California Code of Regulations
Title 10 - Investment
Chapter 12 - California Health Benefit Exchange
Article 4 - General Provisions
Section 6454 - General Standards for Exchange Notices

Universal Citation: 10 CA Code of Regs 6454

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

(a) Any notice of action required to be sent by the Exchange to individuals or employers shall be written and include:

(1) An explanation of the action reflected in the notice, including the effective date of the action;

(2) Any factual bases upon which the decision was made;

(3) Citations to, or identification of, the relevant regulations supporting the action;

(4) Contact information for available customer service resources, including local legal aid and welfare rights offices; and

(5) An explanation of appeal rights, as specified in Section 6604(b) of Article 7 of this chapter.

(b) All Exchange notices shall conform to the accessibility and readability standards specified in Section 6452.

(c) The Exchange shall, at least annually, reevaluate the appropriateness and usability of all notices.

(d) The individual market Exchange shall provide required notices either through standard mail, or if an individual elects, electronically, provided that the requirements for electronic notices in 42 CFR Section 435.918 (July 15, 2013), hereby incorporated by reference, are met, except that the individual market Exchange shall not be required to implement the process specified in 42 CFR Section 435.918(b)(1) for eligibility determinations for enrollment in a QHP through the Exchange and IAPs that are effective before January 1, 2015.

(e) Unless otherwise required by federal or State law, the SHOP shall provide required notices electronically, or if an employer or employee elects, through standard mail. If notices are provided electronically, the SHOP shall comply with the requirements for electronic notices in 42 CFR Section 435.918(b)(2) through (5) for the employer or employee.

(f) In the event that the individual market Exchange or SHOP is unable to send select required notices electronically due to technical limitations, it may instead send these notices through standard mail, even if an election has been made to receive such notices electronically.

Note: Authority cited: Section 100504, Government Code. Reference: Sections 100502 and 100503, Government Code; 42 CFR Section 435.918; and 45 CFR Section 155.230.

Note: Authority cited: Section 100504, Government Code. Reference: Sections 100502 and 100503, Government Code; 42 CFR 435.918; and 45 CFR Section 155.230.

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