California Extension of COBRA Coverage

California health plans must offer an enrollee who exhausted COBRA coverage the opportunity to continue coverage for up to a total of 36 months from the date the enrollee’s continuation coverage began, if the enrollee is entitled to less than 36 months of continuation coverage under COBRA.1 The offer of extended coverage can be at no more than 110 percent of the applicable rate or no more than 150 percent of the applicable rate for a qualified beneficiary determined to be disabled pursuant to Title II or Title XVI of the United States Social Security Act.

Notification of this extended coverage must be included in the notice of the pending termination of COBRA coverage, which is required to be provided to COBRA beneficiaries and included in plan documents provided to employees.

This information is included in the General Notice of COBRA Continuation Coverage Rights - California Employees.

• General Notice of COBRA Continuation Coverage Rights - California Employees

Family, Medical and COBRA

If you have 50 or more employees, you are covered by the Family and Medical Leave Act of 1993 (FMLA). If you have five or more employees, you are covered by the California Family Rights Act (CFRA). FMLA and CFRA provide that certain employees may be eligible for up to 12 weeks of unpaid leave per year. Both FMLA and CFRA require you to maintain health benefits for employees while on leave, but taking this leave is not a qualifying event under COBRA.2 See Family and Medical Leave, for more information on FMLA.

However, a qualifying event will occur if all of the following occur:

• The employee or dependent is covered by the plan on the day before the FMLA leave begins.
• The employee does not return at the end of the leave.
• The employee or dependents would, without COBRA coverage, lose coverage under the group health plan before what would be the maximum COBRA coverage period.3

For COBRA purposes, a qualifying event occurs for an employee taking FMLA or CFRA leave on the last day of the leave. The last day of FMLA or CFRA leave will occur on the date the employee informs you that they’re not returning to work or the end of the maximum FMLA/CFRA leave period, whichever is earlier.4 COBRA will be triggered even if the employee chose not to maintain coverage during the FMLA or CFRA leave.5

Note that if FMLA or CFRA leave is also pregnancy disability related, the employer must continue health benefits during pregnancy disability leave (PDL) for up to four months in a 12-month period per pregnancy (see Pay and Benefits During Pregnancy Disability Leave). If an employee was receiving benefits while on PDL and did not return from the leave, the employee's termination from employment would be a qualifying event for purposes of COBRA.

COBRA and Medicare Entitlement

An employee or qualified beneficiary who has a qualifying event prior to becoming eligible for Medicare must be offered COBRA benefits. COBRA can be discontinued when the employee or qualified beneficiary becomes entitled to Medicare.

An employee or qualified beneficiary already covered by Medicare at the time of the qualifying event is entitled to COBRA continuation benefits when the qualifying event occurs.

1. Health and Safety Code sec. 1366.29