BILL NUMBER: SB 503 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JULY 16, 2015
AMENDED IN SENATE MAY 5, 2015
AMENDED IN SENATE APRIL 20, 2015
INTRODUCED BY Senator Hernandez
FEBRUARY 26, 2015
An act to amend Sections 1366.22, 1366.25,
1366.22 and 24100 of, and to amend, repeal, and add
Section Sections 1366.24 and 1366.25
of, the Health and Safety Code, and to amend Sections
Section 10128.52 and 10128.55
of, and to amend, repeal, and add Section
Sections 10128.54 and 10128.55 of, the Insurance
Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 503, as amended, Hernandez. Cal-COBRA: disclosures.
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 the 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 coverage under a
group benefit plan to employers of 2 to 19 eligible employees to
offer a continuation of that coverage for a specified period of time
to certain qualified beneficiaries, as specified. Existing law
requires a group benefit plan that is subject to Cal-COBRA to make
specified disclosures to covered employees, including that a covered
employee who is considering declining continuation of coverage should
be aware that companies selling individual health insurance may
require a review of the employee's medical history that could result
in a higher premium or denial of coverage.
This bill would eliminate the disclosure requirement described
above. If federal law requiring an individual to maintain minimum
health coverage is repealed or amended to no longer apply to the
individual market, as specified, the bill would reenact that
disclosure requirement to become operative 12 months after that
repeal or amendment. The bill would also, under those same
conditions, require a contract between a group benefit plan that is
subject to Cal-COBRA and an employer to require the employer to make
the same disclosure to a qualified beneficiary in connection with a
notice regarding election of continuation coverage. The bill
would require a group benefit plan that is subject to Cal-COBRA and
that issues, amends, or renews a disclosure on or after July 1, 2016,
to include a notice regarding additional health care coverage
options in that disclosure, as specified. The bill would require a
group contract that is issued, amended, or renewed on or after July
1, 2016, between a group benefit plan that is subject to Cal-COBRA
and an employer to require the employer to give that notice regarding
additional health care coverage options to a qualified beneficiary
of the contract. contract in connection with
a notice regarding election of continuation coverage. The bill
would make conforming changes to related provisions.
Because a willful violation of the bill's requirements relative to
health care service plans would be a crime, this 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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1366.22 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. Sec. 116 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. Sec. 300bb-1 et seq.).
(e) Qualified beneficiaries who fail to meet the requirements of
subdivision (b) of Section 1366.24 or subdivision (i) 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. 2. Section 1366.24 of the Health and Safety Code is amended
to read:
1366.24. (a) Every health care service plan evidence of coverage,
provided for group benefit plans subject to this article, that is
issued, amended, or renewed on or after January 1, 1999, shall
disclose to covered employees of group benefit plans subject to this
article the ability to continue coverage pursuant to this article, as
required by this section.
(b) This disclosure shall state that all enrollees who are
eligible to be qualified beneficiaries, as defined in subdivision (c)
of Section 1366.21, shall be required, as a condition of receiving
benefits pursuant to this article, to notify, in writing, the health
care service plan, or the employer if the employer contracts to
perform the administrative services as provided for in Section
1366.25, of all qualifying events as specified in paragraphs (1),
(3), (4), and (5) of subdivision (d) of Section 1366.21 within 60
days of the date of the qualifying event. This disclosure shall
inform enrollees that failure to make the notification to the health
care service plan, or to the employer when under contract to provide
the administrative services, within the required 60 days will
disqualify the qualified beneficiary from receiving continuation
coverage pursuant to this article. The disclosure shall further state
that a qualified beneficiary who wishes to continue coverage under
the group benefit plan pursuant to this article shall request the
continuation in writing and deliver the written request, by
first-class mail, or other reliable means of delivery, including
personal delivery, express mail, or private courier company, to the
health care service plan, or to the employer if the plan has
contracted with the employer for administrative services pursuant to
subdivision (d) of Section 1366.25, within the 60-day period
following the later of (1) the date that the enrollee's coverage
under the group benefit plan terminated or will terminate by reason
of a qualifying event, or (2) the date the enrollee was sent notice
pursuant to subdivision (e) of Section 1366.25 of the ability to
continue coverage under the group benefit plan. The disclosure
required by this section shall also state that a qualified
beneficiary electing continuation shall pay to the health care
service plan, in accordance with the terms and conditions of the plan
contract, which shall be set forth in the notice to the qualified
beneficiary pursuant to subdivision (d) of Section 1366.25, the
amount of the required premium payment, as set forth in Section
1366.26. The disclosure shall further require that the qualified
beneficiary's first premium payment required to establish premium
payment be delivered by first-class mail, certified mail, or other
reliable means of delivery, including personal delivery, express
mail, or private courier company, to the health care service plan, or
to the employer if the employer has contracted with the plan to
perform the administrative services pursuant to subdivision (d) of
Section 1366.25, within 45 days of the date the qualified beneficiary
provided written notice to the health care service plan or the
employer, if the employer has contracted to perform the
administrative services, of the election to continue coverage in
order for coverage to be continued under this article. This
disclosure shall also state that the first premium payment shall
equal an amount sufficient to pay any required premiums and all
premiums due, and that failure to submit the correct premium amount
within the 45-day period will disqualify the qualified beneficiary
from receiving continuation coverage pursuant to this article.
(c) The disclosure required by this section shall also describe
separately how qualified beneficiaries whose continuation coverage
terminates under a prior group benefit plan pursuant to subdivision
(b) of Section 1366.27 may continue their coverage for the balance of
the period that the qualified beneficiary would have remained
covered under the prior group benefit plan, including the
requirements for election and payment. The disclosure shall clearly
state that continuation coverage shall terminate if the qualified
beneficiary fails to comply with the requirements pertaining to
enrollment in, and payment of premiums to, the new group benefit plan
within 30 days of receiving notice of the termination of the prior
group benefit plan.
(d) Prior to August 1, 1998, every health care service plan shall
provide to all covered employees of employers subject to this article
a written notice containing the disclosures required by this
section, or shall provide to all covered employees of employers
subject to this section a new or amended evidence of coverage that
includes the disclosures required by this section. Any specialized
health care service plan that, in the ordinary course of business,
maintains only the addresses of employer group purchasers of benefits
and does not maintain addresses of covered employees, may comply
with the notice requirements of this section through the provision of
the notices to its employer group purchasers of benefits.
(e) Every plan disclosure form issued, amended, or renewed on and
after January 1, 1999, for a group benefit plan subject to this
article shall provide a notice that, under state law, an enrollee may
be entitled to continuation of group coverage and that additional
information regarding eligibility for this coverage may be found in
the plan's evidence of coverage.
(f) A disclosure issued, amended, or renewed on or after July 1,
2016, for a group benefit plan subject to this article shall include
the following notice:
"In notice:
"In addition to your coverage continuation options, you
may be eligible for the following:
1. Coverage through the state health insurance marketplace, also
known as Covered California. By enrolling through Covered California,
you may qualify for lower monthly premiums and lower out-of-pocket
costs. Your family members may also qualify for coverage through
Covered California.
2. Coverage through Medi-Cal. Depending on your income, you may
qualify for low or no-cost coverage through Medi-Cal. Your family
members may also qualify for Medi-Cal.
3. Coverage through an insured spouse. If your spouse has coverage
that extends to family members, you may be able to be added on that
benefit plan.
Be aware that there is a deadline to enroll in Covered California,
although you can apply for Medi-Cal at anytime. To find out more
about how to apply for Covered California and Medi-Cal, visit the
Covered California Internet Web site at
http://www.coveredca.com."
(g) http://www.coveredca.com."
(g) (1) If Section 5000A of the Internal Revenue Code,
as added by Section 1501 of PPACA, is repealed or amended to no
longer apply to the individual market, as defined in Section 2791 of
the federal Public Health Service Act (42 U.S.C. Sec. 300gg-91), this
section shall become inoperative and is repealed 12 months after the
date of that repeal or amendment.
(2) For purposes of this subdivision, "PPACA" means the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152), and any rules, regulations, or guidance
issued pursuant to that law.
SEC. 3. Section 1366.24 is added to the Health and Safety Code, to
read:
1366.24. (a) Every health care service plan evidence of coverage,
provided for group benefit plans subject to this article, that is
issued, amended, or renewed on or after January 1, 1999, shall
disclose to covered employees of group benefit plans subject to this
article the ability to continue coverage pursuant to this article, as
required by this section.
(b) This disclosure shall state that all enrollees who are
eligible to be qualified beneficiaries, as defined in subdivision (c)
of Section 1366.21, shall be required, as a condition of receiving
benefits pursuant to this article, to notify, in writing, the health
care service plan, or the employer if the employer contracts to
perform the administrative services as provided for in Section
1366.25, of all qualifying events as specified in paragraphs (1),
(3), (4), and (5) of subdivision (d) of Section 1366.21 within 60
days of the date of the qualifying event. This disclosure shall
inform enrollees that failure to make the notification to the health
care service plan, or to the employer when under contract to provide
the administrative services, within the required 60 days will
disqualify the qualified beneficiary from receiving continuation
coverage pursuant to this article. The disclosure shall further state
that a qualified beneficiary who wishes to continue coverage under
the group benefit plan pursuant to this article must request the
continuation in writing and deliver the written request, by
first-class mail, or other reliable means of delivery, including
personal delivery, express mail, or private courier company, to the
health care service plan, or to the employer if the plan has
contracted with the employer for administrative services pursuant to
subdivision (d) of Section 1366.25, within the 60-day period
following the later of (1) the date that the enrollee's coverage
under the group benefit plan terminated or will terminate by reason
of a qualifying event, or (2) the date the enrollee was sent notice
pursuant to subdivision (e) of Section 1366.25 of the ability to
continue coverage under the group benefit plan. The disclosure
required by this section shall also state that a qualified
beneficiary electing continuation shall pay to the health care
service plan, in accordance with the terms and conditions of the plan
contract, which shall be set forth in the notice to the qualified
beneficiary pursuant to subdivision (d) of Section 1366.25, the
amount of the required premium payment, as set forth in Section
1366.26. The disclosure shall further require that the qualified
beneficiary's first premium payment required to establish premium
payment be delivered by first-class mail, certified mail, or other
reliable means of delivery, including personal delivery, express
mail, or private courier company, to the health care service plan, or
to the employer if the employer has contracted with the plan to
perform the administrative services pursuant to subdivision (d) of
Section 1366.25, within 45 days of the date the qualified beneficiary
provided written notice to the health care service plan or the
employer, if the employer has contracted to perform the
administrative services, of the election to continue coverage in
order for coverage to be continued under this article. This
disclosure shall also state that the first premium payment must equal
an amount sufficient to pay any required premiums and all premiums
due, and that failure to submit the correct premium amount within the
45-day period will disqualify the qualified beneficiary from
receiving continuation coverage pursuant to this article.
(c) The disclosure required by this section shall also describe
separately how qualified beneficiaries whose continuation coverage
terminates under a prior group benefit plan pursuant to subdivision
(b) of Section 1366.27 may continue their coverage for the balance of
the period that the qualified beneficiary would have remained
covered under the prior group benefit plan, including the
requirements for election and payment. The disclosure shall clearly
state that continuation coverage shall terminate if the qualified
beneficiary fails to comply with the requirements pertaining to
enrollment in, and payment of premiums to, the new group benefit plan
within 30 days of receiving notice of the termination of the prior
group benefit plan.
(d) Prior to August 1, 1998, every health care service plan shall
provide to all covered employees of employers subject to this article
a written notice containing the disclosures required by this
section, or shall provide to all covered employees of employers
subject to this section a new or amended evidence of coverage that
includes the disclosures required by this section. Any specialized
health care service plan that, in the ordinary course of business,
maintains only the addresses of employer group purchasers of benefits
and does not maintain addresses of covered employees, may comply
with the notice requirements of this section through the provision of
the notices to its employer group purchasers of benefits.
(e) Every plan disclosure form issued, amended, or renewed on or
after January 1, 1999, for a group benefit plan subject to this
article shall provide a notice that, under state law, an enrollee may
be entitled to continuation of group coverage and that additional
information regarding eligibility for this coverage may be found in
the plan's evidence of coverage.
(f) Every disclosure issued, amended, or renewed on or after the
operative date of this section for a group benefit plan subject to
this article shall include the following notice:
"Please notice:
"Please examine your options carefully before declining
this coverage. You should be aware that companies selling individual
health insurance typically require a review of your medical history
that could result in a higher premium or you could be denied coverage
entirely."
(g) entirely."
(g) A disclosure issued, amended, or renewed on or
after July 1, 2016, for a group benefit plan subject to this article
shall include the following notice:
"In notice:
"In addition to your coverage continuation options, you
may be eligible for the following:
1. Coverage through the state health insurance marketplace, also
known as Covered California. By enrolling through Covered California,
you may qualify for lower monthly premiums and lower out-of-pocket
costs. Your family members may also qualify for coverage through
Covered California.
2. Coverage through Medi-Cal. Depending on your income, you may
qualify for low or no-cost coverage through Medi-Cal. Your family
members may also qualify for Medi-Cal.
3. Coverage through an insured spouse. If your spouse has coverage
that extends to family members, you may be able to be added on that
benefit plan.
Be aware that there is a deadline to enroll in Covered California,
although you can apply for Medi-Cal anytime. To find out more about
how to apply for Covered California and Medi-Cal, visit the Covered
California Internet Web site at http://www.coveredca.com."
(h) http://www.coveredca.com."
(h) (1) If Section 5000A of the Internal Revenue Code,
as added by Section 1501 of PPACA, is repealed or amended to no
longer apply to the individual market, as defined in Section 2791 of
the federal Public Health Service Act (42 U.S.C. Sec. 300gg-91), this
section shall become operative 12 months after the date of that
repeal or amendment.
(2) For purposes of this subdivision, "PPACA" means the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152), and any rules, regulations, or guidance
issued pursuant to that law.
SEC. 4. 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 to a qualified beneficiary and the requirement under paragraph
(1) of subdivision (i) to provide a new opportunity to a qualified
beneficiary to elect continuation coverage shall be deemed satisfied
if a health care service plan previously provided a written notice
and additional election opportunity under Section 3001 of ARRA to
that qualified beneficiary prior to the effective date of the act
adding this paragraph.
(h) A group contract
between a group benefit plan and an employer subject to this article
that is issued, amended, or renewed on or after July 1, 2016, shall
require the employer to give the following notice to a qualified
beneficiary:
"In beneficiary in connection with a
notice regarding election of continuation coverage:
"In addition to your coverage continuation options, you
may be eligible for the following:
1. Coverage through the state health insurance marketplace, also
known as Covered California. By enrolling through Covered California,
you may qualify for lower monthly premiums and lower out-of-pocket
costs. Your family members may also qualify for coverage through
Covered California.
2. Coverage through Medi-Cal. Depending on your income, you may
qualify for low or no-cost coverage through Medi-Cal. Your family
members may also qualify for Medi-Cal.
3. Coverage through an insured spouse. If your spouse has coverage
that extends to family members, you may be able to be added on that
benefit plan.
Be aware that there is a deadline to enroll in Covered California,
although you can apply for Medi-Cal anytime. To find out more about
how to apply for Covered California and Medi-Cal, visit the Covered
California Internet Web site at http://www.coveredca.com."
(i) http://www.coveredca.com."
(i) (1) Notwithstanding any other 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 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 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 (k). 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 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.
(j) 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.
(k) 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), by telephone, fax, electronic mail, or
mail.
(2) Within 14 days of receipt of the information specified in
paragraph (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.
(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 to a qualified beneficiary and the requirement under
paragraph (5) of subdivision (i) to provide a new opportunity to a
qualified beneficiary 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 to that
qualified beneficiary prior to the effective date of the act adding
this paragraph.
(5) If an individual does not qualify for either a special
election period or the premium assistance under ARRA, the health care
service plan shall provide a written notice to that 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.
(l) 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).
(m) Notwithstanding any other 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.
(n) 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.
(o) A health care service plan that receives an election notice
from a qualified beneficiary eligible for premium assistance under
ARRA, pursuant to subdivision (i), 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.
(p) (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 (i). 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.
(q) 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.
(r) (1) If Section 5000A of the Internal Revenue Code, as added by
Section 1501 of PPACA, is repealed or amended to no longer apply to
the individual market, as defined in Section 2791 of the federal
Public Health Service Act (42 U.S.C. Sec. 300gg-91), this section
shall become inoperative and is repealed 12 months after the date of
that repeal or amendment.
(2) For purposes of this subdivision, "PPACA" means the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152), and any rules, regulations, or guidance
issued pursuant to that law.
SEC. 5. Section 1366.25 is added to the
Health and Safety Code , 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 to a qualified beneficiary and the requirement under paragraph
(1) of subdivision (k) to provide a new opportunity to a qualified
beneficiary to elect continuation coverage shall be deemed satisfied
if a health care service plan previously provided a written notice
and additional election opportunity under Section 3001 of ARRA to
that qualified beneficiary prior to the effective date of the act
adding this paragraph.
(h) A group contract between a group benefit plan and an employer
subject to this article that is issued, amended, or renewed on or
after the operative date of this section shall require the employer
to give the following notice to a qualified beneficiary in connection
with a notice regarding election of continuation coverage:
"Please examine your options carefully before declining this
coverage. You should be aware that companies selling individual
health insurance typically require a review of your medical history
that could result in a higher premium or you could be denied coverage
entirely."
(i) A group contract between a group benefit plan and an employer
subject to this article that is issued, amended, or renewed on or
after July 1, 2016, shall require the employer to give the following
notice to a qualified beneficiary in connection with a notice
regarding election of continuation coverage:
"In addition to your coverage continuation options, you may be
eligible for the following:
1. Coverage through the state health insurance marketplace, also
known as Covered California. By enrolling through Covered California,
you may qualify for lower monthly premiums and lower out-of-pocket
costs. Your family members may also qualify for coverage through
Covered California.
2. Coverage through Medi-Cal. Depending on your income, you may
qualify for low or no-cost coverage through Medi-Cal. Your family
members may also qualify for Medi-Cal.
3. Coverage through an insured spouse. If your spouse has coverage
that extends to family members, you may be able to be added on that
benefit plan.
Be aware that there is a deadline to enroll in Covered California,
although you can apply for Medi-Cal anytime. To find out more about
how to apply for Covered California and Medi-Cal, visit the Covered
California Internet Web site at http://www.coveredca.com."
(j) (1) Notwithstanding any other 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 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 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 (l). 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 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.
(k) 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.
(l) 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), by telephone, fax, electronic mail, or
mail.
(2) Within 14 days of receipt of the information specified in
paragraph (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.
(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 to a qualified beneficiary and the requirement under
paragraph (5) of subdivision (j) to provide a new opportunity to a
qualified beneficiary 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 to that
qualified beneficiary prior to the effective date of the act adding
this paragraph.
(5) If an individual does not qualify for either a special
election period or the premium assistance under ARRA, the health care
service plan shall provide a written notice to that 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.
(m) 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).
(n) Notwithstanding any other 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.
(o) 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.
(p) A health care service plan that receives an election notice
from a qualified beneficiary eligible for premium assistance under
ARRA, pursuant to subdivision (j), 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.
(q) (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 (j). 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.
(r) 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.
(s) (1) If Section 5000A of the Internal Revenue Code, as added by
Section 1501 of PPACA, is repealed or amended to no longer apply to
the individual market, as defined in Section 2791 of the federal
Public Health Service Act (42 U.S.C. Sec. 300gg-91), this section
shall become operative 12 months after the date of that repeal or
amendment.
(2) For purposes of this subdivision, "PPACA" means the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152), and any rules, regulations, or guidance
issued pursuant to that law.
SEC. 5. SEC. 6. Section 24100 of the
Health and Safety Code is amended to read:
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 (k) of Section
1366.25 of this code or subparagraph (B) of paragraph (1) of
subdivision (k) 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 (k) of Section 1366.25 of
this code or paragraph (1) of subdivision (k) 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. 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. Sec. 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. Sec. 300bb-1 et seq.).
(e) Qualified beneficiaries who fail to meet the requirements of
subdivision (b) of Section 10128.54 or subdivision (i) 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 10128.54 of
the Insurance Code is amended to read:
10128.54. (a) Every insurer's evidence of coverage for group
benefit plans subject to this article, that is issued, amended, or
renewed on or after January 1, 1999, shall disclose to covered
employees of group benefit plans subject to this article the ability
to continue coverage pursuant to this article, as required by this
section.
(b) This disclosure shall state that all insureds who are eligible
to be qualified beneficiaries, as defined in subdivision (c) of
Section 10128.51, shall be required, as a condition of receiving
benefits pursuant to this article, to notify, in writing, the
insurer, or the employer if the employer contracts to perform the
administrative services as provided for in Section 10128.55, of all
qualifying events as specified in paragraphs (1), (3), (4), and (5)
of subdivision (d) of Section 10128.51 within 60 days of the date of
the qualifying event. This disclosure shall inform insureds that
failure to make the notification to the insurer, or to the employer
when under contract to provide the administrative services, within
the required 60 days will disqualify the qualified beneficiary from
receiving continuation coverage pursuant to this article. The
disclosure shall further state that a qualified beneficiary who
wishes to continue coverage under the group benefit plan pursuant to
this article shall request the continuation in writing and deliver
the written request, by first-class mail, or other reliable means of
delivery, including personal delivery, express mail, or private
courier company, to the disability insurer, or to the employer if the
plan has contracted with the employer for administrative services
pursuant to subdivision (d) of Section 10128.55, within the 60-day
period following the later of (1) the date that the insured's
coverage under the group benefit plan terminated or will terminate by
reason of a qualifying event, or (2) the date the insured was sent
notice pursuant to subdivision (e) of Section 10128.55 of the ability
to continue coverage under the group benefit plan. The disclosure
required by this section shall also state that a qualified
beneficiary electing continuation shall pay to the disability
insurer, in accordance with the terms and conditions of the policy or
contract, which shall be set forth in the notice to the qualified
beneficiary pursuant to subdivision (d) of Section 10128.55, the
amount of the required premium payment, as set forth in Section
10128.56. The disclosure shall further require that the qualified
beneficiary's first premium payment required to establish premium
payment be delivered by first-class mail, certified mail, or other
reliable means of delivery, including personal delivery, express
mail, or private courier company, to the disability insurer, or to
the employer if the employer has contracted with the insurer to
perform the administrative services pursuant to subdivision (d) of
Section 10128.55, within 45 days of the date the qualified
beneficiary provided written notice to the insurer or the employer,
if the employer has contracted to perform the administrative
services, of the election to continue coverage in order for coverage
to be continued under this article. This disclosure shall also state
that the first premium payment shall equal an amount sufficient to
pay all required premiums and all premiums due, and that failure to
submit the correct premium amount within the 45-day period will
disqualify the qualified beneficiary from receiving continuation
coverage pursuant to this article.
(c) The disclosure required by this section shall also describe
separately how qualified beneficiaries whose continuation coverage
terminates under a prior group benefit plan pursuant to Section
10128.57 may continue their coverage for the balance of the period
that the qualified beneficiary would have remained covered under the
prior group benefit plan, including the requirements for election and
payment. The disclosure shall clearly state that continuation
coverage shall terminate if the qualified beneficiary fails to comply
with the requirements pertaining to enrollment in, and payment of
premiums to, the new group benefit plan within 30 days of receiving
notice of the termination of the prior group benefit plan.
(d) Prior to August 1, 1998, every insurer shall provide to all
covered employees of employers subject to this article written notice
containing the disclosures required by this section, or shall
provide to all covered employees of employers subject to this article
a new or amended evidence of coverage that includes the disclosures
required by this section. Any insurer that, in the ordinary course of
business, maintains only the addresses of employer group purchasers
of benefits, and does not maintain addresses of covered employees,
may comply with the notice requirements of this section through the
provision of the notices to its employer group purchases of benefits.
(e) Every disclosure form issued, amended, or renewed on and after
January 1, 1999, for a group benefit plan subject to this article
shall provide a notice that, under state law, an insured may be
entitled to continuation of group coverage and that additional
information regarding eligibility for this coverage may be found in
the evidence of coverage.
(f) A disclosure issued, amended, or renewed on or after July 1,
2016, for a group benefit plan subject to this article shall include
the following notice:
"In notice:
"In addition to your coverage continuation options, you
may be eligible for the following:
1. Coverage through the state health insurance marketplace, also
known as Covered California. By enrolling through Covered California,
you may qualify for lower monthly premiums and lower out-of-pocket
costs. Your family members may also qualify for coverage through
Covered California.
2. Coverage through Medi-Cal. Depending on your income, you may
qualify for low or no-cost coverage through Medi-Cal. Your family
members may also qualify for Medi-Cal.
3. Coverage through an insured spouse. If your spouse has coverage
that extends to family members, you may be able to be added on that
benefit plan.
Be aware that there is a deadline to enroll in Covered California,
although you can apply for Medi-Cal at anytime. To find out more
about how to apply for Covered California and Medi-Cal, visit the
Covered California Internet Web site at
http://www.coveredca.com."
(g) http://www.coveredca.com."
(g) (1) If Section 5000A of the Internal Revenue Code,
as added by Section 1501 of PPACA, is repealed or amended to no
longer apply to the individual market, as defined in Section 2791 of
the federal Public Health Service Act (42 U.S.C. Sec. 300gg-91), this
section shall become inoperative and is repealed 12 months after the
date of that repeal or amendment.
(2) For purposes of this subdivision, "PPACA" means the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152), and any rules, regulations, or guidance
issued pursuant to that law.
SEC. 8. SEC. 9. Section 10128.54 is
added to the Insurance Code, to read:
10128.54. (a) Every insurer's evidence of coverage for group
benefit plans subject to this article, that is issued, amended, or
renewed on or after January 1, 1999, shall disclose to covered
employees of group benefit plans subject to this article the ability
to continue coverage pursuant to this article, as required by this
section.
(b) This disclosure shall state that all insureds who are eligible
to be qualified beneficiaries, as defined in subdivision (c) of
Section 10128.51, shall be required, as a condition of receiving
benefits pursuant to this article, to notify, in writing, the
insurer, or the employer if the employer contracts to perform the
administrative services as provided for in Section 10128.55, of all
qualifying events as specified in paragraphs (1), (3), (4), and (5)
of subdivision (d) of Section 10128.51 within 60 days of the date of
the qualifying event. This disclosure shall inform insureds that
failure to make the notification to the insurer, or to the employer
when under contract to provide the administrative services, within
the required 60 days will disqualify the qualified beneficiary from
receiving continuation coverage pursuant to this article. The
disclosure shall further state that a qualified beneficiary who
wishes to continue coverage under the group benefit plan pursuant to
this article must request the continuation in writing and deliver the
written request, by first-class mail, or other reliable means of
delivery, including personal delivery, express mail, or private
courier company, to the disability insurer, or to the employer if the
plan has contracted with the employer for administrative services
pursuant to subdivision (d) of Section 10128.55, within the 60-day
period following the later of (1) the date that the insured's
coverage under the group benefit plan terminated or will terminate by
reason of a qualifying event, or (2) the date the insured was sent
notice pursuant to
subdivision (e) of Section 10128.55 of the ability to continue
coverage under the group benefit plan. The disclosure required by
this section shall also state that a qualified beneficiary electing
continuation shall pay to the disability insurer, in accordance with
the terms and conditions of the policy or contract, which shall be
set forth in the notice to the qualified beneficiary pursuant to
subdivision (d) of Section 10128.55, the amount of the required
premium payment, as set forth in Section 10128.56. The disclosure
shall further require that the qualified beneficiary's first premium
payment required to establish premium payment be delivered by
first-class mail, certified mail, or other reliable means of
delivery, including personal delivery, express mail, or private
courier company, to the disability insurer, or to the employer if the
employer has contracted with the insurer to perform the
administrative services pursuant to subdivision (d) of Section
10128.55, within 45 days of the date the qualified beneficiary
provided written notice to the insurer or the employer, if the
employer has contracted to perform the administrative services, of
the election to continue coverage in order for coverage to be
continued under this article. This disclosure shall also state that
the first premium payment must equal an amount sufficient to pay all
required premiums and all premiums due, and that failure to submit
the correct premium amount within the 45-day period will disqualify
the qualified beneficiary from receiving continuation coverage
pursuant to this article.
(c) The disclosure required by this section shall also describe
separately how qualified beneficiaries whose continuation coverage
terminates under a prior group benefit plan pursuant to Section
10128.57 may continue their coverage for the balance of the period
that the qualified beneficiary would have remained covered under the
prior group benefit plan, including the requirements for election and
payment. The disclosure shall clearly state that continuation
coverage shall terminate if the qualified beneficiary fails to comply
with the requirements pertaining to enrollment in, and payment of
premiums to, the new group benefit plan within 30 days of receiving
notice of the termination of the prior group benefit plan.
(d) Prior to August 1, 1998, every insurer shall provide to all
covered employees of employers subject to this article written notice
containing the disclosures required by this section, or shall
provide to all covered employees of employers subject to this article
a new or amended evidence of coverage that includes the disclosures
required by this section. Any insurer that, in the ordinary course of
business, maintains only the addresses of employer group purchasers
of benefits, and does not maintain addresses of covered employees,
may comply with the notice requirements of this section through the
provision of the notices to its employer group purchases of benefits.
(e) Every disclosure form issued, amended, or renewed on or after
January 1, 1999, for a group benefit plan subject to this article
shall provide a notice that, under state law, an insured may be
entitled to continuation of group coverage and that additional
information regarding eligibility for this coverage may be found in
the evidence of coverage.
(f) Every disclosure issued, amended, or renewed on or after the
operative date of this section for a group benefit plan subject to
this article shall include the following notice:
"Please notice:
"Please examine your options carefully before declining
this coverage. You should be aware that companies selling individual
health insurance typically require a review of your medical history
that could result in a higher premium or you could be denied coverage
entirely."
(g) entirely."
(g) A disclosure issued, amended, or renewed on or
after July 1, 2016, for a group benefit plan subject to this article
shall include the following notice:
"In notice:
"In addition to your coverage continuation options, you
may be eligible for the following:
1. Coverage through the state health insurance marketplace, also
known as Covered California. By enrolling through Covered California,
you may qualify for lower monthly premiums and lower out-of-pocket
costs. Your family members may also qualify for coverage through
Covered California.
2. Coverage through Medi-Cal. Depending on your income, you may
qualify for low or no-cost coverage through Medi-Cal. Your family
members may also qualify for Medi-Cal.
3. Coverage through an insured spouse. If your spouse has coverage
that extends to family members, you may be able to be added on that
benefit plan.
Be aware that there is a deadline to enroll in Covered California,
although you can apply for Medi-Cal anytime. To find out more about
how to apply for Covered California and Medi-Cal, visit the Covered
California Internet Web site at http://www.coveredca.com."
(h) http://www.coveredca.com."
(h) (1) If Section 5000A of the Internal Revenue Code,
as added by Section 1501 of PPACA, is repealed or amended to no
longer apply to the individual market, as defined in Section 2791 of
the federal Public Health Service Act (42 U.S.C. Sec. 300gg-91), this
section shall become operative 12 months after the date of that
repeal or amendment.
(2) For purposes of this subdivision, "PPACA" means the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152), and any rules, regulations, or guidance
issued pursuant to that law.
SEC. 9. SEC. 10. 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 to a qualified beneficiary and the requirement under paragraph
(1) of subdivision (i) to provide a new opportunity to a qualified
beneficiary to elect continuation coverage shall be deemed satisfied
if an insurer previously provided a written notice and additional
election opportunity under Section 3001 of ARRA to that qualified
beneficiary prior to the effective date of the act adding this
paragraph.
(h) A group contract between a group benefit plan and an employer
subject to this article that is issued, amended, or renewed on or
after July 1, 2016, shall require the employer to give the following
notice to a qualified beneficiary:
"In beneficiary in connection with a
notice regarding election of continuation coverage:
"In addition to your coverage continuation options, you
may be eligible for the following:
1. Coverage through the state health insurance marketplace, also
known as Covered California. By enrolling through Covered California,
you may qualify for lower monthly premiums and lower out-of-pocket
costs. Your family members may also qualify for coverage through
Covered California.
2. Coverage through Medi-Cal. Depending on your income, you may
qualify for low or no-cost coverage through Medi-Cal. Your family
members may also qualify for Medi-Cal.
3. Coverage through an insured spouse. If your spouse has coverage
that extends to family members, you may be able to be added on that
benefit plan.
Be aware that there is a deadline to enroll in Covered California,
although you can apply for Medi-Cal anytime. To find out more about
how to apply for Covered California and Medi-Cal, visit the Covered
California Internet Web site at http://www.coveredca.com."
(i) http://www.coveredca.com."
(i) (1) Notwithstanding any other 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 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 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 (k). 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 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.
(j) 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.
(k) 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), by telephone, fax, electronic mail, or mail.
(2) Within 14 days of receipt of the information specified in
paragraph (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.
(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 to a qualified beneficiary and the requirement under
paragraph (5) of subdivision (i) to provide a new opportunity to a
qualified beneficiary 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 to that qualified beneficiary
prior to the effective date of the act adding this paragraph.
(5) If an individual does not qualify for either a special
election period or the subsidy under ARRA, the insurer shall provide
a written notice to that 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.
(l) Notwithstanding any other 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) An insurer that receives an election notice from a qualified
beneficiary eligible for premium assistance under ARRA, pursuant to
subdivision (i), 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, 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 (i). 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.
(p) (1) If Section 5000A of the Internal Revenue Code, as added
by Section 1501 of PPACA, is repealed or amended to no longer apply
to the individual market, as defined in Section 2791 of the federal
Public Health Service Act (42 U.S.C. Sec. 300gg-91), this section
shall become inoperative and is repealed 12 months after the date of
that repeal or amendment.
(2) For purposes of this subdivision, "PPACA" means the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152), and any rules, regulations, or guidance
issued pursuant to that law.
SEC. 11. Section 10128.55 is added to the
Insurance Code , 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 to a qualified beneficiary and the requirement under paragraph
(1) of subdivision (h) to provide a new opportunity to a qualified
beneficiary to elect continuation coverage shall be deemed satisfied
if an insurer previously provided a written notice and additional
election opportunity under Section 3001 of ARRA to that qualified
beneficiary prior to the effective date of the act adding this
paragraph.
(h) A group contract between a group benefit plan and an employer
subject to this article that is issued, amended, or renewed on or
after the operative date of this section shall require the employer
to give the following notice to a qualified beneficiary in connection
with a notice regarding election of continuation coverage:
"Please examine your options carefully before declining this
coverage. You should be aware that companies selling individual
health insurance typically require a review of your medical history
that could result in a higher premium or you could be denied coverage
entirely."
(i) A group contract between a group benefit plan and an employer
subject to this article that is issued, amended, or renewed on or
after July 1, 2016, shall require the employer to give the following
notice to a qualified beneficiary in connection with a notice
regarding election of continuation coverage:
"In addition to your coverage continuation options, you may be
eligible for the following:
1. Coverage through the state health insurance marketplace, also
known as Covered California. By enrolling through Covered California,
you may qualify for lower monthly premiums and lower out-of-pocket
costs. Your family members may also qualify for coverage through
Covered California.
2. Coverage through Medi-Cal. Depending on your income, you may
qualify
for low or no-cost coverage through Medi-Cal. Your family members
may also qualify for Medi-Cal.
3. Coverage through an insured spouse. If your spouse has coverage
that extends to family members, you may be able to be added on that
benefit plan.
Be aware that there is a deadline to enroll in Covered California,
although you can apply for Medi-Cal anytime. To find out more about
how to apply for Covered California and Medi-Cal, visit the Covered
California Internet Web site at http://www.coveredca.com."
(j) (1) Notwithstanding any other 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 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 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 (l). 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 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.
(k) 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.
(l) 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), by telephone, fax, electronic mail, or mail.
(2) Within 14 days of receipt of the information specified in
paragraph (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.
(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 to a qualified beneficiary and the requirement under
paragraph (5) of subdivision (j) to provide a new opportunity to a
qualified beneficiary 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 to that qualified beneficiary
prior to the effective date of the act adding this paragraph.
(5) If an individual does not qualify for either a special
election period or the subsidy under ARRA, the insurer shall provide
a written notice to that 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.
(m) Notwithstanding any other 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.
(n) 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.
(o) An insurer that receives an election notice from a qualified
beneficiary eligible for premium assistance under ARRA, pursuant to
subdivision (j), 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.
(p) (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.
(q) (1) If Section 5000A of the Internal Revenue Code, as added by
Section 1501 of PPACA, is repealed or amended to no longer apply to
the individual market, as defined in Section 2791 of the federal
Public Health Service Act (42 U.S.C. Sec. 300gg-91), this section
shall become operative 12 months after the date of that repeal or
amendment.
(2) For purposes of this subdivision, "PPACA" means the federal
Patient Protection and Affordable Care Act (Public Law 111-148), as
amended by the federal Health Care and Education Reconciliation Act
of 2010 (Public Law 111-152), and any rules, regulations, or guidance
issued pursuant to that law.
SEC. 10. SEC. 12. 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.