Description
All employers with 20 or more employees who provide health and medical benefits must comply with the federal health insurance law – called COBRA. The law gives employees and their dependents the right to continue coverage under their employer’s health plan after termination, resignation, divorce, death, layoff, and other qualifying events. In addition, California law requires covered employers to provide supplemental insurance protection and written disclosures. This publication, by Sheppard Mullin Attorney Richard J. Simmons, reviews the rules in a concise and understandable manner. Among the subjects addressed in the publication are the following:
- COBRA Amendments
- IRS Regulations
- Examination Of All COBRA Rules
- Sanctions And Penalties
- 29-Month Continuation Period
- Insurance Portability Rules
- California Rules
- HIPP Notice For California Workers
- Sample COBRA And State Notices
- Rules On Pre-existing Conditions
- Disability Requirements
- Premium Assistance
- Effect Of Multiple Qualifying Events
- Standards For Measuring The COBRA Continuation Period
- Definition Of “Gross Misconduct”
Table Of Contents
SECTION 1 INTRODUCTION
1.1 Overview
1.2 Health Care Continuation Rules
1.3 Scope Of Publication
SECTION 2 EFFECTIVE DATES
2.1 The Original Statute
2.2 The COBRA Amendments
2.3 The Regulations
2.4 The Plan Year
SECTION 3 COVERED EMPLOYERS AND PLANS
3.1 Covered Plans
3.2 Exemptions From COBRA Coverage
3.3 Expansion Of ADEA Protection For Group Health Plans
3.4 Role Of State Laws
SECTION 4 RIGHT TO CONTINUE COVERAGE UNDER GROUP HEALTH PLANS
4.1 Employees And Other Eligible Individuals
4.2 Events That Trigger Election Rights
4.3 The Gross Misconduct Exception
4.4 Election Period
4.5 Duration Of Coverage
4.6 Additional Conversion Rules
4.7 Cost Of Continuation Coverage
4.8 Costs Of Pediatric Vaccines
4.9 Family And Medical Leave Act
4.10 Domestic Partners
SECTION 5 NOTICE REQUIREMENTS
5.1 Introduction To Notice Requirements
5.2 Initial Notification Obligations
5.3 Notifications Generated By Qualifying Events
5.4 Sanctions For Non-Compliance
5.5 Special Notification Rules For HIPAA Amendments
5.6 California Health Insurance Premium Program Rules
5.7 California Healthcare Continuation Notices
SECTION 6 ADDITIONAL SANCTIONS
6.1 Excise Taxes
6.2 Exceptions
SECTION 7 THE HEALTH INSURANCE PORTABILITY SYSTEM
7.1 The Health Insurance Portability And Accountability Act
7.2 Excluded Plans And Insurance
7.3 Limitations On Preexisting Condition Exclusions
7.4 Discrimination Based On Health Status
7.5 Multi-employer And Multiple Employer Plans
7.6 Sanctions For Violating The Portability Access, And Renewability Rules
7.7 Disclosure Requirements Triggered By A Reduction In Health Benefits
SECTION 8 CALIFORNIA HEALTHCARE CONTINUATION COVERAGE RULES
8.1 Eligibility
8.2 Notification Rules
8.3 Termination Of Supplemental Continuation Coverage
8.4 ERISA Preemption Issues
SECTION 9 CAL-COBRA RULES
9.1 Background Of California Rules
9.2 Coverage Standards And Effective Dates
9.3 Employer Notification Rules
9.4 Obligations Of Insurance Companies
9.5 Costs
9.6 Special Rules For Older Workers
SECTION 10 SUMMARY
APPENDIX A DEPARTMENT OF HEALTH SERVICES NOTICE TO TERMINATING EMPLOYEES
APPENDIX B SAMPLE NOTICE OF HIPAA RULES TO COBRA PARTICIPANTS
APPENDIX C INTERNAL REVENUE SERVICE REGULATIONS
APPENDIX D DEPARTMENT OF LABOR REGULATIONS
APPENDIX E MODEL COBRA CONTINUATION COVERAGE GENERAL NOTICE INSTRUCTIONS
APPENDIX F MODEL COBRA CONTINUATION COVERAGE ELECTION NOTICE INSTRUCTIONS
APPENDIX G CASE TABLE
About The Author
Richard J. Simmons is a Partner in the law firm of Sheppard, Mullin, Richter & Hampton LLP in Los Angeles. He represents employers in various employment law matters involving litigation throughout the country and general advice regarding state and federal wage and hour laws, employment discrimination, wrongful discharge, employee discipline and termination, employee benefits, affirmative action, union representation proceedings, and arbitrations. Mr. Simmons received his B.A., summa cum laude, from the University of Massachusetts, where he was a Commonwealth Scholar and graduated in the Phi Kappa Phi Honor Society. He received his J.D. from Berkeley Law at the University of California at Berkeley where he was the Editor-in-Chief of the Industrial Relations Law Journal, now the Berkeley Journal of Employment and Labor Law.
Mr. Simmons argued the only case before the California Supreme Court that produced a victory for employers and business in 2018. He was recently recognized as the Labor and Employment Attorney of the Year by the Los Angeles Business Journal and was inducted into the Employment Lawyers Hall of Fame. He has lectured nationally on wage and hour, employment discrimination, wrongful termination, and other employment and labor relations matters. He is a member of the National Advisory Board to the Berkeley Journal of Employment and Labor Law, published by Berkeley Law at the University of California at Berkeley. He was also appointed by the California Industrial Welfare Commission as a member of three Minimum Wage Boards for the State of California.
