Cal. Code Regs. Tit. 10, § 6528 - Initial and Annual Enrollment Periods for Qualified Employees
Current through Register 2021 Notice Reg. No. 52, December 24, 2021
(a) A
qualified employee may enroll in a QHP or change his or her 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
the day his or her employer submits all of the information required in Section
6520
and the SHOP has determined that the employer is a qualified
employer.
(c) Subject to
subdivision (e) of this section, the annual employee open enrollment period
begins the day after his or her 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 and after that employer's annual election
period.
(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 his or her annual employee open enrollment
period, the qualified employee will remain in the QHP selected in the previous
year unless:
(1) The qualified employee
terminates his or her 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.
2. New section, including amendment of subsection (c), refiled 4-1-2014 as a deemed emergency pursuant to Government Code section 100504
3. Refiling of 4-1-2014 action on 6-30-2014 as a deemed emergency pursuant to Government Code section 100504
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
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
7. Senate Bill 833 (Stats. 2016, c. 30) modified Government Code section 100504
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
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
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
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
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