(a) Open Enrollment. Beginning on October 1, 2011, an insurer shall establish and administer an open enrollment period each year from October 1 until October 31 for the purpose of offering a child-only individual policy to each qualified individual. During the open enrollment period, an insurer shall accept a completed application to insure a qualified individual for a child-only individual policy on a guaranteed-issue basis without any limitations or exclusions of policy benefits based upon the applicant's health status. An application is not completed unless and until the applicant has supplied all information necessary for the insurer to underwrite the coverage. Such needed information may include medical records, e.g., attending physician's statements, paramedical exams or questionnaires. An insurer shall have ten days from the insurer's receipt of the application or subsequent submissions by the applicant to determine and issue notice to the applicant of needed information. The applicant shall forward the needed information to the insurer no later than December 9 or the first business day after December 9. Upon receipt of the needed information the insurer shall offer coverage at a premium determined through its underwriting. The applicant shall have until December 31 to accept the coverage offered, so that it can become effective on January 1.

(b) Qualifying Event for Loss of Employer-Sponsored Health Insurance or Involuntary Loss of Other Existing Health Insurance. An insurer shall accept an application to insure a qualified individual for a child-only individual policy as long as it is complete and submitted within thirty (30) days upon the occurrence of a “qualifying event” on a guaranteed-issue basis without any limitations or exclusions of policy benefits based upon the applicant's health status as provided in Section One (l)(a)(6) of the Child-Only Law. The insurer shall have forty-five (45) days from the date it accepts the completed application to review the application for purposes of underwriting and to issue a policy. An application is not completed unless and until the applicant has supplied all information necessary for the insurer to underwrite the coverage. Such needed information may include medical records e.g., attending physician's statements, paramedical exams or questionnaires. An insurer shall have ten days from the insurer's receipt of the application or subsequent submissions by the applicant to determine and issue notice to the applicant of needed information. The applicant shall have forty-five (45) days from the applicant's receipt of the insurer's request for information to forward the needed information to the insurer. Upon receipt of the needed information the insurer shall offer coverage at a premium determined through its underwriting, such coverage to become effective within forty-five (45) days. The applicant shall have thirty (30) days to accept the offer of coverage.

(c) First Effective Date of Qualifying Event Participation. To provide insurers with a reasonable amount of time to establish rates or forms to comply with the Child-Only Law and this Rule, the first effective date for applicants to qualify for a child-only individual policy under a “qualifying event” shall be after October 31, 2011.

(d) Notice of the open enrollment opportunity and open enrollment dates for new applicants, as well as the opportunity to enroll due to a Qualifying Event, must be displayed prominently on the carrier's website throughout the year.

(e) Coverage resulting from complete applications received during the open enrollment period shall become effective no later than January 1 following the open enrollment during which the application is received.

(f) Prohibited Practices. To ensure a parent cannot temporarily obtain family coverage at any point in the year only to subsequently drop coverage to make the child a child only subscriber, such actions by the parent shall not constitute an “involuntary loss of other existing insurance” and therefore will not constitute a “qualifying event” under Section (1)(a)(6) of the Child-Only Law.