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 2699.6109 - Participation Requirements for Guaranteed Associations

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Qualified guaranteed associations shall
				be eligible to participate in the program to provide health benefits coverage
				for member employees and individual members. To be a qualified guaranteed
				association, a guaranteed association shall meet the following requirements:
(1) Send a notice to all members of the
				association, as well as any other person known to the association who although
				not an association member is in a category of persons who pursuant to (a)(9)
				below will be eligible for coverage through the guaranteed association, at
				their last known address that they may elect coverage through the guaranteed
				association, and that if they meet the qualifications to be a member employer,
				they may elect to provide coverage for their member employees through the
				guaranteed association. The notice shall state in bold face type that failure
				to elect coverage during the enrollment period permits the program to impose,
				at the time of the employer or person's later decision to elect coverage, an
				exclusion from coverage until the next open enrollment period, as well as,
				depending on the participating carrier selected by the person, a six months
				preexisting condition exclusion once enrolled, unless the individual member can
				demonstrate that he or she had other employer health coverage during the time
				of the enrollment period, or has been directed by court order to provide
				coverage for a spouse or minor child and the person has applied within thirty
				(30) days of losing that coverage. In addition to the initial notice, such
				notice shall be provided to all members who later join the guaranteed
				association and persons who become members of a sponsored category within 30
				days of the date they become members of the guaranteed association or sponsored
				category.
(2) Provide all
				potentially qualified member employers and individual members with at least
				thirty (30) calendar days to decide whether to apply for coverage through the
				program.
(3) Maintain for a period
				of one (1) year at the guaranteed association's principal place of business a
				copy of any notice required by (1) above as well as a list detailing to whom
				the notice was mailed and when.
(4)
				Not offer coverage anywhere but in the program.
(5) Provide coverage in the program to at
				least 1000 persons except for the following:
(A) Sixty (60) days prior to the expiration
				of an existing plan contract that expires prior to July 1, 1994, or, for plan
				contracts expiring after July 1, 1994, sixty (60) days prior to July 1, 1994 an
				association that meets the definition of a guaranteed association pursuant to
				Section 2699.6000 of this part, except for
				the requirements that one thousand (1,000) persons be covered, shall be able to
				participate in the program as if the association were a qualified guaranteed
				association if the persons sponsored by the association satisfy the criteria
				specified in (B) below.
(B) Persons
				determined to be eligible pursuant to (9) below applying to the program
				pursuant to (A) above shall not be qualified unless they:
1. Have been receiving coverage or had
				successfully applied for coverage through the association as of June 30, 1993,
				or
2. Have been receiving coverage
				through the association as of December 31, 1992, and whose coverage lapsed at
				any time thereafter because the employment through which coverage was received
				ended or an employer's contribution to health coverage ended, or
3. Have been covered at any time between June
				30, 1993, and July 1, 1994, under a contract that was in force on June 30,
				1993.
(6)
				Maintain at the guaranteed association's principal place of business and
				provide to the program upon request documents that verify that:
(A) The guaranteed association membership
				includes one or more employers meeting the criteria of a sole employer as
				defined in Section
				2699.6000.
(B) The guaranteed association does not
				condition membership directly or indirectly on the health claims history of any
				person,
(C) The guaranteed
				association uses membership dues solely for and in consideration of the
				membership and membership benefits,
(D) The guaranteed association is organized
				and maintained for purposes unrelated to insurance,
(E) The guaranteed association was in active
				existence on January 1, 1992, and for at least five (5) years prior to that
				date,
(F) The guaranteed
				association has been offering health insurance to its members that reside in
				California for at least five (5) years prior to January 1, 1992, and
(G) The guaranteed association has governing
				documents that provide for the election of its governing board by the
				membership of the association.
(7) For a guaranteed association that has
				provided coverage to its members through the mechanism of a trust, the
				guaranteed association shall provide at the program's request documentation
				that membership in the trust is coincidental with membership in the guaranteed
				association or that individual members are retired members or the spouse or
				dependents of a deceased member.
(8) Provide to the program documents that
				illustrate that the member employers and individual members purchasing coverage
				through the program are bona fide members of the guaranteed association or that
				individual members are retired members or a spouse of a deceased member, and
				provide to the program the beginning date of membership for each member
				employer and individual member.
(9)
				Determine what categories of persons who are not otherwise association members
				the guaranteed association will sponsor for coverage as members. These may only
				include employees of members, association staff, retired members, retired
				employees of members, and surviving spouses and dependents of deceased members.
				The guaranteed association shall commit to the program that the specified
				offering will continue until the guaranteed association's annual
				requalification.