COBRA Notification Requirements for Health, Dental and HCRA Permitting Events and Vision Actions
- DRAFT -
Reason Code Reason Description
Initial COBRA
Notice
Qualifying COBRA
Notice
Notes
100
New Employee
YES
NO
101
Late Enrollment
YES
NO
102
Enroll after Reinstate from
Retirement
YES
NO
103
Return from Military Leave
YES
NO
104
New Enrollment (during Open
Enrollment)
YES
NO
108
Enroll after deletion as dependent
on CalPERS plan
YES
NO
111
New Enrollment for EE off pay
status during OE
YES
NO
200
Adding Newborn/Newly Adopted
Child
YES
NO
201
Adding New Spouse or Step-
children due to marriage
YES
NO
202
Adding child due to change in
custody
YES
NO
203
Adding "miscellaneous" child
YES
NO
204
Adding dependent due to loss of
non-CalPERS health coverage
YES
NO
205
Adding dependent due to return
from Military leave
YES
NO
206
Adding dependent during OE
YES
NO
207
Adding dependent upon return
from off pay status during OE
YES
NO
208
Adding dependent due to court
order
YES
NO
209
Adding dependent to resolve Split
Family Enrollment
YES?
NO
Would only use
this if making
required move of
dependent from
one ee's plan to
another's,
therefore COBRA
notice not
necessary?
210
Adding Certified Disabled
Dependent
YES
NO
215
Adding Domestic Partner
YES
NO
216
Adding Domestic Partner Child
YES
NO
300
Deleting dependent due to death
NO
NO
HEALTH
Initial Draft: June 8, 2004
COBRA Notification Requirements for Health, Dental and HCRA Permitting Events and Vision Actions
- DRAFT -
Reason Code Reason Description
Initial COBRA
Notice
Qualifying COBRA
Notice
Notes
301
Deleting dependent who reaches
23
NO
YES
302
Deleting dependent due to
divorce
NO
YES
303
Deleting child due to marriage
NO
YES
304
Deleting dependent that is
enrolling in their own CalPERS
health plan
NO
NO
305
Deleting dependent that is no
longer disabled
NO
YES
Ceases to be a
CSU-eligible
dependent
306
Deleting ineligible dependent
NO
YES
307
Deleting dependent that obtains
other coverage
NO
NO
Voluntary
deletion
308
Delete dependent du