Cal. Code Regs. Tit. 10, § 6528 - Initial and Annual Enrollment Periods for Qualified Employees
(a) A
qualified employee may enroll in a QHP or change their QHP only during the
initial employee open enrollment period and annual employee open enrollment
period described in this section or during a special enrollment period as
described in Section
6530.
(b) Subject to subdivision (e) of this
section, a qualified employee's initial employee open enrollment period begins
no later than 20 days before the employee application due date specified in
Section 6520(d).
(c) Subject to subdivision (e) of this
section, the annual employee open enrollment period begins the day after their
qualified employer's annual election period has ended.
(d) The initial and annual employee open
enrollment period is at least 20 days.
(e) Beginning January 1, 2014, the SHOP shall
provide to qualified employers, a written annual employee open enrollment
period notification for each qualified employee 60 days prior to the end of the
qualified employer's plan year.
(f)
Qualified employers may allow qualified employees to make a change to their
selected QHP after the effective date of coverage during the first thirty (30)
days of the new plan year, provided that the newly selected QHP is offered by
the same QHP Issuer.
(1) Requests to the SHOP
to make changes to QHP selection received on the first through the fifteenth
day of the month after the effective date shall become retroactively effective
to the first day of the month, unless the employer requests an effective date
of the first of the following month.
(2) Requests to the SHOP to make changes to
QHP selection received on the sixteenth day of the month up to the thirtieth
day of the month after the effective date shall become effective on the first
day of the following month, unless an earlier effective date is requested due
to exceptional circumstances and is permitted by the SHOP and QHP Issuer, as
determined on a case-by-case basis.
(g) If a qualified employee does not enroll
in a different QHP during their annual employee open enrollment period, the
qualified employee will remain in the QHP selected in the previous year unless:
(1) The qualified employee terminates their
coverage from the QHP in accordance with Section
6538(b),
or
(2) The QHP is no longer
available to the qualified employee.
(h) Notwithstanding subdivision (g)(2), if
the qualified employee's current health plan is not available, the qualified
employee shall be enrolled in a health plan offered by the same QHP Issuer at
the same metal tier that is the most similar to the qualified employee's
current health plan, as determined by the SHOP on a case-by-case
basis.
(i) If the QHP Issuer of the
health plan in which the qualified employee is currently enrolled is no longer
available, or if another health plan is not available from the current QHP
Issuer in the same metal tier, the qualified employee may be enrolled in the
lowest cost health plan offered by a different QHP Issuer in the same metal
tier as the qualified employee's current health plan, as determined by the SHOP
on a case-by-case basis.
(j) An
employee who becomes a qualified employee outside of the initial employee open
enrollment period, the annual employee open enrollment period, or a special
enrollment period shall have a 30-day period to enroll in a QHP beginning on
the first day the employee becomes a qualified employee.
(k) For an employer with changes to report to
the initial employer application information in Section
6520(a)(3) the
employer shall notify the SHOP of the updated employee counts.
Notes
Note: Authority cited: Section 100504, Government Code. Reference: Sections 100502 and 100503, Government Code; and 45 CFR Sections 147.104, 155.720, 155.725 and 156.285.
Note: Authority cited: Section 100504, Government Code. Reference: Sections 100502 and 100503, Government Code; and 45 CFR Sections 147.104, 155.720, 155.725 and 156.285.
2. New section, including amendment of subsection (c), refiled 4-1-2014 as a deemed emergency pursuant to Government Code section 100504(a)(6); operative 4-1-2014 (Register 2014, No. 14). A Certificate of Compliance must be transmitted to OAL by 6-30-2014 or emergency language will be repealed by operation of law on the following day.
3. Refiling of 4-1-2014 action on 6-30-2014 as a deemed emergency pursuant to Government Code section 100504(a)(6); operative 6-30-2014 (Register 2014, No. 27). A Certificate of Compliance must be transmitted to OAL by 9-29-2014 or emergency language will be repealed by operation of law on the following day.
4. Refiling of 6-30-2014 order, including amendment of subsections (c), (e) and (f), on 10-2-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats.
5. Editorial correction of History 3 and History 4 (Register 2014, No. 45).
6. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government Code section 100504(a)(6) to change the date upon which a Certificate of Compliance must be transmitted to OAL. Pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of Compliance must be transmitted to OAL by 9-30-2016 or the language in the emergency order of 10-2-2014 will be repealed by operation of law on the following day (Register 2015, No. 38).
7. Senate Bill 833 (Stats. 2016, c. 30) modified Government Code section 100504(a)(6) to extend the date upon which a Certificate of Compliance must be transmitted to OAL. Refiling of 10-2-2014 order on 9-30-2016 as a deemed emergency pursuant to Government Code section 100504(a)(6); operative 9-30-2016 (Register 2016, No. 40). A Certificate of Compliance must be transmitted to OAL by 10-1-2018 pursuant to Government Code section 100504(a)(6) or emergency language will be repealed by operation of law on the following day.
8. Refiling of 9-30-2016 order, including further amendment of section, on 11-28-2016 as a deemed emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 833 (Stats. 2016, c. 30); operative 11-28-2016 (Register 2016, No. 49). A Certificate of Compliance must be transmitted to OAL by 10-1-2018 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
9. Refiling of 11-28-2016 order, including new subsection (i) and subsection relettering, on 4-17-2017 as a deemed emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 833 (Stats. 2016, c. 30); operative 4-17-2017 (Register 2017, No. 16). A Certificate of Compliance must be transmitted to OAL by 10-1-2018 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
10. Refiling of 4-17-2017 order, including further amendment of section, filed 4-20-2018 as a deemed emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 833 (Stats. 2016, c.30); operative 4-20-2018 (Register 2018, No. 16). A Certificate of Compliance must be transmitted to OAL by 10-1-2018 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
11. Certificate of Compliance as to 4-20-2018 order, including repealer of subsection (k), subsection relettering and amendment of Note, transmitted to OAL 8-3-2018 and filed 9-17-2018; amendments effective
12. Amendment of subsections (f)-(f)(2) and (h)-(i) filed 9-7-2021 as an emergency; operative
13. Certificate of Compliance as to 9-7-2021 order, including further amendment of section, transmitted to OAL 8-22-2024 and filed 9-23-2024; amendments effective
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