DEPARTMENT OF MANAGED HEALTH CARE (DMHC)
The following forms may only be used by health plans to comply with the AB 23 (Jones - Chapter 3, Statutes of 2009) requirement to notify enrollees of the right to a subsidy under the American Recovery and Reinvestment Act of 2009. These model notices may only be altered by health plans to include plan-specific information or to select options. Health plans may choose to use either the plain language or standard version of each form posted on this page. Any further alteration will require prior approval from the Department of Managed Health Care.
Cal-COBRA Continuation Coverage Notice for Qualified Beneficiaries currently enrolled in Cal-COBRA.
For use by group health carriers for qualified beneficiaries currently enrolled in Cal-COBRA coverage with qualifying events that occurred on or after September 1, 2008 to advise them of the availability of the premium reduction.
Cal-COBRA Continuation Coverage Supplemental Notice (Plain Language)
Model Notice for Use for Individuals With Qualifying Events After the Effective Date of AB 23 (May 12th, 2009)
For use by group health carriers where coverage is subject to Cal-COBRA continuation requirements during the period that begins with the effective date of AB 23 and ends with December 31, 2009.
Model Notice for Use After AB 23 (Standard)
Model Notice for Use After AB 23 (Plain Language)
Model Notice for use for individuals with qualifying events between Sept 1 and the effective date of AB 23 (May 12, 2009)
For use by group health carriers where coverage is subject to Cal-COBRA continuation requirements during the period that begins with September 1, 2008 and ends with the effective date of AB 23
Model Notice between Sept 1 and AB 23 (Standard)
Model Notice between Sept 1 and AB 23 (Plain Language)
If you prefer a Microsoft Word 2003 format, please contact Sherrie Lowenstein at (916) 322-5874.