Geonetta & Frucht, LLP
By: Geonetta & Frucht, LLP

Cal-COBRA is a California law that lets you keep your group health plan when your job terminates or when your hours are reduced. If you have been denied the Cal-COBRA benefits that you are entitled to, contact a San Francisco Cal-COBRA attorney immediately.

If you have lost your job or if your hours have been reduced, your employer is supposed to inform you if you are entitled to keep your health insurance coverage under Cal-COBRA. But what if you’re qualified to keep your health insurance, you file a claim, and that claim is denied?

What can you do if your health insurance claim under Cal-COBRA is wrongly denied? When should you contact a San Francisco employment benefits lawyer? Keep reading this brief discussion of Cal-COBRA benefits and your employment rights for the answers you may need.

What Does Cal-COBRA Provide?

Cal-COBRA – the California Continuation Benefits Replacement Act – is a state law that is quite comparable to the federal Consolidated Omnibus Budget Reconciliation Act (COBRA) and slightly more extensive.

Like COBRA, the Cal-COBRA program provides eligible retirees and ex-employees as well as their spouses, their ex-spouses, and their dependent children with employer-provided, temporary group health insurance coverage that they otherwise would have lost.

Who is Covered by COBRA and Cal-COBRA?

Under the federal Consolidated Omnibus Budget Reconciliation Act, employers in the private sector who have twenty or more employees, along with local and state governments, must provide COBRA coverage.

In our own state, Cal-COBRA “fills the gap” because it covers those employers who have two to nineteen employees, and it additionally applies to those who work for larger employers after an employee exhausts federal COBRA benefits.

Cal-COBRA applies to HMOs, PPOs, and indemnity policies, but not to self-insured plans. And unlike federal COBRA, Cal-COBRA also applies to churches and faith organizations.

How Long is Coverage Provided by COBRA and Cal-COBRA?

In most cases, the federal COBRA law extends health care insurance coverage for eighteen months after a job loss or reduction of hours, although some employees may qualify for a lengthier extension of coverage.

Cal-COBRA continues group health insurance coverage for as long as thirty-six months after a job loss or reduction of hours, but you must enroll for Cal-COBRA within sixty days of receiving an eligibility notice from the employer.

If you have exhausted all eighteen months of your coverage under federal COBRA, Cal-COBRA lets you stay covered for eighteen more months and for a combined, total coverage period of three years. Cal-COBRA extends full coverage to spouses, ex-spouses, and dependent children.

What Are Your Benefits Under COBRA and Cal-COBRA?

Under COBRA and Cal-COBRA, your health insurance coverage and benefits are the same coverage and benefits enjoyed by the other employees who are enrolled in the same insurance plan.

If other employees have an open enrollment period, so do you. If the employer changes to another plan, you also change plans.

If specialized dental or vision plans are included in the employer’s group insurance plan, those specialized plans must be provided to you under COBRA, but if you exhaust your COBRA benefits and change to Cal-COBRA, the specialized plans no longer have to be provided.

Why May Cal-COBRA Benefits Be Denied?

The legitimate reasons why, as an otherwise qualified employee or ex-employee, you may be denied health insurance coverage under Cal-COBRA include:

  1.  You are eligible for or already enrolled in Medicare.
  2.  You did not enroll for Cal-COBRA within sixty days of receiving an eligibility notice.
  3.  You are covered by a different health insurance plan.
  4.  You relocated out of the health insurance plan’s service area.
  5.  You were terminated for gross misconduct.
  6.  The employer has gone out of business.
  7.  The employer no longer offers the coverage to current employees.

Why Are Legitimate Cal-COBRA Claims Sometimes Denied?

There are several reasons why a qualified applicant might be unable to obtain COBRA or Cal-COBRA benefits. State and federal law spell out an employer’s responsibilities, but not every employer is compliant. Errors and mistakes can also be the reason for a denial of benefits.

When an employee chooses to keep his or her health insurance coverage, the employer must confirm in writing the employee’s eligibility to maintain those benefits under COBRA and Cal-COBRA.

If an employer mistakenly tells you that you are not eligible to retain your health insurance coverage, the employer may be fined and even held liable for your additional health care expenses. Other ways that an employer or plan administrator may violate your rights include:

  1.  not informing you of your eligibility or ineligibility for COBRA or Cal-COBRA
  2.  not sending you all of the necessary documents
  3.  sending you incomplete information or a notice too complicated to understand

When Should You Contact a Cal-COBRA Lawyer?

You may be entitled by federal or state law to benefits and additional compensation if an employer wrongly denies your COBRA or Cal-COBRA coverage or violates other legal requirements. Filing a lawsuit against the employer or plan administrator is one option.

A San Francisco Cal-COBRA attorney can help you determine if in fact you are eligible for COBRA and Cal-COBRA benefits and will help you to obtain those benefits – and in some cases, additional compensation.

As soon as you have been denied health insurance benefits that are rightfully yours, or if your rights have been violated by an employer or plan administrator, schedule a consultation with a San Francisco employment benefits lawyer to discuss your options, including the lawsuit option.

What Will an Employment Benefits Lawyer Do for You?

Your attorney will investigate the reason why your COBRA or Cal-COBRA benefits were denied. If a mistake was made, that mistake can probably be fixed without going to court.

You can be assured that the courts in California are committed to enforcing the laws that protect this state’s workers. If you have to bring a lawsuit to obtain your benefits, and if your attorney proves in court that your employment rights have been violated, the court will be on your side.

If it becomes necessary to take an employer or a plan administrator to court to obtain your COBRA or Cal-COBRA coverage, your attorney will fight aggressively to obtain your benefits and will use every legal tool necessary to bring the matter to its best possible conclusion.

An employment benefits attorney understands the anxiety that a denial of your health insurance benefits can cause. If you are in fact entitled to those benefits, and if your benefits have been denied, now is the time to schedule a consultation with a California employment rights attorney.

Geonetta & Frucht, LLP
By: Geonetta & Frucht, LLP