Cal. Code Regs. tit. 10 § 6702

Current through Register 2024 Notice Reg. No. 44, November 1, 2024

Section 6702 - Certified Plan-Based Enrollment Program Eligibility Requirements

(a) The following entities and individuals are eligible to apply to participate in the Certified Plan-Based Enrollment Program (PBE Program) through the Exchange (Covered California):

(1) Qualified Health Plan Issuers, as defined in Section 6410 of Article 2 of this chapter, under contract with the Exchange to provide at least one QHP through the Exchange that seek to provide enrollment assistance to Consumers.

(2) Issuer Application Assisters, as defined in 45 C.F.R. § 155.20, and Captive Agents, as defined in Section 6410 of Article 2 of this chapter, that are employed or contracted by a PBEE.

(b) An entity who is eligible pursuant to subdivision (a)(1) of this Section may apply to become certified in the PBE Program as a Certified Plan-Based Enrollment Entity (PBEE) according to the following process:

(1) Complete the application for the PBE Program pursuant to Section 6704;

(2) Have their Authorized Contact complete training through the Exchange as required under Section 6706; and

(3) Demonstrate access to Consumers, as defined in Section 6700, for the PBE Program.

(c) An individual who is eligible pursuant to subdivision (a)(2) of this Section may apply to become certified in the PBE Program as a Certified Plan-Based Enroller (PBE) according to the following process:

(1) Be employed or contracted by a registered PBEE as a Captive Agent or Issuer Application Assister pursuant to subdivision (a)(2) of this Section;

(2) Complete requirements of the PBE Training and Certification Standards in Section 6706;

(3) Comply with the privacy and security requirements in 45 C.F.R. § 155.260;

(4) Comply with applicable State law related to the sale, solicitation, and negotiation of insurance products, including applicable State law related to agent, broker, and producer licensure; and conflicts of interest;

(5) Pass the certification exam identified in Section 6706;

(6) Sign the certification statement required in Section 6704(d)(11)(A)-(D);

(7) Complete and pass the Exchange's fingerprinting and criminal background check process in Section 6708; and

(8) Complete refresher training, testing and certification renewal each year pursuant to Section 6706, and at other times if required by the Exchange.

Cal. Code Regs. Tit. 10, § 6702

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 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 pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 7-1-2014 (Register 2014, No. 26). 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.
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).

Note: Authority cited: Sections 100503 and 100504, Government Code. Reference: Section 100503, Government Code; and 45 Code of Federal Regulations, Sections 155.415, 155.260, 156.265 and 156.1230.