Statutes, codes, and regulations
California Code Of Regulations
Title 10 - InvestmentChapter 5.5 - Major Risk Medical Insurance Board
Article 2 - Eligibility, Application, and Enrollment
Section 2698.202 - Determination of Eligibility

Cal. Code Regs. tit. 10 § 2698.202

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Current through Register 2024 Notice Reg. No. 45, November 8, 2024
Section 2698.202 - Determination of Eligibility
(a) Upon receipt of a complete application the program shall determine an applicant's eligibility based upon the criteria specified in section 2698.200.
(b)
(1) Applicants determined ineligible shall be notified in writing by the program, except as in (2) below. The notice shall include the reason for the determination of ineligibility and an explanation of the appeal process. The applicant's initial subscriber contribution shall be refunded.
(2) If an applicant is determined to be currently ineligible, but the applicant has documented pursuant to section 2698.201(d)(2)(U) that he/she will become eligible, the applicant shall be notified that the application will be held until the eligibility date specified, and on that date the applicant will be determined eligible. The applicant's initial subscriber contribution shall not be refunded, unless the applicant's eligibility date is more than 60 days from the date of the notification.
(c) Applicants and any dependents determined eligible shall be either enrolled or placed on a waiting list and shall be notified of their status.
(d) Eligible applicants and any dependents shall be enrolled in accordance with section 2698.203, unless one of the following circumstances exist:
(1) There are no participating health plans offered in the applicant's county of residence.
(2) A program funding shortfall has been projected.
(e) When the circumstances in (d)(1) or (2) exist, applicants and any dependents shall be placed on a waiting list in the order in which their completed applications were received by the program. When health plans are offered or funds become available, whichever is applicable, applicants and any dependents shall be enrolled in accordance with section 2698.203 based upon the order in which they appear on the program's waiting list.
(f) The program shall refund the initial subscriber contribution to all applicants who have been on the program's waiting list for more than 60 days from the date their completed applications were received. Such applicants shall, within 30 days of notification by the program that enrollment is possible, pay the initial subscriber contribution and notify the program of any additional dependents to be enrolled.
(g) The program shall complete the enrollment of an applicant on the waiting list within 15 days of receipt of payment of the initial subscriber contribution that has met the requirements of (f) of this section.

Cal. Code Regs. Tit. 10, § 2698.202

1. New section filed 12-20-90 as an emergency; operative 12-20-90 (Register 91, No. 11). A Certificate of Compliance must be transmitted to OAL by 4-19-91 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 12-20-90 order transmitted to OAL on 4-18-91 and filed 5-17-91 (Register 91, No. 27).
3. Editorial correction of printing error (Register 91, No. 27).
4. New subsection (g) filed 12-19-91 as an emergency; operative 12-19-91 (Register 92, No. 11). A Certificate of Compliance must be transmitted to OAL 4-17-92 emergency language will be repealed by operation of law on the following day.
5. Amendment of subsection (f) filed 3-10-92 as an emergency; operative 3-10-92 (Register 92, No. 19). A Certificate of Compliance must be transmitted to OAL 7-8-92 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 12-19-91 order including amendment of subsection (g) transmitted to OAL 4-8-92 and filed 5-20-92 (Register 92, No. 24).
7. Certificate of Compliance as to 3-10-92 order transmitted to OAL 6-30-92 and filed 7-29-92 (Register 92, No. 31).
8. Amendment of subsection (d), new subsection (e) and relettering and amendment of subsection (h) and NOTE filed 8-11-92; operative 9-11-92 pursuant to Government Code section 11346.2(d) (Register 92, No. 34).
9. Amendment filed 8-4-2003 as an emergency; operative 8-4-2003 (Register 2003, No. 32). Amendments to remain in effect for 180 days pursuant to section 21, chapter 794, Statutes of 2002 (AB 1401). A Certificate of Compliance must be transmitted to OAL by 2-2-2004 or emergency language will be repealed by operation of law on the following day.
10. Certificate of Compliance as to 8-4-2003 order transmitted to OAL 1-23-2004 and filed 3-1-2004 (Register 2004, No. 10).

Note: Authority cited: Sections 12711 and 12712, Insurance Code. Reference: Sections 12711, 12725 and 12728, Insurance Code.

1. New section filed 12-20-90 as an emergency; operative 12-20-90 (Register 91, No. 11). A Certificate of Compliance must be transmitted to OAL by 4-19-91 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 12-20-90 order transmitted to OAL on 4-18-91 and filed 5-17-91 (Register 91, No. 27).
3. Editorial correction of printing error (Register 91, No. 27).
4. New subsection (g) filed 12-19-91 as an emergency; operative 12-19-91 (Register 92, No. 11). A Certificate of Compliance must be transmitted to OAL 4-17-92 emergency language will be repealed by operation of law on the following day.
5. Amendment of subsection (f) filed 3-10-92 as an emergency; operative 3-10-92 (Register 92, No. 19). A Certificate of Compliance must be transmitted to OAL 7-8-92 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 12-19-91 order including amendment of subsection (g) transmitted to OAL 4-8-92 and filed 5-20-92 (Register 92, No. 24).
7. Certificate of Compliance as to 3-10-92 order transmitted to OAL 6-30-92 and filed 7-29-92 (Register 92, No. 31).
8. Amendment of subsection (d), new subsection (e) and relettering and amendment of subsection (h) and Note filed 8-11-92; operative 9-11-92 pursuant to Government Code section 11346.2(d) (Register 92, No. 34).
9. Amendment filed 8-4-2003 as an emergency; operative 8-4-2003 (Register 2003, No. 32). Amendments to remain in effect for 180 days pursuant to section 21, chapter 794, Statutes of 2002 (AB 1401). A Certificate of Compliance must be transmitted to OAL by 2-2-2004 or emergency language will be repealed by operation of law on the following day.
10. Certificate of Compliance as to 8-4-2003 order transmitted to OAL 1-23-2004 and filed 3-1-2004 (Register 2004, No. 10).