California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 5 - Application, Eligibility, and Enrollment Process for the Individual Exchange › Section 6506 - Termination of Coverage in a QHP

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Enrollee-initiated terminations shall be
				conducted in accordance with the following process:
(1) An enrollee may terminate their coverage
				in a QHP through the Exchange, including as a result of the enrollee obtaining
				other MEC, by notifying the Exchange or the QHP issuer.
(2) An enrollee may choose to remain enrolled
				in a QHP at the time of plan selection if they become eligible for other MEC
				and the enrollee does not request termination in accordance with subdivision
				(a)(1) of this section. If the enrollee does not choose to remain enrolled in a
				QHP in such a situation, the Exchange shall initiate termination of their
				enrollment in the QHP upon completion of the redetermination process specified
				in Section
				6496.
(3) An individual, including an enrollee's
				authorized representative, shall be permitted to report the death of an
				enrollee to the Exchange for purposes of initiating termination of the
				enrollee's coverage in accordance with the following requirements:
(A) The individual shall be at least 18 years
				old.
(B) If the individual
				reporting the death is the application filer, the enrollee's authorized
				representative, or anyone in the household of the deceased who was included in
				the initial application, they shall be permitted to initiate termination of the
				deceased's coverage.
(C) If the
				individual reporting the death is not the application filer, the enrollee's
				authorized representative, or anyone in the household of the deceased who was
				included in the initial application, they shall submit satisfactory
				documentation of death to the Exchange before they can initiate termination of
				the deceased's coverage. Satisfactory documentation may include a copy of a
				death certificate, obituary, medical record, power of attorney, proof of
				executor, or proof of estate. The documentation or an attached cover note shall
				provide the following information:
1. Full
				name of the deceased;
2. Date of
				birth of the deceased;
3. The
				Exchange application ID or case number (if known) of the deceased;
4. Social Security Number (if known) of the
				deceased; and
5. Contact
				information for the person submitting the documentation, including full name,
				address, and phone number.
(4) The Exchange shall permit an enrollee to
				retroactively terminate or cancel their coverage or enrollment in a QHP if the
				enrollee demonstrates to the Exchange that:
(A) They attempted to terminate their
				coverage or enrollment in a QHP and experienced a technical error that did not
				allow the enrollee to terminate their coverage or enrollment through the
				Exchange, and requests retroactive termination within 60 days after the
				enrollee discovered the technical error;
(B) Their enrollment in a QHP through the
				Exchange was unintentional, inadvertent, or erroneous and was the result of the
				error or misconduct of an officer, employee, or agent of the Exchange or HHS,
				its instrumentalities, a QHP issuer, or a non-Exchange entity providing
				enrollment assistance or conducting enrollment activities. Such enrollee must
				request cancellation within 60 days of discovering the unintentional,
				inadvertent, or erroneous enrollment. For purposes of this provision,
				misconduct, as determined by the Exchange, includes the failure to comply with
				applicable standards under this title, or other applicable Federal or State
				laws; or
(C) The enrollee was
				enrolled in a QHP without their knowledge or consent by any third party,
				including third parties who have no connection with the Exchange, and requests
				cancellation within 60 days of discovering of the enrollment.