California Code of Regulations
Title 10 - Investment
Chapter 5.5 - Major Risk Medical Insurance Board
Article 2 - Eligibility, Application, and Enrollment
Section 2698.207 - Transfer of Enrollment

Universal Citation: 10 CA Code of Regs 2698.207

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

(a) A subscriber and enrolled dependents, if any, or a dependent subscriber shall be transferred from one participating health plan to another if any of the following occurs:

(1) The subscriber or dependent subscriber so requests, in writing, during an open enrollment period established by the Board. The program shall inform each subscriber or dependent subscriber of each open enrollment period.

(2) The subscriber or dependent subscriber so requests, in writing, because the subscriber or dependent subscriber has moved and no longer resides in an area served by the participating health plan in which the subscriber or dependent subscriber is enrolled, and there is at least one participating health plan serving the area in which the subscriber or dependent subscriber now resides that is accepting new enrollees.

(3) The subscriber or dependent subscriber or the participating health plan so requests, in writing, because of failure to establish a satisfactory subscriber-plan relationship and the executive director determines that the transfer is in the best interests of the program, and there is at least one participating health plan serving the area in which the subscriber or dependent subscriber resides that is accepting new enrollees.

(b) Subscribers, enrolled dependents and dependent subscribers who transfer enrollment pursuant to this section shall not be subject to pre-existing condition exclusions or post-enrollment waiting periods as specified in section 2698.303.

(c) Transfer of enrollment pursuant to (a)(1) shall take effect 30 days after the termination of an open enrollment period. Transfer of enrollment pursuant to (a)(2) or (a)(3) shall take effect within 35 days of approval of the request.

(d) Subscribers or dependent subscribers and participating health plans shall be notified in writing of any transfer of enrollment.

(e) If applicable, the subscriber contribution shall be adjusted as a result of a transfer of enrollment.

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 A Certificate of Compliance must be transmitted to OAL by 4-19-91 or emergency language will be repealed by operation of law on the following day.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 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 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.
5. Certificate of Compliance as to 8-4-2003 order transmitted to OAL 1-23-2004 and filed 3-1-2004 (Register 2004, No. 10).

Note: Authority cited: Sections 12711, 12712 and 12712.5, Insurance Code. Reference: Section 12731, Insurance Code.

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