Cal. Code Regs. tit. 10 § 2699.6145

Current through Register 2024 Notice Reg. No. 45, November 8, 2024

Section 2699.6145 - Other Enrollment Additions by Sole Employers for Employees

The following shall apply to applications for coverage in the program for sole employees and/or their dependents who are not late applicants and which were not part of the initial application of the qualified sole employer or submitted during an open enrollment process. An application for coverage shall be made within 45 days prior to or 60 days after the date the employee becomes an eligible employee. If the application is not made by 60 days after the employee became eligible, the employee shall be considered a late applicant, and also:

(a) For each sole employee whom the sole employer seeks to add, a sole employer shall notify the program in the manner specified by the program of:

(1) The information required by Section 2699.6121(d)(2) of this part.

(2) A declaration that the sole employee is an eligible employee.

(3) If the sole employee for whom coverage is requested previously waived or dropped coverage because he or she had coverage under another employer's sponsored group plan, a copy of the certification signed by the eligible employee attesting to his or her coverage if applicable, written proof of the eligible employee's previous coverage, and the date of termination of the previous coverage.

(b) A sole employer, wishing to enroll additional dependents of enrolled employees shall notify the program in the manner specified by the program of:

(1) The information required by Section 2699.6121(d)(2)(I) of this part,

(2) If the sole employee requesting coverage previously waived or dropped coverage for the dependent because the dependent had coverage under another employer's sponsored group plan, a copy of the certification signed by the sole employee attesting to the dependent's coverage, written proof of the dependent's previous coverage, and the date of termination of the previous coverage,

(3) The birth or adoption of a child, or the addition of a stepchild or spouse, within thirty (30) calendar days of the event to continue coverage of the newborn, adopted child, stepchild, or spouse.

(4) If a court has ordered an enrolled sole employee to enroll the dependent(s) in his or her health benefit plan, a written statement by the employee that a court has ordered the employee to provide the coverage.

(c) If an employee of a qualified sole employer is determined not to be an eligible employee by the program, or if a person for whom coverage as a dependent has been requested is determined not to be an eligible dependent, the sole employer shall be notified of the determination and the sole 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 sole employer's premium covering amounts owed for coverage to persons found either to be ineligible or not an eligible dependent shall be refunded.

(d) The sole employer premium shall be adjusted, if applicable, as of the date of any change in enrollment of sole employees and/or dependents.

(e) Late applicants may not apply pursuant to this section.

Cal. Code Regs. Tit. 10, § 2699.6145

1. Renumbering and amendment of former section 2699.6243 to section 2699.6145 filed 5-27-94; operative 5-27-94 (Register 94, No. 21).
2. Amendment of section heading, first paragraph and subsections (b) and (c) 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 including amendment of subsecdtion (b) 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 10743, Insurance Code.