Section 2699.6177 - Disenrollment of Sole Employees(a) Sole employees and their dependents, if any, shall be disenrolled from the program and from the program's participating carriers when any of the following occur: (1) The enrolled sole employee's participating employer is disqualified from the program.(2) The enrolled sole employee or dependents, if any, has committed an act of fraud or misrepresentation to circumvent the statutes or regulations of the program or the rules of the participating carrier selected by the sole employee.(3) The enrolled sole employee requests disenrollment through a participating employer of him or herself and the employee's dependents or the dependents only, either (A) Because the sole enrollee or dependents have obtained coverage under another employer sponsored plan or,(B) For any other reason.(4) The employee ceases to be a sole employee of the participating employer. However, the former employee and the former employee's qualified dependents may continue in the program pursuant to Section 2699.6191, COBRA Benefits. The employer shall inform the program when an eligible sole employee ceases to be eligible by the end of the month in which the event occurs.(5) A dependent ceases to be a dependent as defined in Section 2699.6000. The employer shall inform the program when an eligible dependent ceases to be eligible by the end of the month in which the event occurs.(b) The program shall disenroll an enrollee pursuant to (a)(1) or (a)(2) above within sixty (60) calendar days of the program's determination to disenroll unless disenrollment is retroactive. If the program determines that an enrolled sole employee and/or dependent has committed an act of fraud or misrepresentation, the program may disenroll the employee and/or dependent as early as the date of the act of fraud or misrepresentation.(c) To request to disenroll enrollees pursuant to (a)(3), (a)(4), or (a)(5) above, a participating employer shall notify the program of the full names, addresses, dates of birth, sex, and social security numbers of the enrollees to be disenrolled. If disenrolled pursuant to (a)(3), the effective date of the disenrollment shall be no later than 60 days from receipt of the notice. Disenrollment will be no earlier than the end of the month in which notice is received. However, if notice is received by the first working day of a month, the disenrollment may be effective on the last day of the previous calendar month. If disenrolled pursuant to (a)(4) or (a)(5), the disenrollment shall be no later than 60 days from receipt of the request unless disenrollment is retroactive, in accordance with (d) below.(d) If the program determines that an employee is or was not a qualified sole employee of a participating employer or a dependent is or was not a dependent of a sole employee, the program may disenroll the employee or dependent. The disenrollment may take place as early as the date the employee ceased being a sole employee or the dependent ceased being a dependent. If the program determines that the enrolled person never had qualifying status as a sole employee or dependent, the disenrollment may take place as early as that person's original effective date of coverage.(e) A participating employer shall be notified by the program in writing of the disenrollment and effective date of disenrollment of a sole employee and/or dependents and the reason for the disenrollment.(f) The program shall notify the participating carrier of the date of disenrollment.(g) The sole employer's premium shall be adjusted, if applicable, as of the effective date of any disenrollment.(h) If disenrolled pursuant to (a)(2) or (a)(3)(B) above, an individual sole employee and dependents, if any, shall not be eligible for enrollment in the program through the same participating employer for one year from the date of disenrollment. If disenrolled pursuant to (a)(3)(A), an employee or dependent who subsequently loses his or her coverage under another employer sponsored health plan can be re-enrolled in the program if the employee or dependent is otherwise eligible and applies for enrollment pursuant to Section 2699.6145 within thirty (30) calendar days of losing coverage.Cal. Code Regs. Tit. 10, § 2699.6177
1. Renumbering and amendment of former section 2699.6261 to section 2699.6177 filed 5-27-94; operative 5-27-94 (Register 94, No. 21).
2. Amendment of subsections (a)(4)-(5), (b)-(d), subsection relettering, and new subsection (g) filed 6-16-95 as an emergency; operative 6-16-95 (Register 95, No. 24). A Certificate of Compliance must be transmitted to OAL by 10-16-95 or emergency language will be repealed by operation of law on the following day.
3. Certificate of Compliance as to 6-16-95 order transmitted to OAL 9-26-95 and filed 10-18-95 (Register 95, No. 42). Note: Authority cited: Section 10731, Insurance Code. Reference: Sections 10731 and 10743, Insurance Code.
1. Renumbering and amendment of former section 2699.6261 to section 2699.6177 filed 5-27-94; operative 5-27-94 (Register 94, No. 21).
2. Amendment of subsections (a)(4)-(5), (b)-(d), subsection relettering, and new subsection (g) filed 6-16-95 as an emergency; operative 6-16-95 (Register 95, No. 24). A Certificate of Compliance must be transmitted to OAL by 10-16-95 or emergency language will be repealed by operation of law on the following day.
3. Certificate of Compliance as to 6-16-95 order transmitted to OAL 9-26-95 and filed 10-18-95 (Register 95, No. 42).