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A health care service plan or insurance company that offers Hospital,
medical or surgical benefits under an individual health care service plan
contract or insurance policy may not decline to offer coverage to, or deny
enrollment of, a federally eligible defined individual or impose any
Preexisting Condition with respect to the coverage. But if you don't take
available COBRA or Cal-COBRA coverage, you lose your rights to this
guaranteed coverage.
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A federally eligible individual is an individual who, as of the date
on which the individual seeks coverage under this provision, meets all
of the following conditions:
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- Has had eighteen (18) or more months of creditable coverage, and whose most recent creditable coverage was under a group health plan, a federal government plan maintained for federal employees, or a governmental plan or church plan as defined in the federal Employee Retirement Income Security Act of 1974 (29 U.S.C. Sec. 1002), and
- Is not eligible for coverage under a group health plan, Medicare, or Medi-Cal, and does not have any other health coverage, and
- Was not terminated from his or her most recent creditable coverage due to nonpayment of premiums or fraud, and
- If offered continuation coverage under COBRA or Cal-COBRA, has elected and exhausted that coverage.
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| Creditable coverage means: |
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- Any individual or group policy, contract, or program that is written or administered by a disability insurer, health care service plan, fraternal benefits society, self-insured employer plan, or any other entity, in this state or elsewhere, and that arranges or provides medical, Hospital, and surgical coverage not designed to supplement other plans. The term includes continuation or conversion coverage but does not include accident only, credit, disability income, Medicare supplement, long-term care, dental, vision, coverage issued as a supplement to liability insurance, insurance arising out of a workers' compensation or similar law, automobile medical payment insurance, or insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance.
- The federal Medicare program pursuant to Title XVIII of the Social Security Act.
- The Medicaid program pursuant to Title XIX of the Social Security Act.
- Any other publicly sponsored program, provided in this state or elsewhere, of medical, Hospital, and surgical care.
- 10 U.S.C.A. Chapter 55 (commencing with Section 1071) (CHAMPUS).
- A medical care program of the Indian Health Service or of a tribal organization.
- A state health benefits risk pool.
- A health plan offered under 5 U.S.C.A. Chapter 89 (commencing with Section 8901) (FEHBP).
- A public health plan as defined in federal regulations authorized by Section 2701(c)(1)(l) of the Public Health Service Act, as amended by Public Law 104-191, the Health Insurance Portability and Accountability Act of 1996.
- A health benefit plan under 22 U.S.C.A. 2.504(e) of the Peace Corps Act.
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