Cal. Code Regs. Tit. 10, § 6532 - Employer Payment of Premiums
(a) Upon
completion of the initial employee open enrollment period by all of the
qualified employees of a qualified employer, the SHOP will send an invoice to
the qualified employer for the total premium amount due for all of that
qualified employer's qualified employees.
(1)
A qualified employer's first premium payment shall be paid in full and must be
delivered to the SHOP or postmarked by the due date indicated on the invoice,
for effectuation to occur on the date requested on the employer's
application.
(2) If a qualified
employer's first payment does not meet the requirements in subdivision (a)(1),
the SHOP will cancel the application of that qualified employer and the
applications of that employer's qualified employees.
(b) Once coverage is effective, the SHOP will
send invoices to qualified employers on the 15th of each month, or the
following business day if the 15th falls on a weekend or holiday, for health
coverage and dental coverage for the following month.
(1) A qualified employer's monthly premium
payment must be delivered to the SHOP or postmarked by the last day of the
invoicing month.
(2) After the
first invoice, the qualified employer must make a monthly premium payment of no
less than 100 dollars less than the total balance due, including any amounts
past due, by the due date on the invoice.
(c) Payment amounts less than the total
amount due will be allocated by the oldest to newest amounts due for health
coverage and dental coverage. Excess payments will be applied as credit to the
employer's future invoice. Payments will be allocated evenly to all members
across the applicable coverage month.
(d) In any month after a qualified employer
has paid its initial month's premium, if a qualified employer does not pay its
premium pursuant to subdivision (b) of this section, the SHOP will, on the day
following the due date of the invoice, mail a notice of delinquency to the
qualified employer that shows the past due balance, informs the qualified
employer of the applicable grace period pursuant to Section
10273.4(a)(1)
of the California Insurance Code and Section
1365(a)(1)
of the California Health and Safety Code, states the effective date of
termination if payment is not received during the grace period, provides
instructions for making the premium payment necessary in order to maintain
coverage in force, and provides notice of the qualified employer's right to
request review of the cancelation by the applicable regulator.
(e) If a qualified employer makes a premium
payment that is returned for any reason, the SHOP shall apply a $25.00
insufficient funds fee. If a qualified employer makes a second premium payment
that is returned unpaid for any reason within six months of the prior returned
payment, the qualified employer shall submit premium payment and the
insufficient funds fee for returned payment in the form of a cashier's check or
money order. This requirement to make monthly premium payments in the form of a
cashier's check or money order shall continue for a period of 12 months
beginning with the first of the month following the last paid-through date. If
premium payment is not submitted in one of these two forms, the qualified
employer group may be subject to termination for non-payment of premium as
described in Section
6538(c)(2).
(f) If a qualified employer has been
terminated pursuant to Section
6538(a), then the
group may request to be reinstated in the same coverage in which it was last
enrolled within 30 days after the effective date of termination. Past due
premiums, if any, must be paid before a group may be reinstated without a lapse
in coverage.
(g) A qualified
employer terminated due to non-payment of premium in Section
6538(c) may
request to be reinstated in the same coverage in which it was last enrolled
within 30 days after the effective date of termination. Past due premiums, if
any, must be paid before a group may be reinstated without a lapse in
coverage.
(h) A qualified employer
may not reinstate coverage 31 or more days following the effective date of
termination and may only reinstate once during the 12-month period beginning at
the time of their original effective date or from their most recent renewal
date, whichever is more recent. Exceptions will be considered on a case-by-case
basis.
(i) Terminated groups
seeking to reapply for coverage 31 or more days following the effective date of
termination shall be considered a new group with an effective date consistent
with the provisions of this Section and Section
6520(a)(13).
(j) Collections for delinquent accounts
payable will be performed as per State Accounting Manual (SAM) section 8776.6
(non-employee accounts receivable).
Notes
Note: Authority cited: Section 100504, Government Code. Reference: Sections 100502 and 100503, Government Code; and 45 CFR Sections 155.705, 155.720 and 156.285.
Note: Authority cited: Section 100504, Government Code. Reference: Sections 100502 and 100503, Government Code; and 45 CFR Sections 155.705, 155.720 and 156.285.
2. New section 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. New section refiled 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. New section, including amendment of subsections (b) and (d), refiled 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 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.
10. Certificate of Compliance as to 4-20-2018 order, including amendment of Note, transmitted to OAL 8-3-2018 and filed
11. Amendment of subsection (e) filed 11-7-2019 as a deemed emergency pursuant to Government Code section 100504(a)(6)(A); operative
12. Amendment of subsections (a)(1), (b), (b)(2)-(c) and (e) filed 9-7-2021 as an emergency; operative
13. Certificate of Compliance as to 9-7-2021 order, including further amendment of subsections (b)(2)-(c) and (e), transmitted to OAL 8-22-2024 and filed 9-23-2024; amendments effective
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