Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a)
(1) Dependents may be enrolled:
(A) Within sixty (60) days of the date the
individual became the subscriber's dependent; or
(B) Within sixty (60) days of the termination of a
dependent's other health care coverage.
(2) A subscriber wishing to enroll additional
dependents shall notify the program in writing of the full names, dates of birth,
sex, social security numbers (not mandatory), and relationship of the dependents to
be enrolled. Social Security numbers and other personal information are used for
identification and administrative purposes.
(3) In order for the program to determine that a
pre-existing condition exclusion or post-enrollment waiting period should be waived,
or partially waived, the subscriber may also provide the documentation required by
section 2698.201(e) for each
dependent to be added. If no documentation is provided, the dependent shall be
subject to the maximum pre-existing condition exclusion or post-enrollment waiting
period described in section
2698.303. Dependents age 18 and under
are not subject to pre-existing condition exclusion or post-enrollment waiting
periods.
(4)
(A) Coverage for newborns and adopted children
eligible pursuant to (a)(1) of this section shall begin upon birth or the date on
which the adoptive child's birth parents or other appropriate legal authority signs
a written document, including, but not limited to, a health facility minor release
report, a medical authorization form, or a relinquishment form, granting the
subscriber or the subscriber' spouse or registered domestic partner, the right to
control health care for the adoptive child or, absent this written document, on the
date there exists evidence of the right of the subscriber or the subscriber's spouse
or registered domestic partner, to control the health care of the child placed for
adoption.
(B) Coverage for all other
dependents eligible pursuant to (a)(1) of this section shall begin within 3 months
of receipt of the notification to the program from the subscriber, and shall begin
on the first day of a month, subject to the provisions of section
2698.303.
(5) Subscribers shall be notified in writing by
the program of the beginning date of coverage by the subscriber's health plan for
enrolled dependents, and, if applicable, of any pre-existing condition exclusion
period or post-enrollment waiting period. The notice shall caution the subscriber
about discontinuing any existing coverage for dependents until full coverage by the
subscriber's health plan has begun.
(6)
The subscriber contribution shall be adjusted as of a dependent's beginning date of
coverage by the program; unless the dependent added was a newborn or an adopted
child.
(7) The subscriber contribution
for a newborn or an adopted child who is enrolled pursuant to (a)(1)(A) of this
section shall be adjusted as of the first day of the month following the child's
birth or first day of the month following the date on which the adoptive child's
birth parents or other appropriate legal authority signs a written document,
including, but not limited to, a health facility minor release report, a medical
authorization form, or a relinquishment form, granting the subscriber or the
subscriber' spouse or registered domestic partner, the right to control health care
for the adoptive child or, absent this written document, on the first day of the
month following the date there exists evidence of the right of the subscriber or the
subscriber's spouse or registered domestic partner, to control the health care of
the child placed for adoption.
(b)
(1) A
subscriber wishing to disenroll dependents shall notify the program of the full
names, dates of birth, sex, social security numbers, and relationship of the
dependents to be disenrolled. Disenrollment of dependents shall be subject to
sections 2698.204(a)(1),
2698.204(a)(2) and
2698.204(c).
(2) The subscriber contribution shall be adjusted,
if applicable, as of the date of a dependent's disenrollment by the
program.
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 subsection (a)
transmitted to OAL on 4-18-91 and filed 5-17-91 (Register 91, No. 27).
3.
Editorial correction of printing error (Register 91, No. 27).
4.
Amendment of subsection (b)(3) and NOTE filed 4-23-96; operative 5-23-96 (Register
96, No. 17).
5. Amendment of section heading and section 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.
6.
Certificate of Compliance as to 8-4-2003 order transmitted to OAL 1-23-2004 and
filed 3-1-2004 (Register 2004, No. 10).
7. Amendment of subsections
(a)(4)(A) and (a)(7) and amendment of NOTE filed 1-14-2009; operative 2-13-2009
(Register 2009, No. 3).
Note: Authority cited: Sections
12711 and
12712, Insurance
Code. Reference: Section
12729, Insurance
Code; and Sections
297,
299 and
299.2, Family
Code.
