Section 1399.826 Of Article 11.7. Child Access To Health Care Coverage From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 11.7.
1399.826
. (a) (1) During each open enrollment period, every health
care service plan offering plan contracts in the individual market,
other than individual grandfathered plan coverage, shall offer to the
responsible party for a child coverage for the child that does not
exclude or limit coverage due to any preexisting condition of the
child.
(b) A health care service plan offering coverage in the individual
market shall not reject an application for a health care service
plan contract from a child or filed on behalf of a child by the
responsible party during an open enrollment period or from a late
enrollee during a period no longer than 63 days from the qualifying
event listed in subdivision (d) of Section 1399.825.
(c) Except to the extent permitted by federal law, rules,
regulations, or guidance issued by the relevant federal agency, a
health care service plan shall not condition the issuance or offering
of individual coverage on any of the following factors:
(1) Health status.
(2) Medical condition, including physical and mental illnesses.
(3) Claims experience.
(4) Receipt of health care.
(5) Medical history.
(6) Genetic information.
(7) Evidence of insurability, including conditions arising out of
acts of domestic violence.
(8) Disability.
(9) Any other health status-related factor as determined by
department.
This subdivision shall not apply to a contract providing
individual grandfathered plan coverage.
(d) When a responsible party for a child submits a premium
payment, based on the quoted premium charges, and that payment is
delivered or postmarked, whichever occurs earlier, within the first
15 days of the month, coverage under the plan contract shall become
effective no later than the first day of the following month. When
that payment is neither delivered nor postmarked until after the 15th
day of the month, coverage shall become effective no later than the
first day of the second month following delivery or postmark of the
payment.
(e) A health care service plan offering coverage in the individual
market shall not reject the request of a responsible party for a
child to include that child as a dependent on an existing health care
service plan contract that includes dependent coverage during an
open enrollment period.
(f) Nothing in this article shall be construed to prohibit a
health care service plan offering coverage in the individual market
from establishing rules for eligibility for coverage and offering
coverage pursuant to those rules for children and individuals based
on factors otherwise authorized under federal and state law for
health plan contracts in addition to those offered on a guaranteed
issue basis during an open enrollment period to children or late
enrollees pursuant to this article. However, a health care service
plan, other than a plan providing individual grandfathered plan
coverage, shall not impose a preexisting condition provision on
coverage, including dependent coverage, offered to a child.
(g) Nothing in this article shall be construed to require a plan
to establish a new service area or to offer health coverage on a
statewide basis, outside of the plan's existing service area.
(h) Nothing in this article shall be construed to prevent a health
care service plan from offering coverage to a family member of an
enrollee in grandfathered health plan coverage consistent with
Section 1251 of PPACA.