Effective January 1, 2003

Employers with 2 to 19 employees:

· HMOs and Health Insurers must offer Cal-COBRA coverage for up to 36 months to all Cal-COBRA beneficiaries who have a qualifying event on or after January 1, 2003. This does not apply to beneficiaries who had a qualifying event prior to January 1, 2003.

Effective September 1, 2003

Employers with 20+ employees:

·        HMOs and Health Insurers must offer individuals who had a qualifying event on or after January 1, 2003 and have exhausted their federal COBRA coverage and who had less than 36 months of COBRA coverage to continue their exact same coverage as Cal-COBRA for up to a total of 36 months of combined coverage under COBRA and then Cal-COBRA.

·        An individual can be enrolled in MRMIP no more than 36 months. HMOs and Health Insurers must provide the “MRMIP graduates” (those leaving MRMIP after 30 or more months of MRMIP coverage) with a guarantee issue health plan that is one of the plan designs offered through MRMIP. The rates for such plans can be 10% higher than the currently prevailing MRMIP rates for the same plan, but the new plan’s annual benefit maximum would be increased from $75,000 to $200,000. (The lifetime cap stays at $750,000 ). The annual and lifetime maximums start over when a member transitions from MRMIP to an HMO and health insurer.

·        HMOs and health insurers must offer conversion coverage if the group contract with an employer terminates or an employer’s participation in the group health plan terminates, and similar group coverage does not replace the coverage within 15 days. The conversion plan must conform to all HIPAA guaranteed issue regulations, including rate limitations for HIPAA Individual Guarantee Issue plans.

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