California Code of Regulations
Title 10 - Investment
Chapter 5.5 - Major Risk Medical Insurance Board
Article 2 - Eligibility, Application, and Enrollment
Section 2698.200 - Basis of Eligibility

Universal Citation: 10 CA Code of Regs 2698.200

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

(a) All eligibility requirements contained herein shall be applied without regard to sex, race, creed, color, sexual orientation, health status, national origin, occupation, or occupational history of the individual applying for the program.

(b) To be eligible for the program, an applicant shall meet the requirements of either (1) or (2):

(1) Meet all of the following requirements;
(A) Be a resident of the State of California; and

(B) Not be eligible for Part A and Part B of Medicare, except those applicants on Medicare solely because of end-stage renal disease; and

(C) Not be eligible to purchase any health insurance for continuation of benefits under the provisions of Health and Safety Code section 1366.20 et. seq., or under the provisions of Insurance Code section 10128.50 et. seq. or have exhausted any health insurance for continuation of benefits under the provisions of 29 US Code 1161 et. seq.; and

(D) Be unable to secure adequate private coverage. An individual shall be deemed unable to secure adequate private health coverage if the individual within the previous 12 months:
1. Has been denied individual coverage; or

2. Has been involuntarily terminated from health insurance coverage for reasons other than nonpayment of premium or fraud; or

3. Has been offered an individual, not a group, health insurance premium rate in excess of the subscriber rate for the individual's first choice participating health plan.

(E) Clauses 2 and 3 of subparagraph (D) shall not apply to applications received on and after January 1, 2014.

(2) Be a dependent of an individual meeting the requirements of (b)(1) of this section.

(c) To remain eligible a subscriber, enrolled dependent or dependent subscriber shall:

(1) Remain a resident of the State of California; and

(2) Not become eligible for Part A and Part B of Medicare, except those applicants who become eligible for Medicare solely because of end-stage renal disease; and

(3) Not exceed a total of 36 consecutive months of enrollment from his/her respective start of coverage date in the program as required by section 2698.204(a)(7); and

(4) Make subscriber contribution payments as required by section 2698.403.

1. New section filed 12-20-90 as an emergency; operative 12-20-90 (Register 91, No. 11). A Certificate of Compliance must be transmitted to OAL by 4-19-91 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 12-20-90 order including amendment of subsections (a) and (b) transmitted to OAL 4-18-91 and filed 5-17-91 (Register 91, No. 27).
3. Amendment of subsection (b) filed 6-27-91 as an emergency; operative 6-27-91 (Register 91, No. 40). A Certificate of Compliance must be transmitted to OAL by 10-25-91 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 6-27-91 order transmitted to OAL 10-23-91 and filed 11-22-91 (Register 92, No. 11).
5. Amendment of subsections (b)(1)(B), (b)(1)(D)5., (c)(2) and NOTE filed 5-19-95; operative 6-19-95 (Register 95, No. 20).
6. Editorial correction inserting inadvertently omitted article 2 heading (Register 96, No. 17).
7. Repealer of subsection (b)(1)(D)4. and subsection renumbering, and amendment of newly designated subsection (b)(1)(D)4. filed 4-23-96; operative 5-23-96 (Register 96, No. 17).
8. Amendment of subsection (b)(1)(D)3. and repealer of subsection (b)(1)(D)4. filed 3-22-2002 as an emergency; operative 3-22-2002 (Register 2002, No. 12). A Certificate of Compliance must be transmitted to OAL by 7-22-2002 or emergency language will be repealed by operation of law on the following day.
9. Editorial correction of HISTORY 8 (Register 2002, No. 35).
10. Certificate of Compliance as to 3-22-2002 order transmitted to OAL 7-19-2002 and filed 8-29-2002 (Register 2002, No. 35).
11. Amendment of subsections (b)(1)(C) and (c)-(c)(2) and new subsections (c)(3)-(4) filed 8-4-2003 as an emergency; operative 8-4-2003 (Register 2003, No. 32). Amendments to remain in effect for 180 days pursuant to section 21, chapter 794, Statutes of 2002 (AB 1401). A Certificate of Compliance must be transmitted to OAL by 2-2-2004 or emergency language will be repealed by operation of law on the following day.
12. Certificate of Compliance as to 8-4-2003 order transmitted to OAL 1-23-2004 and filed 3-1-2004 (Register 2004, No. 10).
13. Amendment of NOTE filed 1-14-2009; operative 2-13-2009 (Register 2009, No. 3).
14. New subsection (b)(1)(E) filed 12-19-2013 as an emergency; operative 12-19-2013 (Register 2013, No. 51). A Certificate of Compliance must be transmitted to OAL by 6-17-2014 or emergency language will be repealed by operation of law on the following day.
15. Certificate of Compliance as to 12-19-2013 order transmitted to OAL 5-22-2014 and filed 6-19-2014 (Register 2014, No. 25).

Note: Authority cited: Sections 12711 and 12712, Insurance Code. Reference: Sections 12711, 12725 and 12733, Insurance Code; and Sections 297, 299 and 299.2, Family Code.

Disclaimer: These regulations may not be the most recent version. California may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.