If you lose your coverage through your employer group, you may eligible to continue your benefits through COBRA. Under the Consolidated Omnibus Budget Reconciliation Act of 1985 (the federal law usually known simply as “COBRA”) if you lose your coverage under the Western Health Advantage medical plan due to certain “Qualifying Events” you or your spouse or dependent children may be to entitled to elect to continuation coverage at your own expense. Examples of Qualifying Events include divorce, reduction of work hours or termination other than for gross misconduct.
Not everyone is entitled to elect COBRA continuation coverage. In general, COBRA benefits are only available for those covered by a group health plan maintained by an employer with 20 or more employees. However, California has enacted a separate law known as the California Continuation Replacement Act, or “Cal-COBRA” that may give you an additional right to elect continuation coverage. Under Cal-COBRA, you may entitled to elect continuation coverage if you are covered by a small employer (2-19 employees) group health plan and are ineligible to elect federal COBRA coverage. The same Qualifying Events as under COBRA are applicable under Cal-COBRA that entitle you or your spouse or your dependent children to elect continuation coverage at your own expense.
Under both COBRA and Cal-COBRA, all benefits you receive under continuation coverage are the same as the benefits available to active eligible employees and their eligible dependents. Your employer can confirm your eligibility for COBRA or Cal-COBRA continuation coverage. (Individuals who move out of the Western Health Advantage service area are not eligible for COBRA or Cal-COBRA continuation coverage.)
Should you have any questions, please contact our enrollment department at 916.563.2206 or 888.442.2206 toll-free.
Note: The American Rescue Plan Act of 2021 (ARPA) provides temporary premium assistance for continuation of coverage and, where an employer elects to offer another option, an opportunity to choose a different health plan. This premium assistance is available from April 1, 2021 through September 30, 2021. To determine if you are eligible for premium assistance, please contact your employer.