California Code of Regulations › Title 10 - Investment › Chapter 5.8 - Managed Risk Medical Insurance Board Healthy Families Program › Article 2 - Eligibility, Application, and Enrollment › Section 2699.6625 - Annual Eligibility Review for Subscribers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Except as specified in (c), each
				subscriber will be re-evaluated annually prior to his or her anniversary date
				in the program to determine continued eligibility for the program. Applicants
				shall be notified of the annual eligibility review process at least sixty (60)
				calendar days prior to the anniversary date.
(b) Notwithstanding (a), as a condition of
				continuing coverage beyond the age of twelve (12) months, an applicant who
				enrolls an AIM infant into the program after nine months of age shall provide
				the information necessary to determine the infant's eligibility for ongoing
				coverage after the age of twelve (12) months at the time of
				enrollment.
(c) If subscribers for
				whom an applicant has applied have different anniversary dates, the annual
				eligibility review will be based on the anniversary date of the last subscriber
				to be enrolled, except as described in Subsection
				2699.6631(f).
(d) To requalify, an applicant must provide
				to the program all of the following information which is required to
				reestablish eligibility: the applicant's name and account number as stated on
				their billing statement; name and address of each enrolled person,
				documentation of gross income of each enrolled person's household as described
				in Subsection
				2699.6600(c)(1)(K),
				documentation of the subscriber's status as described in Subsection
				2699.6600(c)(1)(T),
				if requested in order to verify that the subscriber continues to reside
				lawfully in the United States, documentation of court ordered child support,
				and/or alimony paid, and child care and/or disabled dependent care expenses
				paid in order to determine income deductions as described in Subsection
				2699.6600(c)(1)(L),
				an indication of any pregnant family member living in the home and her expected
				due date, and a statement indicating which person(s) is currently enrolled in
				an employer sponsored health insurance plan. To avoid a break in coverage, all
				required information must be submitted at least ten (10) calendar days before
				the end of the month in which the anniversary date falls.
(e) Continued eligibility will be determined
				pursuant to Sections
				2699.6607 and
				2699.6611(a)(2).
(f) Unless disenrolled pursuant to Section
				2699.6611, persons shall continue
				to be considered eligible for the program for one year from the effective date
				of coverage, or if a later annual eligibility review date is established under
				(c), until that date.
1. New section
				  filed 2-20-98 as an emergency; operative 2-20-98 (Register 98, No. 8). A
				  Certificate of Compliance must be transmitted to OAL by 6-22-98 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 2-20-98 order transmitted to
				  OAL 6-5-98 and filed 7-15-98 (Register 98, No. 29).
3. Amendment of
				  section heading and section filed 5-26-99 as an emergency; operative 5-26-99
				  (Register 99, No. 22). A Certificate of Compliance must be transmitted to OAL
				  by 9-23-99 or emergency language will be repealed by operation of law on the
				  following day.
4. Certificate of Compliance as to 5-26-99 order
				  transmitted to OAL 9-17-99 and filed 10-28-99 (Register 99, No.
				  44).
5. Amendment of subsection (d) filed 1-10-2000 as an emergency;
				  operative 1-10-2000 (Register 2000, No. 2). A Certificate of Compliance must be
				  transmitted to OAL by 5-9-2000 or emergency language will be repealed by
				  operation of law on the following day.
6. Certificate of Compliance
				  as to 1-10-2000 order transmitted to OAL 5-5-2000 and filed 6-16-2000 (Register
				  2000, No. 24).
7. Amendment filed 4-29-2002 as an emergency;
				  operative 4-29-2002 (Register 2002, No. 18). Pursuant to Chapter 946, Statutes
				  of 2000, section
				  2, a Certificate of Compliance
				  must be transmitted to OAL by 10-28-2002 or emergency language will be repealed
				  by operation of law on the following day.
8. Certificate of
				  Compliance as to 4-29-2002 order transmitted to OAL 10-28-2002 and filed
				  12-12-2002 (Register 2002, No. 50).
9. Amendment of subsection (c)
				  filed 7-1-2004 as an emergency; operative 7-1-2004 (Register 2004, No. 27).
				  Pursuant to Section
				  80, A.B. 1762 (Chapter 230, Stats.
				  2003) a Certificate of Compliance must be transmitted to OAL by 12-28-2004 or
				  emergency language will be repealed by operation of law on the following
				  day.
10. Certificate of Compliance as to 7-1-2004 order, including
				  amendment of subsection (a), new subsection (b), subsection relettering and
				  amendment of newly designated subsections (c) and (f), transmitted to OAL
				  11-24-2004 and filed 1-7-2005 (Register 2005, No. 1).
11. Amendment
				  of subsection (e) and NOTE filed 11-30-2007 as an emergency; operative
				  11-30-2007 (Register 2007, No. 48). A Certificate of Compliance must be
				  transmitted to OAL by 5-28-2008 or emergency language will be repealed by
				  operation of law on the following day.
12. Certificate of Compliance
				  as to 7-31-2007 order transmitted to OAL 1-28-2008 and filed 3-12-2008
				  (Register 2008, No. 11).
13. Certificate of Compliance as to
				  11-30-2007 order transmitted to OAL 5-28-2008 and filed 7-7-2008 (Register
				  2008, No. 28).
14. Amendment of subsection (d) filed 9-29-2009 as an
				  emergency; operative 9-29-2009 (Register 2009, No. 40). A Certificate of
				  Compliance must be transmitted to OAL by 3-29-2010 or emergency language will
				  be repealed by operation of law on the following day.
15.
				  Certificate of Compliance as to 9-29-2009 order transmitted to OAL 3-29-2010
				  and filed 5-4-2010 (Register 2010, No. 19).
Note: Authority cited: Section
					 12693.21,
					 Insurance Code. Reference: Sections
					 12693.21,
					 12693.74
					 and
					 12693.96,
					 Insurance Code.