
for coverage pursuant to Chapter 6A of the Public Health Service Act,
42 U.S.C. Section 300bb-1 et seq.
(e) Qualified beneficiaries who fail to meet the requirements of
subdivision (b) of Section 1366.24 or subdivision (h) of Section
1366.25 regarding notification of a qualifying event or election of
continuation coverage within the specified time limits.
(f) Except as provided in Section 3001 of ARRA, qualified
beneficiaries who fail to submit the correct premium amount required
by subdivision (b) of Section 1366.24 and Section 1366.26, in
accordance with the terms and conditions of the plan contract, or
fail to satisfy other terms and conditions of the plan contract.
SEC. 3. Section 1366.25 of the Health and Safety Code is amended
to read:
1366.25. (a) Every group contract between a health care service
plan and an employer subject to this article that is issued, amended,
or renewed on or after July 1, 1998, shall require the employer to
notify the plan, in writing, of any employee who has had a qualifying
event, as defined in paragraph (2) of subdivision (d) of Section
1366.21, within 30 days of the qualifying event. The group contract
shall also require the employer to notify the plan, in writing,
within 30 days of the date, when the employer becomes subject to
Section 4980B of the United States Internal Revenue Code or Chapter
18 of the Employee Retirement Income Security Act, 29 U.S.C. Sec.
1161 et seq.
(b) Every group contract between a plan and an employer subject to
this article that is issued, amended, or renewed on or after July 1,
1998, shall require the employer to notify qualified beneficiaries
currently receiving continuation coverage, whose continuation
coverage will terminate under one group benefit plan prior to the end
of the period the qualified beneficiary would have remained covered,
as specified in Section 1366.27, of the qualified beneficiary's
ability to continue coverage under a new group benefit plan for the
balance of the period the qualified beneficiary would have remained
covered under the prior group benefit plan. This notice shall be
provided either 30 days prior to the termination or when all enrolled
employees are notified, whichever is later.
Every health care service plan and specialized health care service
plan shall provide to the employer replacing a health care service
plan contract issued by the plan, or to the employer's agent or
broker representative, within 15 days of any written request,
information in possession of the plan reasonably required to
administer the notification requirements of this subdivision and
subdivision (c).
(c) Notwithstanding subdivision (a), the group contract between
the health care service plan and the employer shall require the
employer to notify the successor plan in writing of the qualified
beneficiaries currently receiving continuation coverage so that the
successor plan, or contracting employer or administrator, may provide
those qualified beneficiaries with the necessary premium
information, enrollment forms, and instructions consistent with the
disclosure required by subdivision (c) of Section 1366.24 and
subdivision (e) of this section to allow the qualified beneficiary to
continue coverage. This information shall be sent to all qualified
beneficiaries who are enrolled in the plan and those qualified
beneficiaries who have been notified, pursuant to Section 1366.24, of
their ability to continue their coverage and may still elect
coverage within the specified 60-day period. This information shall
be sent to the qualified beneficiary's last known address, as
provided to the employer by the health care service plan or
disability insurer currently providing continuation coverage to the
qualified beneficiary. The successor plan shall not be obligated to
provide this information to qualified beneficiaries if the employer
or prior plan or insurer fails to comply with this section.
(d) A health care service plan may contract with an employer, or
an administrator, to perform the administrative obligations of the
plan as required by this article, including required notifications
and collecting and forwarding premiums to the health care service
plan. Except for the requirements of subdivisions (a), (b), and (c),
this subdivision shall not be construed to permit a plan to require
an employer to perform the administrative obligations of the plan as
required by this article as a condition of the issuance or renewal of
coverage.
(e) Every health care service plan, or employer or administrator
that contracts to perform the notice and administrative services
pursuant to this section, shall, within 14 days of receiving a notice
of a qualifying event, provide to the qualified beneficiary the
necessary benefits information, premium information, enrollment
forms, and disclosures consistent with the notice requirements
contained in subdivisions (b) and (c) of Section 1366.24 to allow the
qualified beneficiary to formally elect continuation coverage. This
information shall be sent to the qualified beneficiary's last known
address.
(f) Every health care service plan, or employer or administrator
that contracts to perform the notice and administrative services
pursuant to this section, shall, during the 180-day period ending on
the date that continuation coverage is terminated pursuant to
paragraphs (1), (3), and (5) of subdivision (a) of Section 1366.27,
notify a qualified beneficiary who has elected continuation coverage
pursuant to this article of the date that his or her coverage will
terminate, and shall notify the qualified beneficiary of any
conversion coverage available to that qualified beneficiary. This
requirement shall not apply when the continuation coverage is
terminated because the group contract between the plan and the
employer is being terminated.
(g) (1) A health care service plan shall provide to a qualified
beneficiary who has a qualifying event during the period specified in
subparagraph (A) of paragraph (3) of subdivision (a) of Section 3001
of ARRA, a written notice containing information on the availability
of premium assistance under ARRA. This notice shall be sent to the
qualified beneficiary's last known address. The notice shall include
clear and easily understandable language to inform the qualified
beneficiary that changes in federal law provide a new opportunity to
elect continuation coverage with a 65-percent premium subsidy and
shall include all of the following:
(A) The amount of the premium the person will pay. For qualified
beneficiaries who had a qualifying event between September 1, 2008,
and May 12, 2009, inclusive, if a health care service plan is unable
to provide the correct premium amount in the notice, the notice may
contain the last known premium amount and an opportunity for the
qualified beneficiary to request, through a toll-free telephone
number, the correct premium that would apply to the beneficiary.
(B) Enrollment forms and any other information required to be
included pursuant to subdivision (e) to allow the qualified
beneficiary to elect continuation coverage. This information shall
not be included in notices sent to qualified beneficiaries currently
enrolled in continuation coverage.
(C) A description of the option to enroll in different coverage as
provided in subparagraph (B) of paragraph (1) of subdivision (a) of
Section 3001 of ARRA. This description shall advise the qualified
beneficiary to contact the covered employee's former employer for
prior approval to choose this option.
(D) The eligibility requirements for premium assistance in the
amount of 65 percent of the premium under Section 3001 of ARRA.
(E) The duration of premium assistance available under ARRA.
(F) A statement that a qualified beneficiary eligible for premium
assistance under ARRA may elect continuation coverage no later than
60 days of the date of the notice.
(G) A statement that a qualified beneficiary eligible for premium
assistance under ARRA who rejected or discontinued continuation
coverage prior to receiving the notice required by this subdivision
has the right to withdraw that rejection and elect continuation
coverage with the premium assistance.
(H) A statement that reads as follows:
"IF YOU ARE HAVING ANY DIFFICULTIES READING OR UNDERSTANDING THIS
NOTICE, PLEASE CONTACT [name of health plan] at [insert appropriate
telephone number]."
(2) With respect to qualified beneficiaries who had a qualifying
event between September 1, 2008, and May 12, 2009, inclusive, the
notice described in this subdivision shall be provided by the later
of May 26, 2009, or seven business days after the date the plan
receives notice of the qualifying event.
(3) With respect to qualified beneficiaries who had or have a
qualifying event between May 13, 2009, and the later date specified
in subparagraph (A) of paragraph (3) of subdivision (a) of Section
3001 of ARRA, inclusive, the notice described in this subdivision
shall be provided within the period of time specified in subdivision
(e).
(4) Nothing in this section shall be construed to require a health
care service plan to provide the plan's evidence of coverage as a
part of the notice required by this subdivision, and nothing in this
section shall be construed to require a health care service plan to
amend its existing evidence of coverage to comply with the changes
made to this section by the enactment of Assembly Bill 23 of the
2009-10 Regular Session or by the act amending this section during
the second year of the 2009-10 Regular Session.
(5) The requirement under this subdivision to provide a written
notice and under the requirement under
paragraph (1) of subdivision (h) to provide a new opportunity
to elect continuation coverage shall not apply
be deemed satisfied if a health care service plan
previously provided a written notice and additional election
opportunity under Section 3001 of ARRA prior to the effective date of
the act adding this paragraph.
(h) (1) Notwithstanding any other provision of law, a qualified
beneficiary eligible for premium assistance under ARRA may elect
continuation coverage no later than 60 days after the date of the
notice required by subdivision (g).
(2) For a qualified beneficiary who elects to continue coverage
pursuant to paragraph (1) this subdivision
, the period beginning on the date of the qualifying event and
ending on the effective date of the continuation coverage shall be
disregarded for purposes of calculating a break in coverage in
determining whether a preexisting condition provision applies under
subdivision (c) of Section 1357.06 or subdivision (e) of Section
1357.51.
(3) For a qualified beneficiary who had a qualifying event between
September 1, 2008, and February 16, 2009, inclusive, and who elects
continuation coverage pursuant to paragraph (1), the continuation
coverage shall commence on the first day of the month following the
election.
(4) For a qualified beneficiary who had a qualifying event between
February 17, 2009, and May 12, 2009, inclusive, and who elects
continuation coverage pursuant to paragraph (1), the effective date
of the continuation coverage shall be either of the following, at the
option of the beneficiary, provided that the beneficiary pays the
applicable premiums:
(A) The date of the qualifying event.
(B) The first day of the month following the election.
(5) Notwithstanding any other provision of law, a qualified
beneficiary who is eligible for the special election opportunity
described in paragraph (17) of subdivision (a) of Section 3001 of
ARRA may elect continuation coverage no later than 60 days after the
date of the notice required under subdivision (j). For a qualified
beneficiary who elects coverage pursuant to this paragraph, the
continuation coverage shall be effective as of the first day of the
first period of coverage after the date of termination of employment,
except, if federal law permits, coverage shall take effect on the
first day of the month following the election. However, for purposes
of calculating the duration of continuation coverage pursuant to
Section 1366.27, the period of that coverage shall be determined as
though the qualifying event was a reduction of hours of the employee.
(6) Notwithstanding any other provision of law, a qualified
beneficiary who is eligible for any other special election
opportunity under ARRA may elect continuation coverage no later than
60 days after the date of the special election notice required under
ARRA.
(i) A health care service plan shall provide a qualified
beneficiary eligible for premium assistance under ARRA written notice
of the extension of that premium assistance as required under
Section 3001 of ARRA.
(j) For qualified beneficiaries who had a qualifying event that
entitles them to the new election period described in paragraph (17)
of subdivision (a) of Section 3001 of ARRA, a health care service
plan, or an administrator or employer if administrative obligations
have been assumed by those entities pursuant to subdivision (d) of
Section 1366.25, shall give those qualified beneficiaries a written
notice regarding the new election period to elect continuation
coverage by implementing the following
(j) A health care service plan, or an
administrator or employer if administrative obligations have been
assumed by those entities pursuant to subdivision (d), shall give the
qualified beneficiaries described in subparagraph (C) of paragraph
(17) of subdivision (a) of Section 3001 of ARRA the written notice
required by that paragraph by implementing the following
procedures:
(1) The health care service plan shall, within 14 days of the
effective date of the act adding this subdivision, send a notice to
employers currently contracting with the health care service plan for
a group benefit plan subject to this article. The notice shall do
all of the following:
(A) Advise the employer that employees whose employment is
terminated on or after March 2, 2010, who were previously enrolled in
any group health care service plan or health insurance policy
offered by the employer may be entitled to special health coverage
rights, including a subsidy paid by the federal government for a
portion of the premium.
(B) Ask the employer to provide the health care service plan with
the name, address, and date of termination of employment for any
employee whose employment is terminated on or after March 2, 2010,
and who was at any time covered by any health care service plan or
health insurance policy offered to their employees on or after
September 1, 2008.
(C) Provide employers with a format and instructions for
submitting the information to the health care service plan, or their
administrator or employer who has assumed administrative obligations
pursuant to subdivision (d) of Section 1366.25 ,
by telephone, fax, electronic mail, or mail.
(2) An employer shall provide the information described in
paragraph (1), with respect to any employee whose employment is
terminated on or after March 2, 2010, and who was enrolled at any
time in a health care service plan or health insurance policy offered
by the employer on or after September 1, 2008, to the health care
service plan within 14 days of receipt of the notification under
paragraph (1). The employer shall continue to provide the information
to the health care service plan within 14 days after the end of each
month for any employee whose employment is terminated in the prior
month until the last date specified in subparagraph (A) of paragraph
(3) of subdivision (a) of Section 3001 of ARRA.
(3)
(2) Within 14 days of receipt of the information
specified in paragraph (2) (1) from the
employer, the health care service plan shall send the written notice
specified in paragraph (17) of subdivision (a) of Section 3001 of
ARRA to those individuals.
(4) For beneficiaries who qualify, the continuation coverage shall
be retroactive to the date of termination of employment, except, if
federal law permits, coverage shall take effect on the first day of
the month following the election. However, for purposes of
calculating the duration of continuation coverage pursuant to Section
1366.27, the period of that coverage shall be determined as though
the qualifying event was a reduction of hours of the employee.
(3) If an individual contacts his or her health care service plan
and indicates that he or she experienced a qualifying event that
entitles him or her to the special election period described in
paragraph (17) of subdivision (a) of Section 3001 of ARRA or any
other special election provision of ARRA, the plan shall provide the
individual with the written notice required under paragraph (17) of
subdivision (a) of Section 3001 of ARRA or any other applicable
provision of ARRA, regardless of whether the plan receives
information from the individual's previous employer regarding that
individual pursuant to Section 24100. The plan shall review the
individual's application for coverage under this special election
notice to determine if the individual qualifies for the special
election period and the premium assistance under ARRA. The plan shall
comply with paragraph (5) if the individual does not qualify for
either the special election period or premium assistance under ARRA.
(4) The requirement under this subdivision to provide the written
notice described in paragraph (17) of subdivision (a) of Section 3001
of ARRA and the requirement under paragraph (5) of subdivision (h)
to provide a new opportunity to elect continuation coverage shall be
deemed satisfied if a health care service plan previously provided
the written notice and additional election opportunity described in
paragraph (17) of subdivision (a) of Section 3001 of ARRA prior to
the effective date of the act adding this paragraph.
(5) If a person an individual does
not qualify for either the special enrollment election
a special election period or the premium
assistance under ARRA, the health care service plan shall provide a
written notice to that person individual
that shall include information on the right to appeal as set
forth in Section 3001 of ARRA.
(6) A health care service plan shall provide information on its
publicly accessible Internet Web site regarding the premium
assistance made available under ARRA and any special election period
provided under that law. A plan may fulfill this requirement by
linking or otherwise directing consumers to the information regarding
COBRA continuation coverage premium assistance located on the
Internet Web site of the United States Department of Labor. The
information required by this paragraph shall be located in a section
of the plan's Internet Web site that is readily accessible to
consumers, such as the Web site's Frequently Asked Questions section.
(k) For purposes of implementing federal premium assistance for
continuation coverage, the department may designate a model notice or
notices that may be used by health care service plans. Use of the
model notice or notices shall not require prior approval of the
department. Any model notice or notices designated by the department
for purposes of this subdivision shall not be subject to the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code).
(l) Notwithstanding any other provision of law, a qualified
beneficiary eligible for premium assistance under ARRA may elect to
enroll in different coverage subject to the criteria provided under
subparagraph (B) of paragraph (1) of subdivision (a) of Section 3001
of ARRA.
(m) A qualified beneficiary enrolled in continuation coverage as
of February 17, 2009, who is eligible for premium assistance under
ARRA may request application of the premium assistance as of March 1,
2009, or later, consistent with ARRA.
(n) A health care service plan that receives an election notice
from a qualified beneficiary eligible for premium assistance under
ARRA, pursuant to subdivision (h), shall be considered a person
entitled to reimbursement, as defined in Section 6432(b)(3) of the
Internal Revenue Code, as amended by paragraph (12) of subdivision
(a) of Section 3001 of ARRA.
(o) (1) For purposes of compliance with ARRA, in the absence of
guidance from, or if specifically required for state-only
continuation coverage by, the United States Department of Labor,
the Internal Revenue
Service, or the Centers for Medicare and Medicaid Services, a health
care service plan may request verification of the involuntary
termination of a covered employee's employment from the covered
employee's former employer or the qualified beneficiary seeking
premium assistance under ARRA.
(2) A health care service plan that requests verification pursuant
to paragraph (1) directly from a covered employee's former employer
shall do so by providing a written notice to the employer. This
written notice shall be sent by mail or facsimile to the covered
employee's former employer within seven business days from the date
the plan receives the qualified beneficiary's election notice
pursuant to subdivision (h). Within 10 calendar days of receipt of
written notice required by this paragraph, the former employer shall
furnish to the health care service plan written verification as to
whether the covered employee's employment was involuntarily
terminated.
(3) A qualified beneficiary requesting premium assistance under
ARRA may furnish to the health care service plan a written document
or other information from the covered employee's former employer
indicating that the covered employee's employment was involuntarily
terminated. This document or information shall be deemed sufficient
by the health care service plan to establish that the covered
employee's employment was involuntarily terminated for purposes of
ARRA, unless the plan makes a reasonable and timely determination
that the documents or information provided by the qualified
beneficiary are legally insufficient to establish involuntary
termination of employment.
(4) If a health care service plan requests verification pursuant
to this subdivision and cannot verify involuntary termination of
employment within 14 business days from the date the employer
receives the verification request or from the date the plan receives
documentation or other information from the qualified beneficiary
pursuant to paragraph (3), the health care service plan shall either
provide continuation coverage with the federal premium assistance to
the qualified beneficiary or send the qualified beneficiary a denial
letter which shall include notice of his or her right to appeal that
determination pursuant to ARRA.
(5) No person shall intentionally delay verification of
involuntary termination of employment under this subdivision.
(p) The provision of information and forms related to the premium
assistance available pursuant to ARRA to individuals by a health care
service plan shall not be considered a violation of this chapter
provided that the plan complies with all of the requirements of this
article.
SEC. 4. Section 1366.27 of the Health and Safety Code is amended
to read:
1366.27. (a) The continuation coverage provided pursuant to this
article shall terminate at the first to occur of the following:
(1) In the case of a qualified beneficiary who is eligible for
continuation coverage pursuant to paragraph (2) of subdivision (d) of
Section 1366.21, the date 36 months after the date the qualified
beneficiary's benefits under the contract would otherwise have
terminated because of a qualifying event.
(2) Except as provided in Section 3001 of ARRA, the end of the
period for which premium payments were made, if the qualified
beneficiary ceases to make payments or fails to make timely payments
of a required premium, in accordance with the terms and conditions of
the plan contract. In the case of nonpayment of premiums,
reinstatement shall be governed by the terms and conditions of the
plan contract and by Section 3001 of ARRA, if applicable.
(3) In the case of a qualified beneficiary who is eligible for
continuation coverage pursuant to paragraph (1), (3), (4), or (5) of
subdivision (d) of Section 1366.21, the date 36 months after the date
the qualified beneficiary's benefits under the contract would
otherwise have terminated by reason of a qualifying event.
(4) The requirements of this article no longer apply to the
qualified beneficiary pursuant to the provisions of Section 1366.22.
(5) In the case of a qualified beneficiary who is eligible for
continuation coverage pursuant to paragraph (2) of subdivision (d) of
Section 1366.21, and determined, under Title II or Title XVI of the
Social Security Act, to be disabled at any time during the first 60
days of continuation coverage, and the spouse or dependent who has
elected coverage pursuant to this article, the date 36 months after
the date the qualified beneficiary's benefits under the contract
would otherwise have terminated because of a qualifying event. The
qualified beneficiary shall notify the plan, or the employer or
administrator that contracts to perform administrative services, of
the social security determination within 60 days of the date of the
determination letter and prior to the end of the original 36-month
continuation coverage period in order to be eligible for coverage
pursuant to this subdivision. If the qualified beneficiary is no
longer disabled under Title II or Title XVI of the Social Security
Act, the benefits provided in this paragraph shall terminate on the
later of the date provided by paragraph (1), or the month that begins
more than 31 days after the date of the final determination under
Title II or Title XVI of the United States Social Security Act that
the qualified beneficiary is no longer disabled. A qualified
beneficiary eligible for 36 months of continuation coverage as a
result of a disability shall notify the plan, or the employer or
administrator that contracts to perform the notice and administrative
services, within 30 days of a determination that the qualified
beneficiary is no longer disabled.
(6) In the case of a qualified beneficiary who is initially
eligible for and elects continuation coverage pursuant to paragraph
(2) of subdivision (d) of Section 1366.21, but who has another
qualifying event, as described in paragraph (1), (3), (4), or (5) of
subdivision (d) of Section 1366.21, within 36 months of the date of
the first qualifying event, and the qualified beneficiary has
notified the plan, or the employer or administrator under contract to
provide administrative services, of the second qualifying event
within 60 days of the date of the second qualifying event, the date
36 months after the date of the first qualifying event.
(7) The employer, or any successor employer or purchaser of the
employer, ceases to provide any group benefit plan to his or her
employees.
(8) The qualified beneficiary moves out of the plan's service area
or the qualified beneficiary commits fraud or deception in the use
of plan services.
(b) If the group contract between the plan and the employer is
terminated prior to the date the qualified beneficiary's continuation
coverage would terminate pursuant to this section, coverage under
the prior plan shall terminate and the qualified beneficiary may
elect continuation coverage under the subsequent group benefit plan,
if any, pursuant to the requirements of subdivision (b) of Section
1366.23 and subdivision (c) of Section 1366.24.
(c) The amendments made to this section by Assembly Bill 1401 of
the 2001-02 Regular Session shall apply to individuals who begin
receiving continuation coverage under this article on or after
January 1, 2003.
SEC. 5. Chapter 1.1 (commencing with Section
24100) is added to Division 20 of the Health and Safety
Code , to read:
CHAPTER 1.1. EMPLOYER DUTIES
24100. (a) For purposes of this section, the following
definitions apply:
(1) "ARRA" means Title III of Division B of the federal American
Recovery and Reinvestment Act of 2009 or any amendment to that
federal law extending federal premium assistance to qualified
beneficiaries, as defined in Section 1366.21 of this code or Section
10128.51 of the Insurance Code.
(2) "Employer" means an employer as defined in Section 1366.21 of
this code or an employer as defined in Section 10128.51 of the
Insurance Code.
(b) An employer shall provide the information described in
subparagraph (B) of paragraph (1) of subdivision (j) of Section
1366.25 of this code or subparagraph (B) of paragraph (1) of
subdivision (j) of Section 10128.55 of the Insurance Code, as
applicable, with respect to any employee whose employment is
terminated on or after March 2, 2010, and who was enrolled at any
time in a health care service plan or health insurance policy offered
by the employer on or after September 1, 2008. This information
shall be provided to the requesting health care service plan or
health insurer within 14 days of receipt of the notification
described in paragraph (1) of subdivision (j) of Section 1366.25 of
this code or paragraph (1) of subdivision (j) of Section 10128.55 of
the Insurance Code. The employer shall continue to provide the
information to the health care service plan or health insurer within
14 days after the end of each month for any employee whose employment
is terminated in the prior month until the last date specified in
subparagraph (A) of paragraph (3) of subdivision (a) of Section 3001
of ARRA.
SEC. 5. SEC. 6. Section 10128.51 of
the Insurance Code is amended to read:
10128.51. (a) "Continuation coverage" means extended coverage
under the group benefit plan under which an eligible employee or
eligible dependent is currently covered, or, in the case of a
termination of the group benefit plan or an employer open enrollment
period, extended coverage under the group benefit plan currently
offered by the employer.
(b) "Group benefit plan" has the same meaning as "health benefit
plan" defined in Section 10700, including group policies of
vision-only and dental-only coverage, provided pursuant to Chapter 8
(commencing with Section 10700) to an employer with 2 to 19 eligible
employees, as defined in Section 10700.
(c) (1) "Qualified beneficiary" means any individual who, on the
day before the qualifying event, is covered under a group benefit
plan offered by a disability insurer pursuant to Article 1
(commencing with Section 10700) of Chapter 8, and has a qualifying
event, as defined in subdivision (d).
(2) "Qualified beneficiary eligible for premium assistance under
ARRA" means a qualified beneficiary, as defined in paragraph (1), who
(A) was or is eligible for continuation coverage as a result of the
involuntary termination of the covered employee's employment during
the period specified in subparagraph (A) of paragraph (3) of
subdivision (a) of Section 3001 of ARRA, (B) elects continuation
coverage, and (C) meets the definition of "qualified beneficiary" set
forth in paragraph (3) of Section 1167 of Title 29 of the United
States Code, as used in subparagraph (E) of paragraph (10) of
subdivision (a) of Section 3001 of ARRA or any subsequent rules or
regulations issued pursuant to that law.
(3) "ARRA" means Title III of Division B of the federal American
Recovery and Reinvestment Act of 2009 or any amendment to that
federal law extending federal premium assistance to qualified
beneficiaries.
(d) "Qualifying event" means any of the following events that, but
for the election of continuation coverage under this article, would
result in a loss of coverage under the group benefit plan to a
qualified beneficiary:
(1) The death of the covered employee.
(2) The termination of employment or reduction in hours of the
covered employee'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.
(4) The loss of dependent status by a dependent enrolled in the
group benefit plan.
(5) With respect to a covered dependent only, the covered employee'
s entitlement to benefits under Title XVIII of the United States
Social Security Act (Medicare).
(e) "Employer" means any employer that meets the definition of
"small employer" as set forth in Section 10700 and (1) employed 2 to
19 eligible employees on at least 50 percent of its working days
during the preceding calendar year, or, if the employer was not in
business during any part of the preceding calendar year, employed 2
to 19 eligible employees on at least 50 percent of its working days
during the preceding calendar quarter, (2) has contracted for health
care coverage through a group benefit plan offered by a disability
insurer, and (3) is not subject to Section 4980B of the United States
Internal Revenue Code or Chapter 18 of the Employee Retirement
Income Security Act, 29 U.S.C. Section 1161 et seq.
(f) "Core coverage" means coverage for hospital, medical, or
surgical benefits provided under the group benefit plan that a
qualified beneficiary was receiving immediately prior to the
qualifying event, other than noncore coverage.
(g) "Noncore coverage" means coverage for vision and dental care.
SEC. 6. SEC. 7. Section 10128.52 of
the Insurance Code is amended to read:
10128.52. The continuation coverage requirements of this article
do not apply to the following individuals:
(a) Individuals who are entitled to Medicare benefits or become
entitled to Medicare benefits pursuant to Title XVIII of the United
States Social Security Act, as amended or superseded. Entitlement to
Medicare Part A only constitutes entitlement to benefits under
Medicare.
(b) Individuals who have other hospital, medical, or surgical
coverage, or who are covered or become covered under another group
benefit plan, including a self-insured employee welfare benefit plan,
that provides coverage for individuals and that does not impose any
exclusion or limitation with respect to any preexisting condition of
the individual, other than a preexisting condition limitation or
exclusion that does not apply to or is satisfied by the qualified
beneficiary pursuant to Sections 10198.6 and 10198.7. A group
conversion option under any group benefit plan shall not be
considered as an arrangement under which an individual is or becomes
covered.
(c) Individuals who are covered, become covered, or are eligible
for federal COBRA coverage pursuant to Section 4980B of the United
States Internal Revenue Code or Chapter 18 of the Employee Retirement
Income Security Act, 29 U.S.C. Section 1161 et seq.
(d) Individuals who are covered, become covered, or are eligible
for coverage pursuant to Chapter 6A of the Public Health Service Act,
42 U.S.C. Section 300bb-1 et seq.
(e) Qualified beneficiaries who fail to meet the requirements of
subdivision (b) of Section 10128.54 or subdivision (h) of Section
10128.55 regarding notification of a qualifying event or election of
continuation coverage within the specified time limits.
(f) Except as provided in Section 3001 of ARRA, qualified
beneficiaries who fail to submit the correct premium amount required
by subdivision (b) of Section 10128.55 and Section 10128.57, in
accordance with the terms and conditions of the policy or contract,
or fail to satisfy other terms and conditions of the policy or
contract.
SEC. 7. SEC. 8. Section 10128.55 of
the Insurance Code is amended to read:
10128.55. (a) Every group benefit plan contract between a
disability insurer and an employer subject to this article that is
issued, amended, or renewed on or after July 1, 1998, shall require
the employer to notify the insurer in writing of any employee who has
had a qualifying event, as defined in paragraph (2) of subdivision
(d) of Section 10128.51, within 30 days of the qualifying event. The
group contract shall also require the employer to notify the insurer,
in writing, within 30 days of the date when the employer becomes
subject to Section 4980B of the United States Internal Revenue Code
or Chapter 18 of the Employee Retirement Income Security Act, 29
U.S.C. Sec. 1161 et seq.
(b) Every group benefit plan contract between a disability insurer
and an employer subject to this article that is issued, amended, or
renewed after July 1, 1998, shall require the employer to notify
qualified beneficiaries currently receiving continuation coverage,
whose continuation coverage will terminate under one group benefit
plan prior to the end of the period the qualified beneficiary would
have remained covered, as specified in Section 10128.57, of the
qualified beneficiary's ability to continue coverage under a new
group benefit plan for the balance of the period the qualified
beneficiary would have remained covered under the prior group benefit
plan. This notice shall be provided either 30 days prior to the
termination or when all enrolled employees are notified, whichever is
later.
Every disability insurer shall provide to the employer replacing a
group benefit plan policy issued by the insurer, or to the employer'
s agent or broker representative, within 15 days of any written
request, information in possession of the insurer reasonably required
to administer the notification requirements of this subdivision and
subdivision (c).
(c) Notwithstanding subdivision (a), the group benefit plan
contract between the insurer and the employer shall require the
employer to notify the successor plan in writing of the qualified
beneficiaries currently receiving continuation coverage so that the
successor plan, or contracting employer or administrator, may provide
those qualified beneficiaries with the necessary premium
information, enrollment forms, and instructions consistent with the
disclosure required by subdivision (c) of Section 10128.54 and
subdivision (e) of this section to allow the qualified beneficiary to
continue coverage. This information shall be sent to all qualified
beneficiaries who are enrolled in the group benefit plan and those
qualified beneficiaries who have been notified, pursuant to Section
10128.54 of their ability to continue their coverage and may still
elect coverage within the specified 60-day period. This information
shall be sent to the qualified beneficiary's last known address, as
provided to the employer by the health care service plan or,
disability insurer currently providing continuation coverage to the
qualified beneficiary. The successor insurer shall not be obligated
to provide this information to qualified beneficiaries if the
employer or prior insurer or health care service plan fails to comply
with this section.
(d) A disability insurer may contract with an employer, or an
administrator, to perform the administrative obligations of the plan
as required by this article, including required notifications and
collecting and forwarding premiums to the insurer. Except for the
requirements of subdivisions (a), (b), and (c), this subdivision
shall not be construed to permit an insurer to require an employer to
perform the administrative obligations of the insurer as required by
this article as a condition of the issuance or renewal of coverage.
(e) Every insurer, or employer or administrator that contracts to
perform the notice and administrative services pursuant to this
section, shall, within 14 days of receiving a notice of a qualifying
event, provide to the qualified beneficiary the necessary premium
information, enrollment forms, and disclosures consistent with the
notice requirements contained in subdivisions (b) and (c) of Section
10128.54 to allow the qualified beneficiary to formally elect
continuation coverage. This information shall be sent to the
qualified beneficiary's last known address.
(f) Every insurer, or employer or administrator that contracts to
perform the notice and administrative services pursuant to this
section, shall, during the 180-day period ending on the date that
continuation coverage is terminated pursuant to paragraphs (1), (3),
and (5) of subdivision (a) of Section 10128.57, notify a qualified
beneficiary who has elected continuation coverage pursuant to this
article of the date that his or her coverage will terminate, and
shall notify the qualified beneficiary of any conversion coverage
available to that qualified beneficiary. This requirement shall not
apply when the continuation coverage is terminated because the group
contract between the insurer and the employer is being terminated.
(g) (1) An insurer shall provide to a qualified beneficiary who
has a qualifying event during the period specified in subparagraph
(A) of paragraph (3) of subdivision (a) of Section 3001 of ARRA, a
written notice containing information on the availability of premium
assistance under ARRA. This notice shall be sent to the qualified
beneficiary's last known address. The notice shall include clear and
easily understandable language to inform the qualified beneficiary
that changes in federal law provide a new opportunity to elect
continuation coverage with a 65-percent premium subsidy and shall
include all of the following:
(A) The amount of the premium the person will pay. For qualified
beneficiaries who had a qualifying event between September 1, 2008,
and May 12, 2009, inclusive, if an insurer is unable to provide the
correct premium amount in the notice, the notice may contain the last
known premium amount and an opportunity for the qualified
beneficiary to request, through a toll-free telephone number, the
correct premium that would apply to the beneficiary.
(B) Enrollment forms and any other information required to be
included pursuant to subdivision (e) to allow the qualified
beneficiary to elect continuation coverage. This information shall
not be included in notices sent to qualified beneficiaries currently
enrolled in continuation coverage.
(C) A description of the option to enroll in different coverage as
provided in subparagraph (B) of paragraph (1) of subdivision (a) of
Section 3001 of ARRA. This description shall advise the qualified
beneficiary to contact the covered employee's former employer for
prior approval to choose this option.
(D) The eligibility requirements for premium assistance in the
amount of 65 percent of the premium under Section 3001 of ARRA.
(E) The duration of premium assistance available under ARRA.
(F) A statement that a qualified beneficiary eligible for premium
assistance under ARRA may elect continuation coverage no later than
60 days of the date of the notice.
(G) A statement that a qualified beneficiary eligible for premium
assistance under ARRA who rejected or discontinued continuation
coverage prior to receiving the notice required by this subdivision
has the right to withdraw that rejection and elect continuation
coverage with the premium assistance.
(H) A statement that reads as follows:
"IF YOU ARE HAVING ANY DIFFICULTIES READING OR UNDERSTANDING THIS
NOTICE, PLEASE CONTACT [name of insurer] at [insert appropriate
telephone number]."
(2) With respect to qualified beneficiaries who had a qualifying
event between September 1, 2008, and May 12, 2009, inclusive, the
notice described in this subdivision shall be provided by the later
of May 26, 2009, or seven business days after the date the insurer
receives notice of the qualifying event.
(3) With respect to qualified beneficiaries who had or have a
qualifying event between May 13, 2009, and the later date specified
in subparagraph (A) of paragraph (3) of subdivision (a) of Section
3001 of ARRA, inclusive, the notice described in this subdivision
shall be provided within the period of time specified in subdivision
(e).
(4) Nothing in this section shall be construed to require an
insurer to provide the insurer's evidence of coverage as a part of
the notice required by this subdivision, and nothing in this section
shall be construed to require an insurer to amend its existing
evidence of coverage to comply with the changes made to this section
by the enactment of Assembly Bill 23 of the 2009-10 Regular Session
or by the act amending this section during the second year of the
2009-10 Regular Session.
(5) The requirement under this subdivision to provide a written
notice and under the requirement under
paragraph (1) of subdivision (h) to provide a new opportunity
to elect continuation coverage shall not apply
be deemed satisfied if an insurer previously provided a
written notice and additional election opportunity under Section 3001
of ARRA prior to the effective date of the act adding this
paragraph.
(h) (1) Notwithstanding any other provision of law, a qualified
beneficiary eligible for premium assistance under ARRA may elect
continuation coverage no later than 60 days after the date of the
notice required by subdivision (g).
(2) For a qualified beneficiary who elects to continue coverage
pursuant to paragraph (1) this subdivision
, the period beginning on the date of the qualifying event and
ending on the effective date of the continuation coverage shall be
disregarded for purposes of calculating a break in coverage in
determining whether a preexisting condition provision applies under
subdivision (e) of Section 10198.7 or subdivision (c) of Section
10708.
(3) For a qualified beneficiary who had a qualifying event between
September 1, 2008, and February 16, 2009, inclusive, and who elects
continuation coverage pursuant to paragraph (1), the continuation
coverage shall commence on the first day of the month following the
election.
(4) For a qualified beneficiary who had a qualifying event between
February 17, 2009, and May 12, 2009, inclusive, and who elects
continuation coverage pursuant to paragraph (1), the effective date
of the continuation coverage shall be either of the following, at the
option of the beneficiary, provided that the beneficiary pays the
applicable premiums:
(A) The date of the qualifying event.
(B) The first day of the month following the election.
(5) Notwithstanding any other provision of law, a qualified
beneficiary who is eligible for the special election period described
in paragraph (17) of subdivision (a) of Section 3001 of ARRA may
elect continuation coverage no later than 60 days after the date of
the notice required under subdivision (j). For a qualified
beneficiary who elects coverage pursuant to this paragraph, the
continuation coverage shall be effective as of the first day of the
first period of coverage after the date of termination of employment,
except, if federal law permits, coverage shall take effect on the
first day of the month following the election. However, for purposes
of calculating the duration of
continuation coverage pursuant to Section 10128.57,
the period of that coverage shall be determined as though the
qualifying event was a reduction of hours of the employee.
(6) Notwithstanding any other provision of law, a qualified
beneficiary who is eligible for any other special election period
under ARRA may elect continuation coverage no later than 60 days
after the date of the special election notice required under ARRA.
(i) An insurer shall provide a qualified beneficiary eligible for
premium assistance under ARRA written notice of the extension of that
premium assistance as required under Section 3001 of ARRA.
(j) For qualified beneficiaries who had a qualifying event that
entitles them to the new election period described in paragraph (17)
of subdivision (a) of Section 3001 of ARRA, an insurer, or an
administrator or employer if administrative obligations have been
assumed by those entities pursuant to subdivision (d) of Section
10128.55, shall give those qualified beneficiaries a written notice
regarding the new election period to elect continuation coverage
(j) A health insurer, or an
administrator or employer if administrative obligations have been
assumed by those entities pursuant to subdivision (d), shall give the
qualified beneficiaries described in subparagraph (C) of paragraph
(17) of subdivision (a) of Section 3001 of ARRA the written notice
required by that paragraph by implementing the following
procedures:
(1) The insurer shall, within 14 days of the effective date of the
act adding this subdivision, send a notice to employers currently
contracting with the insurer for a group benefit plan subject to this
article. The notice shall do all of the following:
(A) Advise the employer that employees whose employment is
terminated on or after March 2, 2010, who were previously enrolled in
any group health care service plan or health insurance policy
offered by the employer may be entitled to special health coverage
rights, including a subsidy paid by the federal government for a
portion of the premium.
(B) Ask the employer to provide the insurer with the name,
address, and date of termination of employment for any employee whose
employment is terminated on or after March 2, 2010, and who was at
any time covered by any health care service plan or health insurance
policy offered to their employees on or after September 1, 2008.
(C) Provide employers with a format and instructions for
submitting the information to the insurer, or their administrator or
employer who has assumed administrative obligations pursuant to
subdivision (d) of Section 1366.25 , by telephone,
fax, electronic mail, or mail.
(2) An employer shall provide the information described in
paragraph (1), with respect to any employee whose employment is
terminated on or after March 2, 2010, and who was enrolled at any
time in a health care service plan or health insurance policy offered
by the employer on or after September 1, 2008, to the insurer within
14 days of receipt of the notification under paragraph (1). The
employer shall continue to provide the information to the insurer
within 14 days after the end of each month for any employee whose
employment is terminated in the prior month until the last date
specified in subparagraph (A) of paragraph (3) of subdivision (a) of
Section 3001 of ARRA.
(3)
(2) Within 14 days of receipt of the information
specified in paragraph (2) (1) from the
employer, the insurer shall send the written notice specified in
paragraph (17) of subdivision (a) of Section 3001 of ARRA to those
individuals.
(4) For beneficiaries who qualify, the continuation coverage shall
be retroactive to the date of termination of employment, except, if
federal law permits, coverage shall take effect on the first day of
the month following the election. However, for purposes of
calculating the duration of continuation coverage pursuant to Section
10128.57, the period of that coverage shall be determined as though
the qualifying event was a reduction of hours of the employee.
(3) If an individual contacts his or her health insurer and
indicates that he or she experienced a qualifying event that entitles
him or her to the special election period described in paragraph
(17) of subdivision (a) of Section 3001 of ARRA or any other special
election provision of ARRA, the insurer shall provide the individual
with the notice required under paragraph (17) of subdivision (a) of
Section 3001 of ARRA or any other applicable provision of ARRA,
regardless of whether the insurer receives or received information
from the individual's previous employer regarding that individual
pursuant to Section 24100 of the Health and Safety Code. The insurer
shall review the individual's application for coverage under this
special election notice to determine if the individual qualifies for
the special election period and the premium assistance under ARRA.
The insurer shall comply with paragraph (5) if the individual does
not qualify for either the special election period or premium
assistance under ARRA.
(4) The requirement under this subdivision to provide the written
notice described in paragraph (17) of subdivision (a) of Section 3001
of ARRA and the requirement under paragraph (5) of subdivision (h)
to provide a new opportunity to elect continuation coverage shall be
deemed satisfied if a health insurer previously provided the written
notice and additional election opportunity described in paragraph
(17) of subdivision (a) of Section 3001 of ARRA prior to the
effective date of the act adding this paragraph.
(5) If a person an individual does
not qualify for either the special enrollment election
a special election period or the subsidy under
ARRA, the insurer shall provide a written notice to that
person individual that shall include information
on the right to appeal as set forth in Section 3001 of ARRA.
(6) A health insurer shall provide information on its publicly
accessible Internet Web site regarding the premium assistance made
available under ARRA and any special election period provided under
that law. An insurer may fulfill this requirement by linking or
otherwise directing consumers to the information regarding COBRA
continuation coverage premium assistance located on the Internet Web
site of the United States Department of Labor. The information
required by this paragraph shall be located in a section of the
insurer's Internet Web site that is readily accessible to consumers,
such as the Web site's Frequently Asked Questions section.
(k) Notwithstanding any other provision of law, a qualified
beneficiary eligible for premium assistance under ARRA may elect to
enroll in different coverage subject to the criteria provided under
subparagraph (B) of paragraph (1) of subdivision (a) of Section 3001
of ARRA.
(l) A qualified beneficiary enrolled in continuation coverage as
of February 17, 2009, who is eligible for premium assistance under
ARRA may request application of the premium assistance as of March 1,
2009, or later, consistent with ARRA.
(m) An insurer that receives an election notice from a qualified
beneficiary eligible for premium assistance under ARRA, pursuant to
subdivision (h), shall be considered a person entitled to
reimbursement, as defined in Section 6432(b)(3) of the Internal
Revenue Code, as amended by paragraph (12) of subdivision (a) of
Section 3001 of ARRA.
(n) (1) For purposes of compliance with ARRA, in the absence of
guidance from, or if specifically required for state-only
continuation coverage by, the United States Department of Labor, the
Internal Revenue Service, or the Centers for Medicare and Medicaid
Services, an insurer may request verification of the involuntary
termination of a covered employee's employment from the covered
employee's former employer or the qualified beneficiary seeking
premium assistance under ARRA.
(2) An insurer that requests verification pursuant to paragraph
(1) directly from a covered employee's former employer shall do so by
providing a written notice to the employer. This written notice
shall be sent by mail or facsimile to the covered employee's former
employer within seven business days from the date the insurer
receives the qualified beneficiary's election notice pursuant to
subdivision (h). Within 10 calendar days of receipt of written notice
required by this paragraph, the former employer shall furnish to the
insurer written verification as to whether the covered employee's
employment was involuntarily terminated.
(3) A qualified beneficiary requesting premium assistance under
ARRA may furnish to the insurer a written document or other
information from the covered employee's former employer indicating
that the covered employee's employment was involuntarily terminated.
This document or information shall be deemed sufficient by the
insurer to establish that the covered employee's employment was
involuntarily terminated for purposes of ARRA, unless the insurer
makes a reasonable and timely determination that the documents or
information provided by the qualified beneficiary are legally
insufficient to establish involuntary termination of employment.
(4) If an insurer requests verification pursuant to this
subdivision and cannot verify involuntary termination of employment
within 14 business days from the date the employer receives the
verification request or from the date the insurer receives
documentation or other information from the qualified beneficiary
pursuant to paragraph (3), the insurer shall either provide
continuation coverage with the federal premium assistance to the
qualified beneficiary or send the qualified beneficiary a denial
letter which shall include notice of his or her right to appeal that
determination pursuant to ARRA.
(5) No person shall intentionally delay verification of
involuntary termination of employment under this subdivision.
SEC. 8. SEC. 9. Section 10128.57 of
the Insurance Code is amended to read:
10128.57. (a) The continuation coverage provided pursuant to this
article shall terminate at the first to occur of the following:
(1) In the case of a qualified beneficiary who is eligible for
continuation coverage pursuant to paragraph (2) of subdivision (d) of
Section 10128.51, the date 36 months after the date the qualified
beneficiary's benefits under the contract would otherwise have
terminated because of a qualifying event.
(2) Except as provided in Section 3001 of ARRA, the end of the
period for which premium payments were made, if the qualified
beneficiary ceases to make payments or fails to make timely payments
of a required premium, in accordance with the terms and conditions of
the policy or contract. In the case of nonpayment of premiums,
reinstatement shall be governed by the terms and conditions of the
policy or contract and by Section 3001 of ARRA, if applicable.
(3) In the case of a qualified beneficiary who is eligible to
continuation coverage pursuant to paragraph (1), (3), (4), or (5) of
subdivision (d) of Section 10116.51, the date 36 months after the
date the qualified beneficiary's benefits under the contract would
otherwise have terminated by reason of a qualifying event.
(4) The requirements of this article no longer apply to the
qualified beneficiary pursuant to the provisions of Section 10128.52.
(5) In the case of a qualified beneficiary who is eligible for
continuation coverage pursuant to paragraph (2) of subdivision (d) of
Section 10128.51, and determined, under Title II or Title XVI of the
Social Security Act, to be disabled any time during the first 60
days of continuation coverage, and the spouse or dependent who has
elected coverage pursuant to this article, the date 36 months after
the date the qualified beneficiary's benefits under the contract
would otherwise have terminated because of a qualifying event. The
qualified beneficiary shall notify the insurer, or the employer or
administrator that contracts to perform administrative services, of
the social security determination within 60 days of the date of the
determination letter and prior to the end of the original 36-month
continuation coverage period in order to be eligible for coverage
pursuant to this subdivision. If the qualified beneficiary is no
longer disabled under Title II or Title XVI of the Social Security
Act, the benefits provided in this paragraph shall terminate on the
later of the date provided by paragraph (1), or the month that begins
more than 31 days after the date of the final determination under
Title II or Title XVI of the United States Social Security Act that
the qualified beneficiary is no longer disabled. A qualified
beneficiary eligible for 36 months of continuation coverage as a
result of a disability shall notify the insurer, or the employer or
administrator that contracts to perform the notice and administrative
services, within 30 days of a determination that the qualified
beneficiary is no longer disabled.
(6) In the case of a qualified beneficiary who is initially
eligible for and elects continuation coverage pursuant to paragraph
(2) of subdivision (d) of Section 10128.51, but who has another
qualifying event, as described in paragraph (1), (3), (4), or (5) of
subdivision (d) of Section 10128.51, within 36 months of the date of
the first qualifying event, and has notified the insurer, or employer
or administrator under contract to provide administrative services,
of the second qualifying event within 60 days of the date of the
second qualifying event, the date 36 months after the date of the
first qualifying event.
(7) The employer, or any successor employer or purchaser of the
employer, ceases to provide any group benefit plan to his or her
employees.
(8) The qualified beneficiary moves out of the insurer's service
area, or the qualified beneficiary commits fraud or deception in the
use of benefits.
(b) If the group benefits contracts between the insurer and the
employer is terminated prior to the date the qualified beneficiary's
continuation coverage would terminate pursuant to this section,
coverage under the prior plan shall terminate and the qualified
beneficiary may elect continuation coverage under the subsequent
group benefit plan, if any, pursuant to the requirements of
subdivision (b) of Section 10128.53 and subdivision (c) of Section
10128.54.
(c) The amendments made to this section by Assembly Bill 1401 of
the 2001-02 Regular Session shall apply to individuals who begin
receiving continuation coverage under this article on or after
January 1, 2003.
SEC. 9. Section 2800.4 is added to the Labor
Code, to read:
2800.4. (a) Any employer that provides a group health plan as
defined in Cal-COBRA, to its employees shall provide the information
required under subdivision (j) of Section 1366.25 of the Health and
Safety Code and subdivision (j) of Section 10128.55 of the Insurance
Code regarding its former employees to the requesting health care
service plan or health insurer.
(b) For purposes of this section, "Cal-COBRA" means Article 4.5
(commencing with Section 1366.20) of Chapter 2.2 of Division 2 of the
Health and Safety Code and Article 1.7 (commencing with Section
10128.50) of Chapter 1 of Part 2 of Division 2 of the Insurance Code.
SEC. 10. It is the intent of the Legislature to enact legislation
that would implement federal legislation that is enacted and that
makes changes to the premium assistance made available under the
federal American Recovery and Reinvestment Act of 2009.
SEC. 11. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.
SEC. 12. This act is an urgency statute necessary for the
immediate preservation of the public peace, health, or safety within
the meaning of Article IV of the Constitution and shall go into
immediate effect. The facts constituting the necessity are:
In order to make federal funds available at the earliest possible
time to address the state's pressing need for federally subsidized
health care coverage premiums for individuals who have lost group
health care coverage due to a qualifying event and may be eligible
for state continuation coverage under Cal-COBRA and in order to help
carry out the powers of the Department of Insurance and the
Department of Managed Health Care to protect the interests of the
public and carry out the intent of the Legislature to encourage the
availability of health care coverage to the public without gaps in
coverage when possible, it is necessary that this act take effect
immediately.