CALIFORNIA - Pacificare Health Systems

PART A
102
Member Eligibility
instances where your coverage under the Health Plan
would otherwise end. In the case of a Subscriber who
is determined to be disabled under the Social Security
Act, the Subscriber will pay 150 percent of the former
employer’s Health Plan group rate after the first 18
months of continuation coverage and up to the month
in which the Subscriber becomes entitled to Medicare,
generally 29 months after the disabling event occurred.
However, if you are not entitled to Medicare by the
29th month, you may be able to extend your benefits.
Please refer to “1401 Extended Continuation Coverage
After COBRA”.
This discussion is intended to inform you, in a
summary fashion, of your rights and obligations under
COBRA. However, the University of California is legally
responsible for informing you of your specific rights
under COBRA. Therefore, please consult with the
University of California regarding the availability and
duration of COBRA continuation coverage.
COBRA Qualifying Events for Subscribers
If you are a Subscriber covered by this Health Plan, you
have a right to choose COBRA continuation coverage
for up to 18 months based upon 102 percent of your
former employer’s Health Plan group rates if you have
a qualifying event described as:
1. You lose your group health coverage because the
termination of your employment (for reasons
other than gross misconduct on your part) or
2. The number of hours you actually work on a
weekly basis are cut back to less than the number
of hours required for continued group Health
Plan eligibility, as determined by your employer.
If you are determined to be disabled under Title II or
Title XVI of the United States Social Security Act within
60 days of your initial qualifying event, you must
notify the University of California of this determination
prior to the 18th month. You are required to pay to
PacifiCare 150 percent of the group rate after the
first 18 months and generally up to the 29th month.
Your coverage under COBRA will end upon your
Medicare entitlement. However, if you are not entitled
to Medicare by the 29th month, you may be able
to extend your benefits. Please refer to “California
Continuation Coverage After COBRA.”
COBRA Qualifying Events for Spouses
If you are the Spouse of a Subscriber covered by this
Health Plan, you have the right to choose COBRA
continuation coverage for up to 36 months based upon
102 percent of the Subscriber’s employer’s Health Plan
group rates (150 percent beginning the 19th month
if the Subscriber is determined disabled by the Social
Security Administration) for yourself if you lose group
health coverage under this Health Plan for any of the
following four reasons:
1. The death of the Subscriber;
2. A termination of the Subscriber’s employment
(for reasons other than gross misconduct) or the
number of hours the Subscriber actually works
on a weekly basis are cut back to less than the
number of hours required for continued group
Health Plan eligibility, as determined by the
Subscriber’s employer;
3. Divorce or legal separation from the Subscriber;
or
4. The Subscriber becomes entitled to Medicare. (In
the case of a Subscriber who is determined to be
disabled under the Social Security Act, the Spouse
will pay 150 percent of the former employer’s
Health Plan group rate after the first 18 months
of continuation coverage and up to a combined
total of 36 months. In the case of a Subscriber
who becomes entitled to Medicare and voluntarily
terminates his or her group Health Plan coverage,
the Spouse may have up to 36 months based
upon 102 percent of the Subscriber’s former
employer’s Health Plan group rates. The length
of your COBRA coverage will be determined
from the date the Subscriber became entitled to
Medicare).
COBRA Qualifying Events for Dependent
Children
In the case of a Dependent child of a Subscriber
enrolled in this Health Plan, he or she has the right
to continuation coverage for up to 36 months based
upon 102 percent of the Subscriber’s former employer
group Health Plan rates (150 percent beginning the
19th month if the Subscriber is determined disabled
by the Social Security Administration) if group health
coverage under this Health Plan is lost for any of the
following five reasons:
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