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Proofs for Trigger, Qualifying Event for Special Enrollment – Kaiser

Kaiser Rules 2017 16 pages

Special Enrollment Rules - Western Poverty Center
Special Enrollment Rules – Western Poverty Center
Short Term Health Insurance - ONLINE proposals & Enrollment If you can't qualify for Special Enrollment
Short Term Health Insurance – ONLINE proposals & Enrollment
If you can’t qualify for Special Enrollment

Kaiser Rules 2017 16 pages

Kaiser Proof Form & Requirements

CA Insurance Code §10965.3 (d)

(d)

(1) Subject to paragraph (2), commencing January 1, 2014, a health insurer shall allow an individual to enroll in or change individual health benefit plans as a result of the following triggering events:

Please start your research into Special Enrollment Periods by reviewing our main page of California Code of Regulations on Qualifying Events

(A) He or she or his or her dependent loses minimum essential coverage.

(B) He or she gains a dependent or becomes a dependent.

(C) He or she is mandated to be covered as a dependent pursuant to a valid state or federal court order.

(D) He or she has been released from incarceration

(E) His or her health coverage issuer substantially violated a material provision of the health coverage contract.

(F) He or she gains access to new health benefit plans as a result of a permanent move.

(G) He or she was receiving services from a contracting provider under another health benefit plan, as defined in Section 10965 of this code or Section 1399.845 of the Health and Safety Code, for one of the conditions described in subdivision (a) of Section 10133.56 of this code and that provider is no longer participating in the health benefit plan.

(H) He or she demonstrates to the Exchange, with respect to health benefit plans offered through the Exchange, or to the department, with respect to health benefit plans offered outside the Exchange, that he or she did not enroll in a health benefit plan during the immediately preceding enrollment period available to the individual because he or she was misinformed that he or she was covered under minimum essential coverage.

(I) He or she is a member of the reserve forces of the United States military returning from active duty or a member of the California National Guard returning from active duty service under Title 32 of the United States Code.

(J) With respect to individual health benefit plans offered through the Exchange, in addition to the triggering events listed in this paragraph, any other events listed in Section 155.420(d) of Title 45 of the Code of Federal Regulations.

(2) With respect to individual health benefit plans offered outside the Exchange, an individual shall have 60 days from the date of a triggering event identified in paragraph (1) to apply for coverage from a health care service plan subject to this section. With respect to individual health benefit plans offered through the Exchange, an individual shall have 60 days from the date of a triggering event identified in paragraph (1) to select a plan offered through the Exchange, unless a longer period is provided in Part 155 (commencing with Section 155.10) of Subchapter B of Subtitle A of Title 45 of the Code of Federal Regulations.

Near as I can tell, this was copied after (Amended by Stats. 2015, Ch. 9, Sec. 9. Effective June 17, 2015.) 

 

AB 1461  Small EmployER Health – Non Grandfathered Requirements  Triggering Events AB 1461

10753.05 (3) A carrier shall provide enrollment periods consistent with PPACA and set forth in Section 155.725 of Title 45 of the Code of Federal Regulations.

A carrier shall provide special enrollment periods consistent with the special enrollment periods required in the individual non grandfathered market in the state, as set forth in Section 10965.3, [AB 1461]except for the triggering events identified in paragraphs (d)(3) and (d)(6) of Section 155.420 of Title 45 of the Code of Federal Regulations with respect to health benefit plans offered through the Exchange.

AB 1461  

Health & Safety Code 1399.849 

CA Code of Regulations 6504 Special Enrollment Periods

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