Section 2699.6183 - Disenrollment of Individual Members and Dependents(a) Individual members 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 individual member's participating guaranteed association is disqualified from the program.(2) The individual member 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 individual member.(3) The individual member requests disenrollment of him or herself and the individual member's dependents or the dependents only, either (A) Because the enrollee or dependents have obtained coverage under another employer sponsored plan or,(B) For any other reason.(4) The individual member ceases to be a member of or sponsored for coverage by the participating guaranteed association. The individual member shall inform the program if the member 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 individual member 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 fraud or misrepresentation, the program may disenroll the member and/or dependent as early as the date of the act of fraud or misrepresentation.(c) To request to disenroll pursuant to (a)(3), (a)(4), or (a)(5) above, a participating individual member 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.(d) If the program determines that an individual member is or was not a qualified individual member or a dependent is or was not a qualified dependent of the individual member, the program may disenroll the member or dependent. The disenrollment may take place as early as the date the individual member ceased being an individual member or dependent ceased being a dependent. If the program determines that the enrolled person never had qualifying status as an individual member or dependent, the disenrollment may take place as early as that person's original effective date of coverage.(e) An individual member and the participating guaranteed association shall be notified by the program in writing of the disenrollment and effective date of disenrollment of an individual member and/or dependents and the reason for the disenrollment.(f) The program shall notify the participating carrier of the date of disenrollment.(g) The individual member's premium shall be adjusted, if applicable, as of the effective date of any disenrollment.(h) If disenrollment pursuant to (a)(2) or (a)(3)(B) above, an individual member and dependents, if any, shall not be eligible for enrollment in the program for one (1) year from the date of disenrollment. If disenrolled pursuant to (a)(3)(A), an individual member or dependent who subsequently loses his or her coverage under an employer sponsored health plan can be re-enrolled in the program if the individual member or dependent is otherwise eligible and applies for enrollment pursuant to Section 2699.6149 within thirty (30) calendar days of losing coverage.Cal. Code Regs. Tit. 10, § 2699.6183
1. Renumbering and amendment of former section 2699.6262.5 to section 2699.6183 filed 5-27-94; operative 5-27-94 (Register 94, No. 21).
2. Amendment of subsections (a)(4)-(c), new subsection (d) subsection relettering and amendment of newly designated subsection (h) 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 2699.6262.5 to section 2699.6183 filed 5-27-94; operative 5-27-94 (Register 94, No. 21).
2. Amendment of subsections (a)(4)-(c), new subsection (d) subsection relettering and amendment of newly designated subsection (h) 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).