Section 2699.6149 - Other Enrollment Additions for Individual MembersThe following shall apply to applications for coverage in the program for individual members and/or their dependents who are not late applicants and which were not part of the initial application of the qualified guaranteed association or submitted during an open enrollment process:
(a) Each application for individual members shall include:(1) The information required by Section 2699.6127 of this part.(2) If the individual member for whom coverage is requested previously had coverage under another employer's sponsored group plan at the time of notification by the guaranteed association, the individual member shall provide written proof of the individual member's previous coverage, and the date of termination of the previous coverage.(b) An individual member wishing to enroll additional dependents shall provide to the program on an enrollment application: (1) The information required by Section 2699.6127 of this part,(2) If the individual member requesting coverage previously did not elect or dropped coverage for the dependent because the dependent had coverage under another employer's sponsored group plan at the time of notification by the guaranteed association, the individual member shall provide written proof of the dependent's previous coverage, and the date of termination of the previous coverage,(3) Notification of 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 an enrolled individual member to enroll the dependent(s) in his or her health benefit plan, a written statement by the individual member that a court has ordered the individual member to provide the coverage.(c) If an individual member of a qualified guaranteed association is determined not to be eligible 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 individual member and the qualified guaranteed association shall be notified of the termination. The notice shall include the reason for the determination of ineligibility and an explanation of the appeal process. The portion of the individual member's premium covering amounts owed for coverage to persons found either to be ineligible or not an eligible dependent shall be refunded.(d) The individual member's premium shall be adjusted, if applicable, as of the date of any change in enrollment of the individual member and/or dependents.(e) Late applicants may not apply pursuant to this section.Cal. Code Regs. Tit. 10, § 2699.6149
1. Renumbering and amendment of former section 2699.6243.6 to section 2699.6149 filed 5-27-94; operative 5-27-94 (Register 94, No. 21). Note: Authority cited: Section 10731, Insurance Code. Reference: Sections 10731 and 10743, Insurance Code.
1. Renumbering and amendment of former section 2699.6243.6 to section 2699.6149 filed 5-27-94; operative 5-27-94 (Register 94, No. 21).