Cal. Code Regs. Tit. 22, § 53925.5 - Disenrollment of Members

(a) The GMC enrollment contractor shall disenroll any member who requests disenrollment when one of the following conditions and (c) are met:

(1) A member requests disenrollment during the first thirty days of enrollment.

(2) A member requests disenrollment during the second through sixth month of enrollment in a PHP that is a federally qualified Health Maintenance Organization, a PCCM plan, or a dental plan, for good cause, as follows:

(A) To comply with any of the criteria specified in Section 14407.8(b), Welfare and Institutions Code;

(B) To accommodate the needs of a foster care child;

(C) To comply with travel distance standards specified in Section 53922.5; or

(D) To grant an alternative to GMC plan enrollment as specified in Section 53923.5, if the process for obtaining that alternative was initiated prior to the effective date of enrollment in a GMC plan.

(3) A member requests disenrollment after having met the six-month minimum enrollment period applicable to enrollment in any PHP that is a federally qualified Health Maintenance Organization, a PCCM plan, or a dental plan.

(4) Any member of a PHP that is not a federally qualified Health Maintenance Organization shall be granted disenrollment from that PHP at any time.

(b) The GMC enrollment contractor shall determine whether to grant a request for disenrollment made by a member during the second through sixth month of enrollment. A disenrollment request from a member enrolled in a PHP that is a federally qualified Health Maintenance Organization, a PCCM plan, or a dental plan, shall be granted by the GMC enrollment contractor if one of the criteria specified in (a)(2) is met.

(c) Each disenrollment request shall be accompanied by an enrollment request for enrollment in a different GMC plan. Any member who does not select another GMC plan shall be assigned to one, in accordance with Section 53921.5.

(d) A member who requests and is denied disenrollment during the second through sixth month of enrollment shall have the right to request assistance from the GMC enrollment contractor in accordance with Section 53926.

Notes

Cal. Code Regs. Tit. 22, § 53925.5

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 citeed: Sections 10725, 14089.7, 14105, 14124.5, 14203 and 14312, Welfare and Institutions Code. Reference: Sections 14089, 14407.6 and 14407.8, 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).