CONTINUATION COVERAGE EXTENSION NOTICE
California Extension of COBRA Eligibility Period
A California law, Assembly Bill 1401, requires that an extension of the COBRA eligibility period to 36 months from the original date be provided to individuals who exhaust their federal COBRA eligibility period, normally 18 months or, in the case of an individual certified by the Social Security Administration as disabled, 29 months. To be eligible for this extension your federal COBRA coverage must have started on or after January 1, 2003.
Premiums
An eligible beneficiary electing extended coverage will be required to pay on or before the due date on a monthly basis, 110% of the applicable rate charged to a similarly situated individual who is an active employee covered by the group plan. In the case of a qualified beneficiary, who is determined to be disabled, pursuant to Title II or Title XVI of the United States Social Security Act, an amount not greater than 150% of the group rate for a similarly situated active employee covered by the group plan.
Extended Eligibility Period
You are eligible for the extended coverage until:
You fail to pay the required monthly premiums on a timely basis;
You become covered by another group health plan, even if the coverage provided is less favorable than your current coverage;
You become entitled to Medicare;
Your former employer ceases to maintain any group health plan(s);
The date 36 months after the date your group benefits would have terminated as the result of your original qualifying event;
If your extended coverage is the result of a disability, the later of the date that is 36 months after the date your coverage would have terminated, because of your original qualifying event, 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. You are required to notify us within 30 days of the date that you are no longer disabled.
COBRA coverage is provided subject to your eligibility. The Plan Administrator may terminate your COBRA coverage retroactively if you are determined to be ineligible for coverage. Please advise us of any change in address promptly.
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