CALIFORNIA - Pacificare Health Systems

Section 8 – Disenrollment From the Secure
Horizons Group Retiree Medicare Advantage Plan
(4) by itself will not prevent coverage
from being continued until the end of any
period for which pre-existing conditions
are excluded or benefits for them are
limited under the other Health Plan.
3. The day the person becomes entitled to
Medicare Benefits.
4. The day the employer no longer provides
group health coverage to any of its
employees.
California Continuation Coverage
Employees entitled to COBRA continuation
coverage due to employment termination
on or after January 1, 1996, are entitled to
extend medical coverage for themselves and
their spouses after their initial 18-month
COBRA period ends, provided the employee
was at least age 60 on the date employment
ended, had worked for the University for
at least five continuous years immediately
prior to termination, and was eligible for and
elected COBRA continuation medical plan
coverage in connection with the termination
of employment. The former spouse of
the above former employee is entitled to
California Continuation Coverage, provided
the former spouse continued coverage
under COBRA as a Qualified Beneficiary. This
continuation does not apply to children of a
former employee. The continuation will end
on the earlier of:
1. the date the individual turns 65;
2. the date the University no longer
maintains the group plan, including any
replacement plan;
3. the date the individual is covered by a
group medical plan not maintained by the
University;
4. the date the individual becomes entitled
to Medicare;
5. with respect to the spouse or former
spouse only, the date five years from
the date COBRA ends for the spouse or
former spouse.
If the employee’s coverage terminates, the
spouse may continue coverage until one of
the terminating events applies to the spouse.
PacifiCare will notify eligible COBRA Qualified
Beneficiaries before the end of the maximum
18-month COBRA continuation period. If an
eligible individual wishes to continue the
coverage, they must apply, in writing, to the
medical carrier no later than 30 days before
the end of the COBRA continuation period.
Cost of Continuation Coverage – The cost
of the coverage will include any portion
previously paid by the Employer and
shall not be more than 102 percent of the
applicable group rate during the period of
basic COBRA coverage; or not more than
150 percent anytime during the 11-month
disability extension period (i.e., during the
19th through the 29th months); or not more
than 213 percent during the extension period
allowed by California Continuation Coverage.
For information on Open Enrollment
actions for which a Qualified Beneficiary
may be eligible and/or any applicable plan
modifications and Premium adjustment,
contact University of California Human
Resources and Benefits 1-800-888-8267,
extension 70651, during the month of
November.
Please note: When your continuation of
coverage ends, you may be able to convert
your coverage to an Individual Conversion
Plan if you wish.
Group Retiree Members may enroll as an
Individual Member in the Secure Horizons
Medicare Advantage Plan. As an individual
Member of the Secure Horizons Medicare
Advantage Plan, you will receive the benefit
package approved by CMS for your county
of residence, which may cover less than
the benefit package available through the
University of California and a plan Premium
may apply.
Questions? Call the Customer Service Department at 1-800-228-2144,
(TDHI) 1-800-685-9355, Monday through Friday, 7:00 a.m. to 9:00 p.m.
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PART B