HIPAA requires that a mandatory guaranteed-issue health option be made available to those exhausting group benefits (either continuation or loss of group in the event the employer dumps the plan).
Each state is free to interpret the implementation of
HIPAA as it best sees fit. Some states have it integrated directly into their major risk pools, while others have it more privatized.
In answer to the question above, California requires any carrier selling individual & family health plans under CA registration (DOI or DMHC) to provide TWO of their most popularly marketed plans to the
HIPAA marketplace (2 for each registration and many carriers in CA are now putting all
PPO through DOI due to hassles with DMHC). There are really only a handful of carriers in California selling in that market, and often you will see two sets of identical
PPO plans available under
HIPAA (see Blue Shield CA & Blue Shield Life & Health) which creates confusion as the carrier has registered one set with DMHC and one set with DOI.
As to Cal-
COBRA, 36 months for all qualifed beneficiaries. Over 20, 18 months federal
COBRA followed by a second 18 months on Cal-
COBRA (with rate increase from 102% to 110%). If under 20, 36 months of Cal-
COBRA. Certain plans are exempt from the extension to 36 months - self funded/self-insured, out of state domiciled plans and
HRA/
HSA PPO plans with higher deductible which can be considered self-funded. This is all covered by AB 1401 in California.
For
HIPAA in CA, DMHC does exert influence as they control the pricing arrangement as it is integrated with MRMIP. So, the carriers have to provide the plans but DMHC determines pricing for those plans based on the MRMIP pricing levels for premiums.
If you like, you can read about all this good stuff on my site
www.davefluker.com
Dave
COBRA
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