reglab/statecodes huggingface dataset:
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6141 - Open Enrollment Period for Guaranteed Association Members

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The program
				shall provide for an annual open enrollment period which shall last for at
				least thirty (30) calendar days for guaranteed association members. During this
				period, enrolled member employees or individual members may transfer from one
				health benefits plan to another, member employees or individual members may
				choose to enroll themselves and their dependents in the program and enrolled
				member employees or individual members may choose to enroll their
				dependents.
(b) Late applicants may
				enroll during this period.
(c) If
				an employee of a qualified member employer or an individual member who applies
				during open enrollment 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 a dependent, the individual member or the member employer shall be notified
				of the determination. The member employer shall notify the member employees.
				The notice shall include the reason for the determination of ineligibility and
				an explanation of the appeal process. The portion of the individual premium
				covering amounts owed for coverage to persons found either to be ineligible or
				not a dependent shall be refunded.
(d) For member employees or individual
				members applying during an open enrollment period, the information required by
				Section 2699.6139(d)
				shall be submitted by the employer or individual member. Individual members
				shall not be required to submit state EDD wage reporting forms.
1. Renumbering
				  and amendment of former section
				  2699.6242.5 to section
				  2699.6141 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
2. Amendment of subsection (d) filed
				  10-18-95; operative 10-18-95 pursuant to Government Code section
				  11343.4(d)
				  (Register 95, No. 42).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6143 - Open Enrollment for Dental Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The program shall provide for an annual
				open enrollment period for dental benefits which shall last for at least (30)
				thirty consecutive days.
(b) During
				open enrollment the following may occur:
(1)
				Eligible employees and individual members, and dependents, who are enrolled for
				dental benefits may transfer from one dental benefits plan to
				another.
(2) Small employers and
				guaranteed associations may elect the dental benefit
				option.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6145 - Other Enrollment Additions by Sole Employers for Employees

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6146 - Later Addition of Member Employers and Individual Members

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The following shall apply to application for participation
				  for member employers and individual members who did not apply during the
				  initial enrollment of their guaranteed association:
(a) For member employers:
(1) A new member of the guaranteed
				association shall apply to participate as a member employer within 90 days of
				joining the guaranteed association.
(2) A current member of a guaranteed
				association who becomes eligible to participate as a member employer shall
				apply to participate as a member employer within 90 days of becoming
				eligible.
(3) A member of a
				guaranteed association who elected not to participate as a member employer
				during the guaranteed association's initial enrollment or open enrollment shall
				not be eligible to participate as a member employer until the next open
				enrollment.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6147 - Other Enrollment Additions by Member Employers for Member Employees

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The 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.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6149 - Other Enrollment Additions for Individual Members

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The 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.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6151 - Other Applications for Dental Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Sole employers who have elected the
				dental benefits option who are applying for coverage for sole employees or
				dependents pursuant to Section
				2699.6145 and member employers who
				have elected the dental benefits option who are applying for coverage for
				member employees or dependents pursuant to Section
				2699.6147 shall comply with the
				application requirements of Subsection
				2699.6129(c)(3) and
				(4).
(b) Individual members and dependents whose
				guaranteed association has elected the dental benefits option who are applying
				for coverage pursuant to Section
				2699.6149 shall comply with the
				application requirements of Subsection
				2699.6129(d).
1. New section
				  filed 5-23-94 as an emergency; operative 5-23-94 (Register 94, No. 21). A
				  Certificate of Compliance must be transmitted to OAL by 9-20-94 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 5-23-94 order transmitted to
				  OAL 9-16-94 and filed 10-27-94 (Register 94, No.
				  43).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6153 - Enrollment

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Sole employees and their dependents and guaranteed
				  association members and their dependents who have applied to the program and
				  have been accepted into the program shall be enrolled in a health benefit plan
				  of the sole employee's or guaranteed association member's choice available in
				  the service area of the sole employee's or guaranteed association member's
				  residence.
1. Renumbering
				  of former section
				  2699.6244 to section
				  2699.6153 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10733,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6155 - Selection of Dental Benefit Plan

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Sole employees and their dependents and guaranteed
				  association members and their dependents who have applied to the program for
				  dental benefits and have been accepted by the program for dental benefits shall
				  be enrolled in a dental benefit plan of the sole employee's or guaranteed
				  association member's choice available in the service area of the sole
				  employee's or guaranteed association member's residence.
1. New section
				  filed 5-23-94 as an emergency; operative 5-23-94 (Register 94, No. 21). A
				  Certificate of Compliance must be transmitted to OAL by 9-20-94 or emergency
				  language will be repealed by operation of law on the following
				  day.
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10733,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6157 - Special Initial Election for Dental Benefits. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New section
				  filed 5-23-94 as an emergency; operative 5-23-94 (Register 94, No. 21). A
				  Certificate of Compliance must be transmitted to OAL by 9-20-94 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 5-23-94 order transmitted to
				  OAL 9-16-94 and filed 10-27-94 (Register 94, No. 43).
3. Repealer
				  filed 10-18-95; operative 10-18-95 pursuant to Government Code section
				  11343.4(d)
				  (Register 95, No. 42).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10733,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6159 - Effective Date of Coverage for Sole Employees

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For enrolled sole employees and
				dependents, the effective date of coverage shall be as follows:
(1) For enrollees whose eligibility
				determination was made pursuant to Section
				2699.6131(a) the
				effective date of coverage shall be within twenty (20) calendar days of a
				determination of eligibility.
(2)
				For enrollees who enroll or transfer pursuant to Section
				2699.6139 the effective date of
				coverage shall be established by the program and shall be no later than
				forty-five (45) calendar days following the end of the open enrollment
				period.
(3) For enrollees who were
				enrolled pursuant to Section
				2699.6145 the effective date of
				coverage shall be determined by the program and shall be no later than
				forty-five (45) calendar days from the receipt of a complete
				application.
(4) For newborn or
				adopted children that are dependents, the effective date of coverage shall be
				upon birth or adoption of the child. The effective date for coverage for
				stepchildren that are dependents shall be upon marriage by a sole employee to
				the stepchild's parent. The effective date for coverage of a spouse shall be
				upon marriage.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6161 - Effective Date of Coverage for Member Employees

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For enrolled member employees and their
				dependents the effective date of coverage shall be as follows:
(1) For enrollees whose eligibility
				determination was made pursuant to Section
				2699.6133(b) the
				effective date of coverage shall be within twenty (20) calendar days of a
				determination of eligibility.
(2)
				For enrollees who enroll or transfer pursuant to Section
				2699.6141 the effective date of
				coverage shall be established by the program and shall be no later than
				forty-five (45) calendar days following the end of the open enrollment
				period.
(3) For enrollees who were
				enrolled pursuant to Section
				2699.6147 the effective date of
				coverage shall be determined by the program and shall be no later than
				forty-five (45) calendar days from the receipt of a complete
				application.
(4) For newborn or
				adopted children that are dependents, the effective date of coverage shall be
				upon birth or adoption of the child. The effective date for coverage for
				stepchildren that are dependents shall be upon marriage by a member employee or
				individual member to the stepchild's parent. The effective date for coverage of
				a spouse shall be upon marriage.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6163 - Effective Date of Coverage for Individual Members

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For enrolled individual members and their
				dependents the effective date of coverage shall be as follows:
(1) For enrollees whose eligibility
				determination was made pursuant to Section
				2699.6133(c) the
				effective date of coverage shall be within twenty (20) calendar days of a
				determination of eligibility.
(2)
				For enrollees who enroll or transfer pursuant to Section
				2699.6141 the effective date of
				coverage shall be established by the program and shall be no later than
				forty-five (45) calendar days following the end of the open enrollment
				period.
(3) For enrollees who
				enroll or transfer pursuant to Section
				2699.6149 the effective date of
				coverage shall be established by the program and shall be no later than
				forty-five (45) calendar days from the receipt of a complete
				application.
(4) For newborn or
				adopted children that are dependents, the effective date of coverage shall be
				upon birth or adoption of the child. The effective date for coverage for
				stepchildren that are dependents shall be upon marriage by a member employee or
				individual member to the stepchild's parent. The effective date for coverage of
				a spouse shall be upon marriage.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6165 - Effective Date of Coverage for Dental Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The effective date of dental coverage for
				an enrollee whose complete application is received by the program on or before
				the fifteenth day of the month shall be the first day of the next
				month.
(b) The effective date of
				dental coverage for an enrollee whose complete application is received by the
				program after the fifteenth day of the month shall be the first day of the
				month following the next month.
1. New section
				  filed 5-23-94 as an emergency; operative 5-23-94 (Register 94, No. 21). A
				  Certificate of Compliance must be transmitted to OAL by 9-20-94 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 5-23-94 order transmitted to
				  OAL 9-16-94 and filed 10-27-94 (Register 94, No.
				  43).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6167 - Participating Sole Employer Disqualification

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A sole employer shall be disqualified
				from participation in the program if any of the following occur:
(1) It is found by the program pursuant to
				Section 2699.6117 to no longer be a
				qualified sole employer. However, an employer shall not be determined to be no
				longer eligible to participate in the program solely because the employer
				employs more than 50 eligible employees, provided the employer employs no more
				than 100 eligible employees.
(2) It
				is found by the program to no longer be in compliance with the participation
				requirements as set forth in Section
				2699.6107.
(3) It fails to pay the monthly employer
				premium for the enrolled sole employees and enrolled dependents as set forth in
				Section 2699.6311 and
				2699.6313 of this
				chapter.
(4) It so requests in
				writing. Such requests shall be provided to the program at least thirty (30)
				calendar days prior to the effective date of the requested
				disqualification.
(5) It has
				committed an act of fraud or misrepresentation to circumvent the statutes or
				regulations of the program.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6169 - Disqualification of Guaranteed Associations

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A guaranteed association shall be
				disqualified from participation in the program if any of the following occur:
(1) It is found by the program to no longer
				be a qualified guaranteed association.
(2) It so requests in writing. Such requests
				shall be provided to the program at least sixty (60) calendar days prior to the
				effective date of the requested disqualification.
(3) It has committed an act of fraud or
				misrepresentation to circumvent the statutes or regulations of the
				program.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6171 - Continuation of Coverage upon Disqualification of Guaranteed Association

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) If a guaranteed
				association is disqualified a member employer which meets the definition of
				sole employer set forth in Section
				2699.6000 may continue coverage in
				the program without the sponsorship of a guaranteed association by notifying
				the program in writing of the member employer's change in status to sole
				employer. All member employees of the employer will become sole
				employees.
(b) Individual members
				shall not be continued in the program without the sponsorship of a qualified
				guaranteed association.
1. Renumbering
				  and amendment of former section
				  2699.626.15 to section
				  2699.6171 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6173 - Disqualification of Member Employers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A member employer shall be disqualified
				from participation in the program if any of the following occur:
(1) Their guaranteed association is
				disqualified and the member employer does not change its status to sole
				employer pursuant to 2699.6171.
(2)
				It is found by the program pursuant to Section
				2699.6119(b) to
				no longer be a qualified member employer.
(3) It is found by the program to no longer
				be in compliance with the participation requirements as set forth in Section
				2699.6111.
(4) It fails to pay the monthly employer
				premium for the enrolled member employees and enrolled dependents as set forth
				in Sections
				2699.6311 and
				2699.6315 of this part.
(5) It so requests in writing. Such requests
				shall be provided to the program at least thirty (30) calendar days prior to
				the effective date of the requested disqualification.
(6) It has committed an act of fraud or
				misrepresentation to circumvent the statutes or regulations of the
				program.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6175 - Disqualification of Individual Members

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An individual member shall be
				disqualified from participation in the program if any of the following occur:
(1) If the guaranteed association is
				disqualified.
(2) He or she is
				found by the program to no longer be a qualified individual member.
(3) The individual member fails to pay the
				monthly individual member premium for the enrolled individual member and
				enrolled dependents as set forth in Sections
				2699.6311 and
				2699.6313 of this part.
(4) The individual member so requests in
				writing. Such requests shall be provided to the program at least thirty (30)
				calendar days prior to the effective date of the requested
				disqualification.
(5) The
				individual member has committed an act of fraud or misrepresentation to
				circumvent the statutes or regulations of the program.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6176 - Disqualification for Dental Benefits Coverage

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A small employer or individual member
				shall be disqualified from participation in the dental benefits option in the
				program if any of the following occur:
(1) It
				is disqualified by the program pursuant to Sections
				2699.6167,
				2699.6173, or
				2699.6175 from participation for
				health benefits coverage.
(2) The
				small employer or guaranteed association of an individual member fails to meet
				the requirements of Section
				2699.6115
(3) It so requests in writing. Such requests
				shall be provided to the program in writing before the due date of the dental
				benefits premium.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6177 - Disenrollment of Sole Employees

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(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.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6181 - Disenrollment of Member Employees and Dependents

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Member 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 member employee's guaranteed association is disqualified. However, the
				member employee shall not be disenrolled if the member employer notifies the
				program that the member employer is changing to sole employer status.
(2) The enrolled member employee's
				participating employer is disqualified from the program.
(3) The enrolled member 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.
(4) The enrolled member employee requests
				disenrollment through a participating employer of him or herself and the
				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.
(5) The employee ceases to be a member
				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 member employee ceases to be
				eligible by the end of the month in which the event occurs.
(6) 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.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6183 - Disenrollment of Individual Members and Dependents

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(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.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6185 - Discontinuance of Dental Benefits Coverage

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Sole employees and individual members,
				and their dependents shall be discontinued from dental coverage under the
				following circumstances:
(1) The enrollee is
				disenrolled from health benefits coverage in the program.
(2) The participating employer of an eligible
				employee is disqualified for the dental benefits option.
(3) The guaranteed association of an
				individual member is disqualified for the dental benefits
				option.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6187 - Transfer of Enrollment for Sole and Member Employees

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Other than transfers requested during an
				open enrollment period, an enrolled member or sole employee and enrolled
				dependents shall be transferred from one participating carrier to another if
				any of the following occurs:
(1) The
				participating employer so requests, in writing, because the employee has moved
				and no longer resides in an area served by the participating carrier in which
				the enrolled employee is enrolled, and there is at least one participating
				carrier serving the area in which the enrolled employee now resides.
(2) The participating employer so requests,
				in writing, on behalf of the employee, or the participating carrier so
				requests, in writing, because of failure to establish a satisfactory
				relationship between the enrolled employee or enrolled dependent and the
				participating carrier, and the Executive Director determines that the transfer
				is in the best interests of the program, and there is at least one other
				participating carrier serving the area in which the enrolled employee
				resides.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6189 - Transfer of Enrollment for Individual Members

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Other than transfers requested during an
				open enrollment period, enrolled individual members and enrolled dependents
				shall be transferred from one participating carrier to another if any of the
				following occurs:
(1) The individual member
				so requests, in writing, because the individual member has moved and no longer
				resides in an area served by the participating carrier in which the individual
				member is enrolled, and there is at least one participating carrier serving the
				area in which the individual member now resides.
(2) The individual member so requests, in
				writing, or the participating carrier so requests, in writing, because of
				failure to establish a satisfactory relationship between the individual member
				and the participating carrier, and the Executive Director determines that the
				transfer is in the best interests of the program, and there is at least one
				other participating carrier serving the area in which the individual member
				resides.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6191 - Cobra Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				Qualified small employers that have enrollees who qualify for extended coverage
				under the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 as
				amended shall be permitted to obtain such coverage by notifying the program in
				writing of the enrollees' intent to obtain COBRA coverage and the information
				required by Section
				2699.6177(c).
(b) The program shall notify the employer
				consistent with the requirements of COBRA of any necessary procedures for
				obtaining enrollee COBRA coverage within fifteen (15) calendar days of
				notification pursuant to (a) above.
(c) The COBRA eligible former employee will
				be individually billed and shall be responsible for making all premium payments
				pursuant to the same standards of payment for employers in Article 4 (Sections
				2699.6300 et seq.) and the payment
				requirements of COBRA, for as long as the former employee and enrolled
				dependents remain eligible for COBRA coverage.
(d) Nothing in this part shall relieve any
				small employer or any participating carrier of their obligations as set forth
				in the Consolidated Omnibus Reconciliation Act of 1986 as amended.
1. Renumbering
				  and amendment of former section
				  2699.6271 to section
				  2699.6191 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
2. Amendment of subsection (b) 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: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6193 - Transfer of Enrollment for Dental Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Other than transfers requested during an
				open enrollment period, an enrollee shall be transferred from one participating
				carrier to another if any of the following occurs:
(1) The participating employer on behalf of
				the employee, or the individual member, so requests, in writing, because the
				enrollee has moved and no longer resides in an area served by the participating
				dental benefits carrier in which the enrollee is enrolled, and there is at
				least one participating dental benefits carrier serving the area in which the
				enrollee now resides.
(2) The
				participating employer on behalf of the employee, or the individual member, so
				requests, in writing, or the participating dental benefits carrier so requests,
				in writing, because of failure to establish a satisfactory relationship between
				the enrollee and the participating dental benefits carrier, and the Executive
				Director determines that the transfer is in the best interests of the program,
				and there is at least one other participating dental carrier serving the area
				in which the enrolled employee resides.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6195 - Payment to Insurance Agents and Brokers for Member Employers and Individual Members when Premiums Collected by Guaranteed Association

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) This subsection applies to guaranteed
				associations with an effective date of coverage prior to September 1, 1998 that
				have not made an election pursuant to Section
				2699.6116.
(1) When the qualified guaranteed association
				collects the employer premium and individual member premium from the member
				employers and the individual members it shall be as follows:
(A) The guaranteed association may collect
				from its members and pay to agents as defined in Section
				31 of the
				Insurance Code or brokers as defined in Section
				33 of the
				Insurance Code an amount consistent with the policies and practices of the
				qualified guaranteed association.
(B) The employer premium or individual member
				premium shall include an agent or broker fee if the guaranteed association has
				elected to utilize the services of an agent or
				broker.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6198 - Payment to Insurance Agents and Brokers for Dental Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) If the employer
				premium or individual member premium includes an agent or broker fee pursuant
				to the provisions of Sections
				2699.6194,
				2699.6196, and
				2699.6197, the employer premium or
				the individual member premium shall include an additional $1.00 per month agent
				or broker fee for each enrollee receiving dental coverage in the
				program.
(b) An employer premium or
				individual member premium paid as described in Section
				2699.6195 shall include an agent
				or broker fee for the dental benefits option as determined by the qualified
				guaranteed association.
1. New section
				  filed 5-23-94 as an emergency; operative 5-23-94 (Register 94, No. 21). A
				  Certificate of Compliance must be transmitted to OAL by 9-20-94 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 5-23-94 order transmitted to
				  OAL 9-16-94 and filed 10-27-94 (Register 94, No.
				  43).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6201 - Scope of Dental Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The basic scope of benefits offered by a
				participating dental carrier as a dental benefit plan shall include all of the
				benefits and services listed in this section, subject to the exclusions listed
				in Section
				2699.6205. No other dental
				benefits shall be permitted to be offered by a participating dental carrier.
				The basic scope of dental benefits shall be as follows:
(1) Diagnostic and Preventive Benefits
(A) Initial, periodic and emergency oral
				examinations, limited as follows:
1. Routine
				oral examinations: one every six months per enrollee.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6203 - Excluded Health Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Health benefits plans offered under this
				program shall exclude the following benefits:
(1) Services, supplies, items, procedures or
				equipment which are not medically necessary. "Medically necessary" as applied
				to the diagnosis or treatment of illness is an article or service that is not
				investigational and is necessary because:
(A)
				It is appropriate and is provided in accordance with accepted medical standards
				in the state of California, and could not be omitted without adversely
				affecting the patient's condition or the quality of medical care rendered;
				and
(B) As to inpatient care, it
				could not have been provided in a physician's office, in the outpatient
				department of a hospital, or in a less costly facility without adversely
				affecting the patient's condition or the quality of medical care rendered;
				and
(C) If the proposed article or
				service is not commonly used, its application or proposed application has been
				preceded by a thorough review and application of conventional therapies;
				and
(D) The service or article has
				been demonstrated to be of significantly greater therapeutic value than other,
				less expensive, services or articles.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6205 - Excluded Dental Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Dental benefits plans offered under this
				program shall exclude the following benefits:
(1) Procedures, treatment or products which
				are not necessary for the patient's dental health. Procedures, treatments, or
				products are considered necessary for the patient's dental health if they are
				not investigational and are necessary because:
(A) They are appropriate and are provided in
				accordance with accepted dental care standards in the state of California, and
				could not be omitted without adversely affecting the patient's condition or the
				quality of dental care rendered; and
(B) If the proposed article or service is not
				commonly used, its application or proposed application has been preceded by a
				thorough review and application of conventional therapies; and
(C) The service or article has been
				demonstrated to be of significantly greater therapeutic value than other, less
				expensive, services or articles.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6207 - Administration of Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A participating carrier shall administer each of its health
				  benefits plans pursuant to the carrier's administrative procedures, medical
				  protocols and medical review criteria and procedures.
1. Renumbering
				  of former section
				  2699.632 to section
				  2699.6207 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.