Cal. Code Regs. Tit. 22, § 53921 - Member Enrollment

(a) Enrollment in GMC plans shall be mandatory for those eligible beneficiaries specified in Section 53906(a), and voluntary for those specified in Section 53906(b).

(b) Enrollment shall be limited to eligible beneficiaries who reside within the GMC program area.

(c) The department or the GMC enrollment contractor shall mail an enrollment form and GMC plan information to each eligible beneficiary described in Section 53906(a). The mailing shall include GMC options presentation information and instructions to enroll in GMC plans within thirty days of the postmark date on the mailing envelope.

(d) Each eligible beneficiary described in Section 53906(a) shall enroll in GMC plans within thirty days of receipt of an enrollment from with instructions from the department or the GMC enrollment contractor to select GMC plans.

(1) In the event an eligible beneficiary described in Section 53906(a) does not enroll in GMC plans within thirty days, the GMC enrollment contractor shall assign the eligible beneficiary to GMC plans, in accordance with Section 53921.5.

(2) For purposes of selection of GMC plans:

(A) In the case of a family group, eligible beneficiary means the individual or entity with legal authority to make a choice on behalf of dependent family members.

(B) In the case of a foster care child, eligible beneficiary means the entity with legal authority to make a choice on behalf of the child.

(e) Each eligible beneficiary enrolling in a GMC plan shall enroll in a dental plan and either a PHP or PCCM plan. An eligible beneficiary shall not be enrolled in more than one PHP or PCCM plan and one dental plan at any one time.

(f) The GMC enrollment contractor shall process all enrollments.

(g) An eligible beneficiary is enrolled upon completion of all of the following events:

(1) Either of the following enrollment activities:

(A) The voluntary signing and dating by the eligible beneficiary of an enrollment form and departmental validation of the beneficiary's enrollment form; or

(B) The assignment, as specified in Section 53921.5, of an eligible beneficiary to a PHP or PCCM plan and a dental plan.

(2) Departmental verification of the beneficiary's Medi-Cal eligibility.

(3) Addition of the beneficiary's name to the approved list of members, which is effective the first day of any given month and which is furnished monthly to the GMC plan by the department.

Notes

Cal. Code Regs. Tit. 22, § 53921

1. New section filed 3-11-94; operative 3-11-94; Submitted to OAL for printing only pursuant to section 147, SB 485 (Chapter 722, Statutes of 1992) (Register 94, No. 15).

Note: Authority cited: Sections 10725, 14089.7, 14105, 14124.5, 14203 and 14312, Welfare and Institutions Code. Reference: Section 14089, Welfare and Institutions Code.

1. New section filed 3-11-94; operative 3-11-94; Submitted to OAL for printing only pursuant to section 147, SB 485 (Chapter 722, Statutes of 1992) (Register 94, No. 15).