Section 2699.6133 - Initial Qualification for the Program for Guaranteed Associations and Association Members(a) Upon receipt of a complete application from a guaranteed association, the program shall determine tentatively the guaranteed association's qualification for the program subject to compliance with Subsection 2699.6109(a)(5). Upon tentative determination that the guaranteed association is a qualified guaranteed association, the program in consultation with the qualified guaranteed association shall institute a process for gathering applications from member employers, member employees, and individual members. No application from a member employer, member employee, or individual member shall be considered complete until the guaranteed association is determined to be qualified for participation in the program.(b) Upon receipt of a complete application from a member employer, at any time other than open enrollment, the program shall determine the member employer's qualification for the program, determine the eligibility of each of the employees that apply for coverage, and determine whether each person for whom coverage as a dependent has been requested is a dependent. The program may rely upon the application to determine the employer member's qualification. The determination shall be made: (1) Within ten calendar days of receipt of a complete application from a member employer and member employees.(c) Upon receipt of a complete application from an individual member during the initial open enrollment period of their guaranteed association, the program shall determine the individual member's qualification for the program and determine whether each person for whom coverage as a dependent has been requested is a dependent. The program may rely upon the application to determine the individual member's qualification. The determination shall be made after sixty (60) calendar days and within seventy (70) calendar days of receipt of a complete application from an individual member. However, if the individual member has qualifying prior coverage at the time of application the determination shall be made within ten (10) calendar days.(d) Guaranteed association members determined not qualified for the program will be notified in writing by the program. The guaranteed association shall also be notified. The notice shall include the reason for the determination of disqualification and an explanation of the appeal process. The guaranteed association member's initial premium shall be refunded.(e) If an employee of a qualified member employer is determined not to be a sole employee by the program, or if a person for whom coverage as a dependent has been requested is determined not to be a dependent, the member employer shall be notified of the determination and the member employer shall notify the employee. The notice shall include the reason for the determination of ineligibility and an explanation of the appeal process. The portion of the member employer's initial premium covering amounts owed for coverage to persons found either to be ineligible or not a dependent shall be refunded.Cal. Code Regs. Tit. 10, § 2699.6133
1. Renumbering of former section 2699.624.5 to section 2699.6133 filed 5-27-94; operative 5-27-94 (Register 94, No. 21).
2. Amendment of subsections (a), (b), (c) and (e) filed 12-29-94 as an emergency; operative 12-29-94 (Register 94, No. 52). A Certificate of Compliance must be transmitted to OAL 4-28-95 or emergency language will be repealed by operation of law on the following day.
3. Certificate of Compliance as to 12-29-94 order transmitted to OAL 4-12-95 and filed 5-22-95 (Register 95, No. 21). Note: Authority cited: Section 10731, Insurance Code. Reference: Sections 10731 and 10741, Insurance Code.
1. Renumbering of former section 2699.624.5 to section 2699.6133 filed 5-27-94; operative 5-27-94 (Register 94, No. 21).
2. Amendment of subsections (a), (b), (c) and (e) filed 12-29-94 as an emergency; operative 12-29-94 (Register 94, No. 52). A Certificate of Compliance must be transmitted to OAL 4-28-95 or emergency language will be repealed by operation of law on the following day.
3. Certificate of Compliance as to 12-29-94 order transmitted to OAL 4-12-95 and filed 5-22-95 (Register 95, No. 21).