Eligibility for Continuation Coverage

The continuation coverage laws only apply to employer-sponsored health coverage. The laws do not apply to individual coverage, or jobs with the federal government or churches, although federal employees have similar protections. If you’re covered under a self-insured plan, you are eligible for federal protections, but not state protections (see Laws Providing Continuation Coverage). If you’re covered under an association-sponsored plan, contact the California Department of Insurance or the California Department of Managed Health Care (DMHC) to learn more about your rights.

To be eligible for continuation coverage, you must have lost your employer-sponsored group coverage because of a qualifying event. Many events that cause you to lose your original coverage are considered qualifying events, unless you have been fired for gross misconduct.

Example:
You are fired from your job because you don't have the right skills. You are eligible for continuation coverage.
Example:
You are fired from your job because you were stealing from the safe. You are probably not eligible for continuation coverage.

For employees, qualifying events include:

  • Quitting
  • Being fired for a reason besides gross misconduct
  • Being laid off
  • Having your work hours reduced

If you are covered under your spouse’s employer-sponsored health coverage, you can get continuation coverage if your spouse loses coverage for any of the above reasons or because:

  • The employee dies
  • There’s a divorce or legal separation
  • The employee becomes eligible for Medicare

For domestic partners, eligibility for continuation coverage depends on which law applies. If Cal-COBRA applies, you are treated the same as a spouse. Domestic partners are not eligible for COBRA protections, although many employers offer continuation coverage plans with features similar to COBRA.

If you are covered as the dependent of an employee who has employer-sponsored coverage, and that employee loses coverage for any of the above reasons, you’re eligible for continuation coverage. In addition, most plans have an age limit after which you’re no longer considered dependent. Reaching this age is also considered a qualifying event.

Example:
You are covered under your mother's employer-sponsored health coverage plan. That plan has an age limit for children over 26 years old. When you turn 26, you can no longer be covered under your mother's policy, but you are eligible for continuation coverage.

Each eligible individual has an independent right to elect COBRA.

Example:
You are covered by employer-sponsored health coverage. Your husband and son are also covered through your plan. You lose your job, so all three of you are eligible for continuation coverage, but not all of you have to take it. You could decide you don't want it, but your husband and child could still sign up.

Getting Continuation Coverage

To be eligible for continuation coverage, you have to be on the employer-sponsored health plan on the day before a qualifying event happens. After the qualifying event, your employer has to notify the health plan within 30 days of that event. If you divorce or legally separate from your spouse, or you reach an age when you’re no longer considered a dependent child, you have to tell the health plan within 60 days.

The health plan then has 14 days to send you a notice telling you that you are eligible for continuation coverage. They will send an application along with the notice that explains how much your premium will be. The cost to you will generally be the entire amount of the premium, including what the employer used to pay, plus a small cost for administrative fees.

You have 60 days from the day you qualify to enroll in continuation health coverage. If you get a notice after your qualifying event, you have 60 days from the day you receive the notice. If you don’t get a notice, and think that you should have, contact both the employer and the health plan. Be sure to meet all deadlines for applying and paying premiums. The former employer does not have to send you a bill for the premiums. It’s up to you to remember to pay on time. For COBRA coverage, there is a 30 day grace period on late payments, but providers can cancel your coverage and retroactively reinstate it when they receive the premium. Otherwise the rules are strict and being late may cause your coverage to end. It’s also helpful to keep everything in writing.

If you are on Medi-Cal, the Medi-Cal/Health Insurance Premium Payment (HIPP) program may be able to help you pay continuation coverage premiums.