28 CA ADC § 1300.65


      28 CCR s 1300.65

      Cal. Admin. Code tit. 28, s 1300.65


      CALIFORNIA CODE OF REGULATIONS
      TITLE 28. MANAGED HEALTH CARE
      DIVISION 1. THE DEPARTMENT OF MANAGED HEALTH CARE
      CHAPTER 2. HEALTH CARE SERVICE PLANS
      ARTICLE 6. APPEALS ON CANCELLATION
      This database is current through 06/09/06, Register 2006, No. 23.

      s 1300.65. Cancellation of Enrollment.

      (a) For the purposes of subdivision (a)(3) of Section 1365 of the Act, 
      "good cause" means a cause for cancellation or failure to renew which the 
      Director has not found to be objectionable by regulation.

      (b) In the event that the plan cancels or refuses to renew a plan 
      contract, or a subscription or enrollment thereunder, the plan shall mail 
      a notice of cancellation to the subscriber at the subscriber's address of 
      record with the plan. However, in the event that the plan cancels or 
      refuses to renew a group contract, the plan need not mail a notice of 
      cancellation to each subscriber thereunder if:

      (1) the plan contract requires the group contract holder to mail promptly 
      any such notice to each subscriber,

      (2) the plan mails or hand delivers a notice of cancellation to the group 
      contract holder designated in the plan contract, and

      (3) the plan demonstrates that the group contract holder promptly mailed a 
      legible, true copy of the notice of cancellation to each subscriber at the 
      subscriber's current address and promptly provided proof of such mailing 
      and the date thereof to the plan. Unless the plan contract otherwise 
      provides, a notice of cancellation pursuant to subdivision (a)(2) of 
      Section 1365 of the Act may be effective upon mailing to the subscriber, 
      and a notice of cancellation pursuant to subdivision (a)(3) may be 
      effective 15 days after the notice is mailed to the subscriber. This 
      subsection is not applicable to a loss of eligibility for Medi-Cal 
      benefits.

      (c) A notice of cancellation must be in writing and dated, and must state

      (1) the cause for cancellation, with specific reference to the clause of 
      the plan contract giving rise to the right of cancellation,

      (2) that the cause for cancellation was not the enrollee's or subscriber's 
      health status or requirements for health care services,

      (3) the time when the cancellation is effective in accordance with the 
      provisions of subsection (b) or Medi-Cal requirements, as appropriate, and

      (4) that a subscriber or enrollee who alleges that an enrollment or 
      subscription has been cancelled or not renewed because of the enrollee's 
      or subscriber's health status or requirements for health care services may 
      request a review of cancellation by the Director.

      (d) A plan which refuses to renew a subscription or enrollment shall give 
      notice to the person seeking such renewal substantially in the form and 
      content required by subsection (c), except where nonrenewal or 
      nonenrollment is based on avoidance of duplication of coverage where the 
      subscriber or applicant has become eligible for Medi-Care benefits.

      (e) The terms "cancellation" and "failure to renew," for the purposes of 
      Section 1365 of the Act, do not include a voluntary termination by a 
      subscriber or the termination of a plan contract which does not contain a 
      renewal provision.


      


      Note: Authority cited: Section 1344, Health and Safety Code. Reference: 
      Section 1365, Health and Safety Code. 


       HISTORY 
         
      1. Amendment filed 1-12-83; effective thirtieth day thereafter (Register 
      83, 
      No. 3).

      2. Change without regulatory effect amending subsections (a) and (c)(4) 
      filed
      7-18-2000 pursuant to section 100, title 1, California Code of Regulations 

      (Register 2000, No. 29).
      28 CA ADC s 1300.65

      END OF DOCUMENT

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