CalHR's Responsibility After Receiving Completed COBRA Election Form

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CalHR will send a COBRA Enrollment Confirmation Memo to participants. CalHR will process participants' payments and ensure the amounts are credited to their MRA.
 Events Resulting in the Loss of COBRA Coverage
Failure to pay the required contributions within the prescribed timeframes.
Failure to request reimbursement for valid medical expenses by June for the prior plan year account.
 
Form Completion

The Reimbursement Enrollment Authorization (STD. R) is used as the COBRA Continuation Verification notice. Only the following sections should be completed:
Section : Mark "COBRA Continuation of MRA".
Section : Indicate the Social Security Number of the enrolled employee.
Section A: Indicate the monthly COBRA contribution amount (not including the administrative fee).
Section : Participant must b2b email list provide their original signature/date.
Section : Indicate the effective date of the COBRA enrollment which is the month following their last paycheck. For example, if the employee is paid on August st for the July pay period, the effective date for the COBRA contribution should be September st. 



Example in Section 

Section : Indicate the date of the qualifying event; i.e., date of retirement, date of termination of employment.
Sections -: Indicate appropriate information.
Section : Indicate the type of qualifying event, i.e., retirement, termination of employment. Provide participant's phone number and home address. A confirmation statement will be sent to the address you provide.
Section - : Indicate appropriate information.
 
Keep one copy of the completed STD. R with the COBRA Election Form in the employee's personnel file and mail the original STD. R and COBRA payment to the:
 
California Department of Human Resources
Benefits Division/FlexElect Program
 S Street North Building, Suite 
Sacramento, CA -
 
Do not send any copies to SCO
 
 Retiring While Enrolled in FlexElect
Retired employees are not eligible for FlexElect. Accordingly, there are several different situations that may apply to employees who retire while enrolled in FlexElect. The following gives examples of these situations and the appropriate action that should be taken.
 
If employees retire and
 
Choose the Cash Option instead of their own medical insurance plan

Employees have up to days prior to and days following, the date of their retirement to enroll in any California Public Employees' Retirement System (CalPERS) medical insurance plan. If employees do not enroll within the specified time period, they must wait until the next health open enrollment period. The enrollment at that point would be handled through CalPERS.
 
Form processing

Enrolls in a health plan up to days prior to retirement: Employees must complete an HBD- to enroll in health and a STD. C to cancel their FlexElect enrollment. The Permitting Event Code to be used on the STD. C is , and the Permitting Event Date is the date the HBD- is received in the employing office (as shown on the form). Both forms should be submitted as a package to SCO for processing.
Enrolls in a health plan no later than days after retirement: The Personnel Office must complete an HBD- and submit to CalPERS for processing. It is not necessary for employees to complete a STD. C to cancel their FlexElect as their enrollment will be automatically terminated upon their retirement in SCO's payroll system.