Section 2699.6147 - Other Enrollment Additions by Member Employers for Member EmployeesThe following shall apply to applications for coverage in the program for member employees and/or their dependents who are not late applicants and which were not part of the initial application period of the qualified guaranteed association 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 member 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 member employee whom the member employer seeks to add, a member 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 employee is an eligible employee.(3) If the employee for whom coverage is requested previously waived coverage because he or she had coverage under another employer's sponsored group plan, a copy of the certification signed by the 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 member employer wishing to enroll additional dependents of enrolled employees shall notify the program on an enrollment application of: (1) The information required by Section 2699.6121(d)(2)(I) of this part,(2) If the 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 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, and(4) If a court has ordered a member 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 member employer is determined not 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 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 premium covering amounts owed for coverage of persons found either to be ineligible or not an eligible dependent shall be refunded.(d) The member employer's premium shall be adjusted, if applicable, as of the date of any change in enrollment of eligible employee members and/or dependents.(e) Late applicants may not apply pursuant to this section.Cal. Code Regs. Tit. 10, § 2699.6147
1. Renumbering and amendment of former section 2699.6243.5 to section 2699.6147 filed 5-27-94; operative 5-27-94 (Register 94, No. 21).
2. Amendment of section heading, first paragraph, subsection (a) and NOTE 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 10743, Insurance Code.
1. Renumbering and amendment of former section 2699.6243.5 to section 2699.6147 filed 5-27-94; operative 5-27-94 (Register 94, No. 21).
2. Amendment of section heading, first paragraph, subsection (a) and Note 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).