California Health and Safety Code 1399.62 – (a) Every contract containing hospital, medical, or surgical …
(a) Every contract containing hospital, medical, or surgical expense benefits or service benefits shall contain a reasonable extension of such benefits upon discontinuance of the contract with respect to employees or dependents who become totally disabled while enrolled under the contract on or after the date this article becomes applicable to such contract and who continue to be totally disabled at the date of discontinuance of the contract.
(b) Every contract providing hospital, medical or surgical expense benefits or service benefits shall be deemed to include a reasonable extension of such benefits upon discontinuance of the contract if it provides benefits for covered services directly relating to the condition causing total disability existing at the time dues payments cease for the employee or dependent and incurred during a period of not less than 12 months thereafter, which period shall not be interrupted by discontinuance of the contract.
Terms Used In California Health and Safety Code 1399.62
- Carrier: shall mean the health care service plan or other entity responsible for the payment of benefits or provision of services under a group contract. See California Health and Safety Code 1399.61
- Contract: shall mean any group health care service plan or contract subject to the provisions of this article. See California Health and Safety Code 1399.61
- Contract: A legal written agreement that becomes binding when signed.
- Dependent: A person dependent for support upon another.
- Discontinuance: shall mean the termination of the contract between the entire employer unit under a contract and the health care service plan, and does not refer to the termination of any agreement between any individual member under a contract and the health care service plan. See California Health and Safety Code 1399.61
- Dues: shall mean the consideration payable to the carrier. See California Health and Safety Code 1399.61
- Employee: shall mean all agents, employees, and members of unions or associations to whom benefits are provided under a contract. See California Health and Safety Code 1399.61
- Extension of benefits: shall mean the continuation of coverage under a particular benefit provided under a contract following discontinuance with respect to an employee or dependent who is totally disabled on the date of discontinuance. See California Health and Safety Code 1399.61
- Replacement coverage: shall mean the benefits provided by a succeeding carrier. See California Health and Safety Code 1399.61
That extension of benefits may be terminated at such time as the employee or dependent is no longer totally disabled or at such time as a succeeding carrier may elect to provide replacement coverage to that employee or dependent without limitation as to the disabling condition.
(c) The services provided during any extension of benefits may be subject to all limitations or restrictions contained in the contract.
(Amended by Stats. 1983, Ch. 888, Sec. 1.)