CFR > Title 45 - Public Welfare > SUBTITLE A—DEPARTMENT OF HEALTH AND HUMAN SERVICES > SUBCHAPTER B—REQUIREMENTS RELATING TO HEALTH CARE ACCESS (parts 140 to 159) > PART 148—REQUIREMENTS FOR THE INDIVIDUAL HEALTH INSURANCE MARKET > SUBPART B—Requirements Relating to Access and Renewability of Coverage (§148.120 to §148.128) > 148.126—Determination of an eligible individual.

148.126—Determination of an eligible individual.

(a) General rule. Each issuer offering health insurance coverage in the individual market is responsible for determining whether an applicant for coverage is an eligible individual as defined in § 148.103.
(b) Specific requirements. (1) The issuer must exercise reasonable diligence in making this determination.
(2) The issuer must promptly determine whether an applicant is an eligible individual.
(3) If an issuer determines that an individual is an eligible individual, the issuer must promptly issue a policy to that individual.
(c) Insufficient information— (1) General rule. If the information presented in or with an application is substantially insufficient for the issuer to make the determination described in paragraph (b)(2) of this section, the issuer may immediately request additional information from the individual, and must act promptly to make its determination after receipt of the requested information
(2) Failure to provide a certification of creditable coverage. If an entity fails to provide the certificate that is required under this part or part 146 of this subchapter to the applicant, the issuer is subject to the procedures set forth in § 148.124(d)(1) concerning an individual's right to demonstrate creditable coverage.
[62 FR 17000, Apr. 8, 1997]

Code of Federal Regulations

Effective Date Note: At 62 FR 17000, Apr. 8, 1997, § 148.126 was added. This section contains information collection and recordkeeping requirements and will not become effective until approval has been given by the Office of Management and Budget.