Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) A
qualified individual may enroll in a QHP, or an enrollee may change QHPs, only
during the initial open enrollment period, as specified in subdivision (b) of this
section, the annual open enrollment period, as specified in subdivision (d) of this
section, or a special enrollment period, as described in Section
6504, for which the qualified
individual has been determined eligible.
(b) The initial open enrollment period begins
October 1, 2013 and extends through March 31, 2014.
(c) Regular coverage effective dates for initial
open enrollment period for a QHP selection received by the Exchange from a qualified
individual:
(1) On or before December 23, 2013,
shall be January 1, 2014;
(2) On or
between December 24, 2013 and December 31, 2013, shall be February 1,
2014;
(3) On or between the first and
fifteenth day of the month for any month between January 2014 and March 31, 2014,
shall be the first day of the following month; and
(4) On or between the sixteenth and last day of
the month for any month between January 2014 and March 31, 2014, shall be the first
day of the second following month.
(d) Annual open enrollment period for benefit
years beginning:
(1) On January 1, 2015 begins on
November 15, 2014 and extends through February 15, 2015.
(2) On or after January 1, 2016 through December
31, 2018 begins on November 1, of the calendar year preceding the benefit year, and
extends through January 31 of the benefit year.
(3) On or after January 1, 2019 begins on November
1 and extends through December 15 of the calendar year preceding the benefit
year.
(4) On or after January 1, 2023
begins on November 1 of the calendar year preceding the benefit year, and extends
through January 31 of the benefit year.
(e) Beginning 2014, the Exchange shall provide a
written annual open enrollment notification to each enrollee no earlier than the
first day of the month before the open enrollment period begins and no later than
the first day of the open enrollment period.
(f) Coverage effective dates are as follows:
(1) For the benefit year beginning on January 1,
2015, for a QHP selection received by the Exchange from a qualified individual:
(A) From November 15, 2014 through December 15,
2014, shall be January 1, 2015;
(B) From
December 16, 2014 through January 15, 2015, shall be February 1, 2015; and
(C) From January 16, 2015 through February 15,
2015, shall be March 1, 2015.
(2) For the benefit year beginning on or after
January 1, 2016, for a QHP selection received by the Exchange from a qualified
individual:
(A) On or before December 15 of the
calendar year preceding the benefit year, shall be January 1;
(B) From December 16 of the calendar year
preceding the benefit year through January 15 of the benefit year, shall be February
1; and
(C) From January 16 through
January 31 of the benefit year, shall be March 1.
(3) For the benefit year beginning on or after
January 1, 2023, for a QHP selection received by the Exchange from a qualified
individual:
(A) From November 1 through December 31
of the calendar year preceding the benefit year, shall be no later than January 1 of
the benefit year; and
(B) From January 1
through January 31 of the benefit year, shall be no later than February 1 of the
benefit year.
(g) A
qualified individual's coverage shall be effectuated in accordance with the coverage
effective dates specified in subdivisions (c) and (f) of this section if:
(1) The individual makes their initial premium
payment, reduced by the APTC amount they are determined eligible for by the
Exchange, by the premium payment due date, as defined in Section
6410 of Article 2 of this chapter;
and
(2) The applicable QHP issuer
receives such payment on or before such due date.
Note: Authority cited: Section 100504, Government Code.
Reference: Sections 100502 and 100503, Government Code; and
45 CFR Section
155.410.
Note: Authority cited: Section
100504,
Government Code. Reference: Sections
100502 and
100503,
Government Code; and 45 CFR
Section
155.410.
