California Code of Regulations › Title 28 - Managed Health Care › Division 1 - The Department of Managed Health Care › Chapter 2 - Health Care Service Plans › Article 6 - Appeals on Cancellation › Section 1300.65.2 - Cancellations or Nonrenewals for Nonpayment of Premiums

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) General Requirements
(1) Applicability. This section shall apply
				  to all cancellations and nonrenewals for nonpayment of premiums pursuant to
				  Health and Safety Code section
				  1365(a)(1)(A),
				  unless an enrollee, subscriber, or group contract holder is entitled to a
				  longer grace period pursuant to state or federal law.
(2) Grace Period
(A) The grace period may not begin sooner
				  than the day after the last date of paid coverage. Grace period is defined in
				  California Code of Regulations, title 28, section
				  1300.65(a)(9).
(B) A plan shall provide coverage pursuant to
				  the terms of the contract during the entire grace period. The term "Grace
				  Period" does not include the "Federal Grace Period," as defined in California
				  Code of Regulations, title 28, section
				  1300.65(a)(8),
				  which applies to individuals receiving APTC pursuant to the PPACA, section
				  1401 (26 U.S.C. §
													36B).
(3) Notices
(A) Upon determining that an enrollee,
				  subscriber, or group contract holder has failed to make a premium payment by
				  the due date, the plan shall send a Notice of Start of Grace Period to the
				  enrollee, subscriber, or group contract holder, notifying the recipient that a
				  payment delinquency has triggered a grace period starting from the day the
				  Notice of Start of Grace Period is dated. This Notice shall, at minimum,
				  contain the information set forth in California Code of Regulations, title 28,
				  section 1300.65.2(b)(1).
(B) The plan shall send a Notice of Start of
				  Grace Period to each subscriber in a group contract unless:
(i) The plan contract requires the group
				  contract holder to promptly send any such Notice to each subscriber;
				  and
(ii) The plan sends the Notice
				  to the group contract holder designated in the plan
				  contract.
(C) A plan
				  shall not delegate the responsibility for sending the Notice of Start of Grace
				  Period to a group contract holder for each subscriber in the group unless the
				  plan has complied with California Code of Regulations, title 28, section
				  1300.65.2(a)(3)(B).
(D) In the case where a plan has delegated
				  the responsibility for sending the Notice of Start of Grace Period to a group
				  contract holder, the Notice of Start of Grace Period to the group contract
				  holder triggers the 30-day grace period. Any subsequent notice to the
				  subscribers in the group does not restart the 30-day grace period.
(E) For the purposes of this section, all
				  plans shall notify an enrollee, subscriber, or group contract holder when the
				  plan has cancelled, rescinded, or not renewed health coverage in one of the
				  following two ways:
(i) Send a written notice
				  of termination to the enrollee, subscriber, or group contract holder, when
				  required pursuant to California Code of Regulations, title 10, section
				  6506(e)(1). This
				  notice shall include the notice of grievance rights set forth in California
				  Code of Regulations, title 28, section
				  1300.65.5, and any notice required
				  under Health and Safety Code section
				  1366.50;
				  or
(ii) Send the Notice of End of
				  Coverage. This Notice shall be sent after the date coverage ends, and no later
				  than five calendar days after the date coverage ended. At a minimum, this
				  Notice shall contain the information set forth in California Code of
				  Regulations, title 28, section
				  1300.65.2(b)(2).
(4) Notwithstanding California Code of
				  Regulations, title 28, section
				  1300.65(a)(14), a
				  plan may implement a premium payment threshold policy, as defined in California
				  Code of Regulations, title 28, section
				  1300.65(a)(21).
(5) In the event the plan, after compliance
				  with all timing and notice requirements of this section, fails to receive all
				  outstanding premium amounts from the enrollee, subscriber, or group contract
				  holder on or before the last day of the grace period, as specified in the
				  Notice of Start of Grace Period, coverage may be cancelled prospectively only
				  after the expiration of the entire grace period.
(6) The plan shall continue the enrollee,
				  subscriber, and/or group contract holder's coverage uninterrupted pursuant to
				  the plan contract upon payment of all outstanding premium amounts at any time
				  before the expiration of the grace period.
(7) The enrollee, subscriber, or group
				  contract holder is financially responsible for any and all premiums and any
				  copayments, coinsurance, or deductible amounts obligated under the plan
				  contract, including those incurred for services received during the grace
				  period.