California Code of Regulations
Title 10 - Investment
Chapter 5.8 - Managed Risk Medical Insurance Board Healthy Families Program
Article 2 - Eligibility, Application, and Enrollment
Section 2699.6625 - Annual Eligibility Review for Subscribers
Current through Register 2024 Notice Reg. No. 12, March 22, 2024
(a) Except as specified in (c), each subscriber will be re-evaluated annually prior to his or her anniversary date in the program to determine continued eligibility for the program. Applicants shall be notified of the annual eligibility review process at least sixty (60) calendar days prior to the anniversary date.
(b) Notwithstanding (a), as a condition of continuing coverage beyond the age of twelve (12) months, an applicant who enrolls an AIM infant into the program after nine months of age shall provide the information necessary to determine the infant's eligibility for ongoing coverage after the age of twelve (12) months at the time of enrollment.
(c) If subscribers for whom an applicant has applied have different anniversary dates, the annual eligibility review will be based on the anniversary date of the last subscriber to be enrolled, except as described in Subsection 2699.6631(f).
(d) To requalify, an applicant must provide to the program all of the following information which is required to reestablish eligibility: the applicant's name and account number as stated on their billing statement; name and address of each enrolled person, documentation of gross income of each enrolled person's household as described in Subsection 2699.6600(c)(1)(K), documentation of the subscriber's status as described in Subsection 2699.6600(c)(1)(T), if requested in order to verify that the subscriber continues to reside lawfully in the United States, documentation of court ordered child support, and/or alimony paid, and child care and/or disabled dependent care expenses paid in order to determine income deductions as described in Subsection 2699.6600(c)(1)(L), an indication of any pregnant family member living in the home and her expected due date, and a statement indicating which person(s) is currently enrolled in an employer sponsored health insurance plan. To avoid a break in coverage, all required information must be submitted at least ten (10) calendar days before the end of the month in which the anniversary date falls.
(e) Continued eligibility will be determined pursuant to Sections 2699.6607 and 2699.6611(a)(2).
(f) Unless disenrolled pursuant to Section 2699.6611, persons shall continue to be considered eligible for the program for one year from the effective date of coverage, or if a later annual eligibility review date is established under (c), until that date.
1. New section
filed 2-20-98 as an emergency; operative 2-20-98 (Register 98, No. 8). A
Certificate of Compliance must be transmitted to OAL by 6-22-98 or emergency
language will be repealed by operation of law on the following
day.
2. Certificate of Compliance as to 2-20-98 order transmitted to
OAL 6-5-98 and filed 7-15-98 (Register 98, No. 29).
3. Amendment of
section heading and section filed 5-26-99 as an emergency; operative 5-26-99
(Register 99, No. 22). A Certificate of Compliance must be transmitted to OAL
by 9-23-99 or emergency language will be repealed by operation of law on the
following day.
4. Certificate of Compliance as to 5-26-99 order
transmitted to OAL 9-17-99 and filed 10-28-99 (Register 99, No.
44).
5. Amendment of subsection (d) filed 1-10-2000 as an emergency;
operative 1-10-2000 (Register 2000, No. 2). A Certificate of Compliance must be
transmitted to OAL by 5-9-2000 or emergency language will be repealed by
operation of law on the following day.
6. Certificate of Compliance
as to 1-10-2000 order transmitted to OAL 5-5-2000 and filed 6-16-2000 (Register
2000, No. 24).
7. Amendment filed 4-29-2002 as an emergency;
operative 4-29-2002 (Register 2002, No. 18). Pursuant to Chapter 946, Statutes
of 2000, section
2, a Certificate of Compliance
must be transmitted to OAL by 10-28-2002 or emergency language will be repealed
by operation of law on the following day.
8. Certificate of
Compliance as to 4-29-2002 order transmitted to OAL 10-28-2002 and filed
12-12-2002 (Register 2002, No. 50).
9. Amendment of subsection (c)
filed 7-1-2004 as an emergency; operative 7-1-2004 (Register 2004, No. 27).
Pursuant to Section
80, A.B. 1762 (Chapter 230, Stats.
2003) a Certificate of Compliance must be transmitted to OAL by 12-28-2004 or
emergency language will be repealed by operation of law on the following
day.
10. Certificate of Compliance as to 7-1-2004 order, including
amendment of subsection (a), new subsection (b), subsection relettering and
amendment of newly designated subsections (c) and (f), transmitted to OAL
11-24-2004 and filed 1-7-2005 (Register 2005, No. 1).
11. Amendment
of subsection (e) and NOTE filed 11-30-2007 as an emergency; operative
11-30-2007 (Register 2007, No. 48). A Certificate of Compliance must be
transmitted to OAL by 5-28-2008 or emergency language will be repealed by
operation of law on the following day.
12. Certificate of Compliance
as to 7-31-2007 order transmitted to OAL 1-28-2008 and filed 3-12-2008
(Register 2008, No. 11).
13. Certificate of Compliance as to
11-30-2007 order transmitted to OAL 5-28-2008 and filed 7-7-2008 (Register
2008, No. 28).
14. Amendment of subsection (d) filed 9-29-2009 as an
emergency; operative 9-29-2009 (Register 2009, No. 40). A Certificate of
Compliance must be transmitted to OAL by 3-29-2010 or emergency language will
be repealed by operation of law on the following day.
15.
Certificate of Compliance as to 9-29-2009 order transmitted to OAL 3-29-2010
and filed 5-4-2010 (Register 2010, No. 19).
Note: Authority cited: Section 12693.21, Insurance Code. Reference: Sections 12693.21, 12693.74 and 12693.96, Insurance Code.
