Cal. Code Regs. Tit. 10, § 6704 - Program Application

(a) An entity or individual who is eligible for the Certified Plan-Based Enrollment Program (PBE Program) may apply to become a Certified Plan Based Enrollment Entity (PBEE) or a Certified Plan-Based Enroller (PBE) according to the following process.

(1) The entity or individual shall submit all application information, documentation, and declarations required in this Section.

(2) The application shall demonstrate that the entity or individual is capable of carrying out at least those duties described in the PBEE eligibility requirements in this Article and has existing relationships, or could readily establish relationships, with Consumers, as defined in Section 6700.

(3) The Exchange shall review the program application and, if applicable, request any missing information necessary to determine eligibility.

(4) Entities or individuals who have submitted a completed application and demonstrated ability to meet the above requirements shall be notified of available opportunities by the Exchange for the individual or entity (via the entity's Authorized Contact and his or her designees, if applicable) to complete the training requirements in Section 6706. All individuals and entities (via the entity's Authorized Contact and his or her designees, if applicable) shall have 90 days to complete and pass the training and testing requirements in Section 6706. Failure to complete training standards within 90 calendar days may result in the termination of the individual's or entity's certification application with the Exchange.

(5) All individuals who are seeking certification by the Exchange as PBEs of the PBEE shall meet the following requirements:

(A) Submit all information, documentation, and declarations required in subdivision (d) of this Section;

(B) Pass the PBE Fingerprinting and Criminal Record Check process in Section 6708;

(C) Complete the required training in Section 6706; and

(D) Pass the required certification exam administered by the Exchange pursuant to Section 6706.

(6) Entities or individuals who complete and pass all certification requirements in subdivision (a) of this Section, as applicable, shall be certified as PBEEs or PBEs, respectively, by the Exchange and assigned a PBEE or PBE certification number.

(7) Entities and individuals who have been denied certification by the Exchange may appeal the denial of their certification through the process established by Section 6718 or 6708.

(b) A PBEE application shall contain the following information:

(1) Entity Full name;

(2) Legal name;

(3) Date submitted;

(4) Primary e-mail address;

(5) Primary phone number;

(6) Secondary phone number;

(7) Federal Employment Identification Number;

(8) State Tax Identification Number;

(9) For the primary site and each sub-site, the following information:

(A) Site Location Address;

(B) Mailing Address;

(C) County;

(D) Contact name;

(E) Primary e-mail address;

(F) Primary phone number;

(G) Secondary phone number;

(H) Whether the entity provides in-person assistance at this site; and

(I) Hours of operation;

(10) Name, e-mail address, primary and secondary phone number for the Authorized Contact;

(11) A certification by the Authorized Contact, or his or her designee, that the PBEE has presented information in the application that is true and correct to the best of his or her knowledge; and

(12) For each Certified PBE to be affiliated with the applicant entity, a completed application for each individual as required in subdivision (d) below must be included in the entity's application.

(c) The Authorized Contact of the PBEE shall notify the Exchange of every individual to be added as an affiliated PBE that was not included in the entity's initial application. Such notification shall include the individual's application as required in subdivision (d) of this Section. The individual shall become certified by the process required by subdivision (a) of this Section.

(d) An individual's application to become a PBE shall contain the following information:

(1) First and last name;

(2) Business email address;

(3) Driver's license number or identification number issued by a State Department of Motor Vehicles;

(4) Languages that the applicant can speak;

(5) Languages that the applicant can write;

(6) For Issuer Application Assisters, as defined in 45 CFR § 155.20: Disclosure of all criminal convictions and administrative actions taken against the applicant, and any arrests for which the applicant is currently out on bail or his or her own recognizance;

(7) A certification by the applicant that:

(A) The applicant shall comply with the PBE Program requirements of this Article and Section 6500(f) of Article 5 of this chapter;

(B) The applicant is a natural person of not less than 18 years of age;

(C) The statements made in the application are true, correct and complete to the best of his or her knowledge and belief; and

(D) The applicant will adhere to any applicable State and federal laws and regulations;

(8) The signature of the applicant applying to become a PBE and date signed;

(9) The name and signature of the Authorized Contact, or that of his or her designee, and date signed;

(10) An indication of whether the applicant is licensed in good standing as an agent with the California Department of Insurance, and if so, the applicant's license number; and

(11) An indication of whether the applicant is certified by the Exchange as a Certified Insurance Agent, Certified Enrollment Counselor, Certified Application Counselor, or serves in any other enrollment function of the Exchange including Service Center Representative and County Eligibility Worker, and, if applicable, the certification number.

(e) The Authorized Contact of the PBEE shall notify the Exchange in writing of every individual to be removed as an affiliated PBE within 30 days of the date of separation. Such notification shall include the individual's name, certification number, and effective date of removal.

(f) The PBEE shall hold a valid executed agreement with the Exchange to offer at least one QHP through the Exchange.

Notes

Cal. Code Regs. Tit. 10, § 6704

Note: Authority cited: Sections 100503 and 100504, Government Code. Reference: Section 100503, Government Code; and 45 Code of Federal Regulations, Sections 155.415 and 156.1230.

1. New section filed 9-30-2013 as an emergency; operative 9-30-2013 (Register 2013, No. 40). A Certificate of Compliance must be transmitted to OAL by 4-1-2014 or emergency language will be repealed by operation of law on the following day.
2. New section, including amendment of subsections (b)(19)(C), (e)(1) and (e)(5), refiled 4-1-2014 as an emergency; 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 6-26-2014 as an emergency; operative 7-1-2014 (Register 2014, No. 26). 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 refiled with amendments 10-2-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 ( Stats. 2014, c. 31 ); operative 10/2/2014 (Register 2014, No. 40). A Certificate of Compliance must be transmitted to OAL by 9-30-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
5. Editorial correction of History 3 (Register 2014, No. 51).
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. Certificate of Compliance as to 10-2-2014 order, including further amendment of section, transmitted to OAL 4-12-2016 and filed 5-23-2016; amendments effective 5-23-2016 pursuant to Government Code section 11343.4(b)(3) (Register 2016, No. 22).
8. Repealer of subsections (b)(7) and (b)(10), subsection renumbering, repealer of newly designated subsections (b)(9)(H) and (b)(9)(K)-(L), subsection relettering, amendment of newly designated subsection (b)(9)(H), repealer of subsections (d)(4)-(7), subsection renumbering and amendment of newly designated subsections (d)(4)-(5) filed 1-29-2018; operative 1/29/2018 pursuant to Government Code section 11343.4(b)(3) (Register 2018, No. 5).