Section 599.502 - Enrollment(a) Type of Enrollment. An eligible employee or annuitant may enroll for self alone, self and one family member or self and two or more family members. If he or she enrolls for other than self alone, he or she shall enroll all eligible family members. All eligible family members shall be enrolled under the enrollment of only one employee or annuitant. The following family members are not required to be enrolled: (1) A family member covered under another basic group plan that is not contracted for or approved by the Board;(2) A family member who is a spouse not living in the member's household; or(3) A family member who is a child who has attained the age of 18; or(4) A family member who is a member of the armed forces.(5) A plan shall not be liable for benefits for a family member, other than as provided in Sections 599.502(e)(1)(E) and 599.503(c), nor shall an employee or annuitant be obligated for an increased premium or charge because of such member unless he or she has been included by name in the employee's or annuitant's enrollment.(6) Upon discovery that a family member required to be enrolled has not been so included, except as provided in Sections 599.502(e)(1)(E) and 599.503(c), the employee or annuitant shall be given notice that all coverage of family members will cease on the last day of the following month unless he or she has changed his or her enrollment to include such family members prior to the cessation of such coverage.(b) Initial Enrollment. (1) An eligible employee shall enroll or register not to enroll no later than his or her 60th calendar day of employment or reemployment following a break in service of at least one full monthly pay period.(2) A permanent intermittent employee shall enroll or register not to enroll no later than 60 calendar days following the end of a control period in which he or she received credit for a minimum of 480 paid hours.(3) An annuitant or an employee who is brought within coverage of the Act shall enroll or register not to enroll within sixty days of notice of eligibility.(4) An employee who is on leave of absence without compensation, temporary disability compensation whether or not supplemented by sick leave or vacation, or Non-industrial Disability Leave, or Industrial Disability Leave, or other non-pay status, may not enroll while in such status but shall enroll or register not to enroll within 60 days of his or her return to pay status, if he or she would otherwise have been eligible to enroll during the nonpay status.(5) An employee of a contracting agency which has filed an election to be subject to the Public Employees' Medical and Hospital Care Act, including an employee of such agency who was on leave of absence or other non-pay status and was enrolled in a health benefits plan of the agency, but shall enroll or register not to enroll no later than the 60th calendar day following such agency's effective date of participation under the Act.(6) An annuitant who retired while an employee of a contracting agency which has elected to be subject to the Public Employees' Medical and Hospital Care Act, and whose retirement is effective on or prior to the effective date of such election, may enroll no later than the 60th calendar day following notification of eligibility.(7) An employee whose enrollment did not become effective under the provisions of Section 599.503(a) because of failure to accomplish premium deductions may enroll within 60 calendar days of notification of right to enroll.(c) Re-enrollment: (1) An employee whose enrollment terminated under Section 599.506(a)(5) may enroll within 60 calendar days following the end of a control period in which he or she received credit for a minimum of 480 paid hours.(2) An employee whose enrollment terminated because of administrative failure to continue payroll deductions under Section 599.506(a)(1)(B) may enroll within 60 calendar days of receipt of notification of termination.(3) A person whose enrollment terminated upon separation from employment and who is retired with an effective date no later than 120 days following the date of separation, may enroll as an annuitant within 60 calendar days of receipt of notification of eligibility or during any open enrollment period.(4) An annuitant whose enrollment terminated under Section 599.506(d) because his or her retirement allowance was not sufficient to pay the withholdings of any plan in which he or she was eligible to be enrolled may re-enroll within 60 calendar days of notification that his or her retirement allowance is sufficient to pay the withholdings of a plan in which he or she is eligible to be enrolled.(d) The Board will, at least once every three years, provide every employee and annuitant previously enrolled or eligible to enroll or continue enrollment an opportunity for enrollment, and every enrolled employee and annuitant an opportunity for change of enrollment, on such terms and conditions as it may prescribe.(e) Change of Enrollment.(1)(A) An enrolled employee or annuitant may, prior to, at the time of, or within 60 calendar days after acquiring his or her first eligible family member required to be enrolled, change his or her enrollment to include all family members required to be enrolled.(B) An enrolled employee or annuitant may change his or her enrollment to include all eligible family members required to be enrolled who are acceptable for enrollment under underwriting standards of the carrier if at the time of such change he or she presents a certification of such acceptability from the carrier of the plan in which he or she is enrolled or if such change of enrollment is made during an open enrollment period.(C) A family member who is not enrolled because of other group coverage or because such person is a spouse not living in the employee's or annuitant's household may not thereafter be enrolled as a family member except during an open enrollment period or pursuant to the carrier's certification of acceptability under its underwriting standards.(D) A family member who is a child who has attained the age of 18 and who is not enrolled may not be enrolled except upon return from military service as provided in Section 599.502(e)(2), or pursuant to the carrier's certification of acceptability under underwriting standards, or during an open enrollment period.(E) Notwithstanding any other provision of this subchapter, an employee or annuitant enrolled for self only may enroll a newborn or adopted child provided application for enrollment is received within 60 calendar days of the date of birth or the date physical custody was obtained. The coverage of a newborn or adopted child of an employee or annuitant enrolled for self only begins on the date of birth or the date physical custody is obtained and ends on the last day of that month unless an application to enroll that child is received.(2) An employee or annuitant may at any time change his or her enrollment from self and family to self alone, or delete an eligible family member who is a child who has attained the age of 18 or enters military service. An employee or annuitant may decrease "family member" enrollment from self and two or more to self and one family member on or after the day on which the last family member in excess of one: (A) ceases to be a family member;(B) becomes enrolled in another basic group plan; or(C) in case of a spouse, ceases to live in his or her household or enters military service.(D) A spouse whose enrollment is terminated on the basis of ceasing to live in the household may not be enrolled thereafter except during an open enrollment period or pursuant to the carrier's certification of acceptability under its underwriting standards.(E) A family member who is a spouse or a child who was deleted from an employee's or annuitant's enrollment upon entering military service or was in military service at the time of initial enrollment or at the time he or she became a family member may be enrolled upon return from military service.(3) Except as described in 599.506(f), when a mandatory change of enrollment results in a retroactive cancellation or deletion of enrollment and creates a difference in premium based on the date a family member became ineligible for coverage and the date an employee or annuitant changed his or her enrollment to delete the ineligible family member, the employer and employee or annuitant may receive a refund. The amount of the refund shall not exceed those excess premiums paid for a period of up to six months prior to the date on which the action is processed and recorded, pursuant to the employee's or annuitant's request for retroactive cancellation or deletion of the ineligible family member.(4) An employee or annuitant who is not enrolled, but is covered under the Public Employees' Medical and Hospital Care Act and this subchapter by enrollment of a spouse, may enroll in the same plan as was the spouse for self alone or self and eligible family members within 60 calendar days after termination of the spouse's enrollment. An employee who is not enrolled, but is covered by the enrollment of a parent, may enroll in any plan available within 60 calendar days after the termination of coverage as a family member. An employee or annuitant who is covered by enrollment of another under this subchapter may enroll in the same plan for self alone or self and eligible family members within 60 calendar days after the effective date of a change terminating his or her enrollment.(5) An employee who is enrolled as an annuitant and whose status as an annuitant terminates, may enroll in the same plan under which he or she was covered as an annuitant, in a manner which will continue coverage.(6)(A) An employee or annuitant who is enrolled in a plan with a restricted geographic service area and who moves, including all enrolled family members, or changes employment address may, within 31 calendar days before the move and ending 60 calendar days after the move, enroll in another health benefits plan.(B) An employee or annuitant who is enrolled in a plan with a restricted geographic service area and who moves, and whose enrolled family members do not move, may, within 31 calendar days before the move and ending 60 calendar days after the move, enroll in another health benefits plan.(C) An employee or annuitant who is enrolled in a plan with a restricted geographic service area and whose enrolled family members move, may within 31 calendar days before the move and ending 60 calendar days after the move, enroll in another health benefits plan.(D) An employee or annuitant who moves into, or commences employment within, the service area of a plan with a restricted geographic service area may change his or her enrollment to that plan within the period beginning 31 calendar days before and ending 60 calendar days after the move.(E) An employee or annuitant enrolled in a supplemental plan who moves, other than temporarily, out of the United States as defined in the Federal Social Security Act, may change his or her enrollment to a plan that provides coverage outside the United States.(7) An employee or annuitant who is enrolled in a health benefits plan which ceases to be an approved health benefits plan may enroll in another plan at any time within 60 calendar days after the date set by the Board for withdrawal of its approval of the plan.(8) When an employee or annuitant enrolled for self and family dies, leaving a family member as an annuitant entitled to enrollment in a health benefits plan, the enrollment shall continue by enrollment of the surviving annuitant. The family member annuitant may change or cancel the enrollment providing he or she does so within 60 calendar days of notification of continuation. The effective date of the change or cancellation shall be the first of the month following the death.(9) For purposes of this subsection (e) and subsection (a) of this section, a change in custody of a child, whether or not accompanied by a change in economic dependency, at the option of the enrolled employee or employees may be considered to terminate or begin eligibility of the child as a family member of the employee or employees affected by the change in custody.(10) An employee whose enrollment was continued under Section 599.504(b), (c), (d), (e) or (g) may within 60 days of return to pay status make any change in enrollment which he or she could have made had he or she been in pay status during the continuation.(11) Upon a determination by the Board or the Executive Officer that an employee or annuitant is unable to maintain a satisfactory physician-patient or plan-employee-annuitant relationship, the Board or Executive Officer may permit a change of enrollment to another plan.(12) An employee may add or delete family members under the provisions of this section during a period of continuation of enrollment under the provisions of Section 599.504.(13) Enrollment of any person in a supplemental plan may not be changed to enrollment in a basic plan unless there is an involuntary termination of Medicare benefits or as provided in subdivision (e)(6)(E) of this section.(f) Multiple Enrollment. (1) A family member may be enrolled with respect to only one employee or annuitant. An employee or annuitant, who is also a family member of an employee or annuitant, may not be enrolled both as an employee or annuitant and a family member. Enrollment as a family member continues upon entry into employment unless the person enrolls under the rules applicable to employees, in which event enrollment as a family member terminates on the effective date of enrollment as an employee.(2) An annuitant who would otherwise also be eligible to enroll as an employee must enroll as an annuitant; however, an annuitant who fails to enroll under rules applicable to annuitants and who subsequently becomes an employee, may enroll under rules applicable to employees.(3) Employees who are employed in more than one position with an employer or employed by more than one employer may enroll with respect to one position or employer only.(4) An employee or annuitant shall enroll him or herself and all eligible family members into one basic or supplemental plan offered by the Board at the time of enrollment. Where an employee or annuitant and all eligible family members may not enroll in one basic or supplemental plan at the time of enrollment due to the eligibility rules prescribed by the Board, the employee or annuitant shall enroll him or herself and all eligible family members into only one basic plan and into only one supplemental plan provided by the same carrier unless, pursuant to a rulemaking action under the Administrative Procedure Act, the Board authorizes employees and annuitants and all eligible family members to enroll into one basic plan and into one supplemental plan provided by one or more different carriers. All enrollments shall be under the name of only one employee or annuitant.(5) Where an employee or annuitant has filed more than one enrollment form, in the absence of specific instruction from the employee or annuitant to the contrary, the last enrollment form filed shall be taken as indicating the plan in which the employee desires to enroll.(g) Late Enrollment or Change of Enrollment. Upon a determination by the Board or the Executive Officer that an employee or annuitant was unable, for cause beyond his or her control, to enroll or to change enrollment within the time limits prescribed by this subchapter, the Board shall accept his or her enrollment or change of enrollment provided he or she enrolls or changes enrollment within 31 days after he or she is first able to do so.(h) Procedure. The employing office will afford each eligible employee and annuitant an opportunity to enroll or to register not to enroll during such times as his enrollment is authorized under these rules by supplying the necessary information relating to available plans and by assisting in the completion of a health benefits plan enrollment form. The employing office will forward all such forms properly completed to the Board's Health Benefits Division.Cal. Code Regs. Tit. 2, § 599.502
1. Amendment of subsections (c), (d)(3), and (f)(1)(D) filed 8-5-76; effective thirtieth day thereafter (Register 76, No. 32). For prior history, see Register 75, No. 49.
2. Amendment filed 6-15-79; designated effective 8-1-79 (Register 79, No. 24).
3. Amendment filed 6-27-80; designated effective 8-1-80 (Register 80, No. 26).
4. Amendment of subsections (a)-(d) and (f) filed 6-9-86; effective thirtieth day thereafter (Register 86, No. 24).
5. Amendment of subsections (f)(5)(A)-(D) filed 10-4-2001 as an emergency; operative 10-4-2001 (Register 2001, No. 40). A Certificate of Compliance must be transmitted to OAL by 2-1-2002 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 10-4-2001 order transmitted to OAL 2-1-2002 and filed 3-18-2002 (Register 2002, No. 12).
7. Amendment of subsection (f)(2)(C) and amendment of NOTE filed 6-24-2005; operative 6-24-2005 pursuant to Government Code section 11343.4 (Register 2005, No. 25).
8. Redesignation of portions of second paragraph of subsection (f)(2)(C) as new subsections (f)(2)(D)-(E), redesignation and amendment of former third paragraph of subsection (f)(2)(C) as new subsection (f)(3) and subsection renumbering filed 9-27-2011; operative 9-27-2011 pursuant to Government Code section 11343.4 (Register 2011, No. 39).
9. Amendment of subsection (f)(6)(E), repealer and new subsection (g)(4) and new subsection (g)(5) filed 5-15-2013; operative 7-1-2013 (Register 2013, No. 20).
10. Amendment of subsection (g)(4) filed 11-21-2017; operative 1-1-2018 (Register 2017, No. 47).
11. Amendment of subsections (a)(5)-(6), repealer of subsection (c), subsection relettering and amendment of newly designated subsection (e)(1)(D), (e)(9) and (e)(13) filed 2-28-2020; operative 4-1-2020 (Register 2020, No. 9). Note: Authority cited: Sections 22794, 22796, 22803, 22830, 22846 and 22860, Government Code. Reference: Sections 22830, 22831, 22832, 22834, 22836, 22837, 22839, 22840, 22841, 22842, 22843, 22844, 22846, 22847 and 22848, Government Code.
1. Amendment of subsections (c), (d)(3), and (f)(1)(D) filed 8-5-76; effective thirtieth day thereafter (Register 76, No. 32). For prior history, see Register 75, No. 49.
2. Amendment filed 6-15-79; designated effective 8-1-79 (Register 79, No. 24).
3. Amendment filed 6-27-80; designated effective 8-1-80 (Register 80, No. 26).
4. Amendment of subsections (a)-(d) and (f) filed 6-9-86; effective thirtieth day thereafter (Register 86, No. 24).
5. Amendment of subsections (f)(5)(A)-(D) filed 10-4-2001 as an emergency; operative 10-4-2001 (Register 2001, No. 40). A Certificate of Compliance must be transmitted to OAL by 2-1-2002 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 10-4-2001 order transmitted to OAL 2-1-2002 and filed 3-18-2002 (Register 2002, No. 12).
7. Amendment of subsection (f)(2)(C) and amendment of Note filed 6-24-2005; operative 6-24-2005 pursuant to Government Code section 11343.4 (Register 2005, No. 25).
8. Redesignation of portions of second paragraph of subsection (f)(2)(C) as new subsections (f)(2)(D)-(E), redesignation and amendment of former third paragraph of subsection (f)(2)(C) as new subsection (f)(3) and subsection renumbering filed 9-27-2011; operative 9-27-2011 pursuant to Government Code section 11343.4 (Register 2011, No. 39).
9. Amendment of subsection (f)(6)(E), repealer and new subsection (g)(4) and new subsection (g)(5) filed 5-15-2013; operative 7-1-2013 (Register 2013, No. 20).
10. Amendment of subsection (g)(4) filed 11-21-2017; operative 1-1-2018 (Register 2017, No. 47).
11. Amendment of subsections (a)(5)-(6), repealer of subsection (c), subsection relettering and amendment of newly designated subsection (e)(1)(D), (e)(9) and (e)(13) filed 2-28-2020; operative 4/1/2020 (Register 2020, No. 9).