California

Insurance Code

4,514 sections, each with the official text and a plain-English explanation of what it means for you.

• § 10711 — No carrier shall be required by the provisions of this chapter: (a) To offer coverage to, or accept applications from, a small employer as defined in paragraph (1) of subdivision (w) of Section 10700,
• § 10712 — (a) A carrier shall not be required to offer coverage or accept applications for benefit plan designs pursuant to this chapter where the commissioner determines that the acceptance of an application o
• § 10713 — All health benefit plans written, issued, or administered by carriers on or after the effective date of this chapter, and all health benefit plans in force on or after the effective date of this chapt
• § 10714 — Premiums for benefit plan designs written, issued, or administered by carriers on or after the effective date of this act, shall be subject to the following requirements: (a) (1) The premium for new b
• § 10715 — Carriers shall apply standard employee risk rates consistently with respect to all small employers.
• § 10716 — In connection with the offering for sale of any benefit plan design to small employers: Each carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of the followi
• § 10717 — (a) No carrier shall provide or renew coverage subject to this chapter until it has done all of the following: (1) A statement has been filed with the commissioner listing all of the carrier’s benefit
• § 10718 — (a) In addition to any other remedy permitted by law, the commissioner shall have the administrative authority to assess penalties against carriers, insurance producers, and other entities engaged in
• § 10718.5 — (a) (1) In addition to any other remedy permitted by law, whenever the commissioner shall have reason to believe that any carrier, production agent, or other person or entity engaged in the business o
• § 10718.55 — (a) Carriers may enter into contractual agreements with qualified associations, as defined in subdivision (b), under which these qualified associations may assume responsibility for performing specifi
• § 10718.7 — Notwithstanding any other provision of law, no provision of this chapter shall be construed to limit the applicability of any other provision of the Insurance Code unless such provision is in conflict
• § 10719 — The California Small Group Reinsurance Fund is hereby authorized to be created solely to allow carriers to share in financing the cost of covering high risk small employer groups.
• § 10719.1 — Any person or entity subject to the requirements of this chapter shall comply with the standards set forth in Chapter 7 (commencing with Section 3750) of Part 1 of Division 9 of the Family Code and Se
• § 1072 — The commissioner shall make, or cause to be made by the insurance authority of the State where the insurer is organized, an examination of the books and records of the insurer.
• § 10720 — (a) The fund shall be governed by a board of directors, which shall initially be elected by small employer carriers and small employer health care service plans.
• § 10720.1 — The fund shall have the general powers and authority granted under the laws of California to insurance companies and health care service plans licensed to transact business, except the power to issue
• § 10721 — The fund shall provide for the financing of its reinsurance and operating costs, including actuarially sound reserves for unpaid losses, by charging members a reinsurance contribution and, as necessar
• § 10722 — If assessments exceed actual losses and administrative expenses of the fund, the excess shall be held at interest and used by the fund to offset future losses or to reduce fund premiums.
• § 10723 — Any unsatisfied net liability or outstanding assessment owed by an insolvent member participating in the fund shall be assumed by and apportioned among the remaining members in the fund in the same ma
• § 10724 — Carriers choosing to participate shall comply with all requirements for participation established by the fund.
• § 10725 — The fund’s board of directors shall establish the rules, conditions, and procedures pertaining to the reinsurance of members’ risks by the fund.
• § 10726 — Nothing in this article relieves members of participating in the fund from complying with the underwriting and rating provisions included in Article 1 (commencing with Section 10700) and Article 2 (co
• § 10727 — The fund shall be exempt from any and all taxes.
• § 10728 — For purposes of agreements entered into pursuant to this article, the fund, and its officers, directors, agents, and employees shall have no liability for any damages other than actual damages.
• § 10729 — The fund shall establish rules, conditions, and procedures relating to the indemnification of any person or member of the fund made a party to any claim, action, suit, or proceeding because the person
• § 1073 — Whenever any insurer withdraws from business in this State, and whenever for any reason the commissioner revokes or cancels the certificate of authority admitting any insurer, the commissioner shall t
• § 10730 — (a) The Voluntary Alliance Uniting Employers Purchasing Program is hereby created and shall be administered by the Major Risk Medical Insurance Board.
• § 10731 — The board may do any of the following: (a) Enter into contracts with carriers to provide health benefits coverage to eligible employees and their dependents.
• § 10731.2 — Any person or entity subject to the requirements of this chapter shall comply with the standards set forth in Chapter 7 (commencing with Section 3750) of Part 1 of Division 9 of the Family Code and Se
• § 10732 — The board shall establish geographic areas within which participating carriers may offer health coverage to eligible employees and dependents.
• § 10733 — On or after the effective date of this chapter, the board shall enter into contracts with carriers for the purpose of providing health benefits coverage to eligible employees and dependents.
• § 10733.5 — Notwithstanding any other provision of law, an employer purchasing coverage through the program shall not be determined to be no longer eligible to participate in the program solely because the employ
• § 10734 — (a) Notwithstanding any other provision of law, the board shall not be subject to licensure or regulation by the Department of Insurance or the Department of Managed Health Care, as the case may be.
• § 10735 — The board shall contract with a broad range of carriers in an area, if available, to ensure that enrollees have a choice from among a reasonable number and types of competing carriers.
• § 10737 — The board shall use appropriate and efficient means to notify small employers of the availability of sponsored health coverage from the program.
• § 10738 — The board shall make available to small employers marketing materials that accurately summarize the benefits plans and rates that are offered by the carrier through the program.
• § 10739 — Unless authorized by the board, no participating carrier shall, in an area served by the program, directly, or through an employee, agent, or contractor, provide a small group or enrollee with any mar
• § 1074 — Upon the failure of such insurer to pay the expense of such advertising within thirty days after the presentation of the bill therefor, the commissioner shall collect such fee from the surety in the b
• § 10740 — Participating carriers may contract with agents or brokers to provide marketing and servicing of health benefits coverage offered through the program.
• § 10741 — The board shall enforce conditions of participation in the program for small employers and enrollees which shall conform with the requirements of this chapter.
• § 10742 — The board shall establish a mechanism to collect premiums from small employers, including remittance of the share of the premium paid by the enrollee.
• § 10743 — The board may prohibit employers or employees who drop coverage after enrolling in the pool from reenrolling in the program for up to 12 months.
• § 10744 — The board shall arrange to pay contractors as specified in program contracts.
• § 10745 — The board shall pay participating carriers their contracted rates.
• § 10746 — Participating carriers shall offer rates to small employers or enrollees in the program that, at a minimum, are consistent with the program regulations and existing statutes and regulations regulating
• § 10747 — The board may adjust payments made to a carrier if the board finds that the carrier has a significantly disproportionate share of high- or low-risk enrollees.
• § 10748 — If a small employer, employee, or dependent of a small employer is dissatisfied with any action or failure to act which has occurred in connection with eligibility for, or enrollment in the program, t
• § 10748.5 — No later than three years from the effective date of this article, the board shall issue a request for proposals that solicits nonprofit entities to submit bids to assume administrative and fiscal res
• § 10748.6 — The board shall accept and review proposals submitted from nonprofit entities for assumption of administrative and financial responsibility of the program at any time prior to the process described in
• § 10748.7 — There is in the program a five-member small employer advisory panel to be appointed by the board to provide consultation to the board on program design and implementation.
• § 10749 — There is created a Voluntary Alliance Uniting Employers Fund which shall consist of moneys collected pursuant to this article and any funds loaned by the board for operating expenses.
• § 10750 — This chapter shall not apply to a health benefit plan that is subject to Chapter 8.
• § 10752 — As used in this article, the following definitions shall apply: (a) “Attachment point” means the amount of health claims incurred by a small employer in a policy year for its employees and their depen
• § 10752.1 — A stop-loss insurer shall not exclude any employee or dependent on the basis of an actual or expected health status-related factor.
• § 10752.2 — A stop-loss insurer shall renew, at the option of the small employer, all stop-loss insurance policies written, issued, administered, or renewed on or after January 1, 2014, and all small employer sto
• § 10752.3 — A stop-loss insurance policy issued, reissued, or renewed on or after January 1, 2014, and prior to January 1, 2016, to a small employer shall not contain any of the following provisions: (a) An indiv
• § 10752.4 — A stop-loss insurance policy issued, reissued, or renewed on or after January 1, 2016, to a small employer shall not contain any of the following provisions: (a) An individual attachment point for a p
• § 10752.43 — Sections 10752.
• § 10752.46 — On April 1, 2014, and on April 1 annually thereafter, a stop-loss insurer shall report to the Department of Insurance the number of small employer stop-loss policies it had issued and in effect as of
• § 10752.5 — The commissioner may adopt regulations as may be necessary to carry out the purposes of this article.
• § 10752.6 — A stop-loss insurer that violates the provisions of this article is subject to the remedies and administrative penalties applicable to insurers in Sections 10718 and 10718.
• § 10752.7 — Nothing in this article shall affect the ongoing operations of multiple employer welfare arrangements regulated pursuant to Article 4.
• § 10752.8 — The provisions of this article are severable.
• § 10753 — (a) “Agent or broker” means a person or entity licensed under Chapter 5 (commencing with Section 1621) of Part 2 of Division 1.
• § 10753.01 — (a) For purposes of this chapter, “health benefit plan” does not include policies or certificates of specified disease or hospital confinement indemnity provided that the carrier offering those polici
• § 10753.02 — (a) This chapter shall apply only to nongrandfathered health benefit plans and only with respect to plan years commencing on or after January 1, 2014.
• § 10753.02.1 — Any person or entity subject to the requirements of this chapter shall comply with the standards set forth in Chapter 7 (commencing with Section 3750) of Part 1 of Division 9 of the Family Code and Se
• § 10753.03 — The commissioner shall have the authority to determine whether a health benefit plan is covered by this chapter, and to determine whether an employer is a small employer within the meaning of Section
• § 10753.04 — The commissioner may issue regulations that are necessary to carry out the purposes of this chapter.
• § 10753.05 — (a) A group or individual policy or contract or certificate of group insurance or statement of group coverage providing benefits to employees of small employers as defined in this chapter shall not be
• § 10753.05.2 — (a) For contracts expiring after July 1, 1994, 60 days prior to July 1, 1994, an association that meets the definition of guaranteed association, as set forth in Section 10753, except for the requirem
• § 10753.06 — Every carrier shall file with the commissioner the reasonable participation requirements and employer contribution requirements that are to be included in its health benefit plans.
• § 10753.06.5 — (a) With respect to small employer health benefit plans offered outside the Exchange, after a small employer submits a completed application, the carrier shall, within 30 days, notify the employer of
• § 10753.08 — A health benefit plan shall not impose a preexisting condition provision or a waiting or affiliation period upon any individual.
• § 10753.09 — Nothing in this chapter shall be construed as prohibiting a carrier from restricting enrollment of late enrollees to open enrollment periods provided under Section 10753.
• § 10753.11 — (a) To the extent permitted by PPACA, a carrier shall not be required by the provisions of this chapter to do any of the following: (1) Offer coverage to, or accept applications from, a small employer
• § 10753.12 — (a) A carrier shall not be required to offer coverage or accept applications for benefit plan designs pursuant to this chapter where the carrier demonstrates to the satisfaction of the commissioner bo
• § 10753.13 — All health benefit plans subject to this chapter shall be renewable with respect to all eligible employees or dependents at the option of the policyholder, contractholder, or small employer except as
• § 10753.14 — (a) The premium rate for a small employer health benefit plan issued, amended, or renewed on or after January 1, 2014, shall vary with respect to the particular coverage involved only by the following
• § 10753.16 — In connection with the offering for sale of a health benefit plan subject to this chapter to small employers: Each carrier shall make a reasonable disclosure, as part of its solicitation and sales mat
• § 10753.17 — (a) No carrier shall provide or renew coverage subject to this chapter until a statement has been filed with the commissioner listing all of the carrier’s health benefit plans currently in force that
• § 10753.18 — (a) In addition to any other remedy permitted by law, the commissioner shall have the administrative authority to assess penalties against carriers, insurance producers, and other entities engaged in
• § 10753.18.5 — (a) (1) In addition to any other remedy permitted by law, whenever the commissioner shall have reason to believe that any carrier, production agent, or other person or entity engaged in the business o
• § 10753.18.55 — (a) Carriers may enter into contractual agreements with qualified associations, as defined in subdivision (b), under which these qualified associations may assume responsibility for performing specifi
• § 10753.18.7 — Notwithstanding any other provision of law, no provision of this chapter shall be construed to limit the applicability of any other provision of the Insurance Code unless such provision is in conflict
• § 10755 — As used in this chapter, the following definitions shall apply: (a) “Agent or broker” means a person or entity licensed under Chapter 5 (commencing with Section 1621) of Part 2 of Division 1.
• § 10755.01 — (a) For purposes of this chapter, “health benefit plan” does not include policies or certificates of specified disease or hospital confinement indemnity provided that the carrier offering those polici
• § 10755.02 — (a) This chapter shall apply only to grandfathered health benefit plans and only with respect to plan years commencing on or after January 1, 2014.
• § 10755.02.1 — Any person or entity subject to the requirements of this chapter shall comply with the standards set forth in Chapter 7 (commencing with Section 3750) of Part 1 of Division 9 of the Family Code and Se
• § 10755.03 — The commissioner shall have the authority to determine whether a health benefit plan is covered by this chapter, and to determine whether an employer is a small employer within the meaning of Section
• § 10755.04 — (a) The department may adopt emergency regulations implementing this chapter no later than August 31, 2013.
• § 10755.05 — (a) (1) Each carrier, except a self-funded employer, shall fairly and affirmatively renew all of the carrier’s health benefit plans that are sold to small employers or associations that include small
• § 10755.05.1 — (a) For contracts expiring after July 1, 1994, 60 days prior to July 1, 1994, an association that meets the definition of guaranteed association, as set forth in Section 10755, except for the requirem
• § 10755.06 — Every carrier shall file with the commissioner the reasonable participation requirements that will be required in renewing its health benefit plans.
• § 10755.08 — A health benefit plan shall not impose a preexisting condition provision or a waiting or affiliation period upon any individual.
• § 10755.09 — Nothing in this chapter shall be construed as prohibiting a carrier from restricting enrollment of late enrollees to open enrollment periods consistent with federal law.
• § 10755.11 — No carrier shall be required by the provisions of this chapter: (a) To include in a health benefit plan an otherwise eligible employee or dependent, when the eligible employee or dependent does not wo
• § 10755.13 — All grandfathered health benefit plans shall be renewable with respect to all eligible employees or dependents at the option of the policyholder, contractholder, or small employer except as follows: (
• § 10755.14 — Premiums for grandfathered health benefit plans written or administered by carriers on or after the January 1, 2014, shall be subject to the following requirements: (a) (1) The premium for new busines
• § 10755.15 — Carriers shall apply standard employee risk rates consistently with respect to all small employers.
• § 10755.16 — In connection with the renewal of any grandfathered health benefit plan to small employers: Each carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of the fol
• § 10755.17 — (a) No carrier shall renew coverage subject to this chapter until it has done all of the following: (1) A statement has been filed with the commissioner listing all of the carrier’s grandfathered heal
• § 10755.18 — (a) In addition to any other remedy permitted by law, the commissioner shall have the administrative authority to assess penalties against carriers, insurance producers, and other entities engaged in
• § 10755.18.5 — (a) (1) In addition to any other remedy permitted by law, whenever the commissioner shall have reason to believe that any carrier, production agent, or other person or entity engaged in the business o
• § 10755.18.6 — (a) Carriers may enter into contractual agreements with qualified associations, as defined in subdivision (b), under which these qualified associations may assume responsibility for performing specifi
• § 10755.18.7 — Notwithstanding any other provision of law, no provision of this chapter shall be construed to limit the applicability of any other provision of the Insurance Code unless such provision is in conflict
• § 1076 — The withdrawing insurer shall pay to the commissioner a fee of one thousand four hundred ten dollars ($1,410) for all services and expenses in connection with the withdrawal.
• § 1077 — As used in this article: (a) “Insurer” means and includes every person engaged as indemnitor, surety, or contractor in the business of entering into contracts of life or disability insurance or of ann
• § 1077.1 — The provisions of the article shall apply to all of the following: (a) All domestic life or disability insurers, except the State Compensation Insurance Fund.
• § 1077.2 — (a) An insurer may be subject to administrative supervision by the commissioner if, upon examination or at any other time it appears in the commissioner’s discretion that any of the following applies:
• § 1077.3 — (a) Notwithstanding any other provision of law, and except as set forth in this section, proceedings, hearings, notices, correspondence, reports, records, and other information in the possession of th
• § 1077.4 — During the period of supervision, the commissioner or his or her designated appointee shall serve as the administrative supervisor.
• § 1077.5 — During the period of supervision the insurer may contest an action taken or proposed to be taken by the supervisor specifying the manner wherein the action being complained of would not result in impr
• § 1077.6 — Nothing contained in this article shall preclude the commissioner from initiating judicial proceedings to place an insurer in conservation, rehabilitation, or liquidation proceedings or other delinque
• § 1077.7 — The commissioner may adopt reasonable rules necessary for the implementation of this article.
• § 1077.8 — Notwithstanding any other provision of law, the commissioner may meet with a supervisor appointed under this article and with the attorney or other representative of the supervisor, without the presen
• § 1077.9 — There shall be no liability on the part of, and no cause of action of any nature shall arise against, the commissioner or the department or its employees or agents for any action taken by them in the
• § 1077.95 — The authority granted pursuant to this article is in addition to, and not in lieu of, any other provision of this code.
• § 10785 — (a) A disability insurer that covers hospital, medical, or surgical expenses under an individual health benefit plan as defined in subdivision (a) of Section 10198.
• § 10786 — (a) (1) On and after January 1, 2014, a health insurer providing health insurance coverage shall provide to policyholders in individual policies or certificate holders in group policies who cease to b
• § 108 — Liability insurance includes: (a) Insurance against loss resulting from liability for injury, fatal or nonfatal, suffered by any natural person, or resulting from liability for damage to property, or
• § 108.1 — Insurers admitted to transact liability insurance are also deemed to be admitted to transact workers’ compensation insurance for the purpose of covering those persons defined as employees by subdivisi
• § 1080 — Any domestic incorporated mutual life insurer or disability insurer or life and disability insurer issuing nonassessable policies on a reserve basis may merge, consolidate or otherwise unite with or b
• § 10800 — This chapter shall be known as the Private Health Care Voluntary Purchasing Alliance Act.
• § 10801 — The purpose of this chapter is to improve the competition in the pricing and delivering of health care coverage for employers and small employers.
• § 10802 — This chapter is also intended to provide a meaningful choice of high quality, fairly priced health care providers, and health care coverage for participating employers and employees of a purchasing al
• § 10803 — It is envisioned that a purchasing alliance will contract with qualified group carriers to provide a meaningful choice of carriers providing health benefit plans or ancillary benefit plans to purchasi
• § 10810 — As used in this chapter: (a) “Ancillary benefit plan” means a policy or contract written or administered by a participating carrier that covers dental or vision benefits for the covered eligible emplo
• § 10820 — (a) The commissioner shall regulate the establishment and conduct of purchasing alliances as set forth in this chapter.
• § 10821 — (a) An entity seeking to obtain a certificate of registration to act as a purchasing alliance shall complete and file with the commissioner an application designated by the commissioner.
• § 10821.5 — (a) The purchasing alliance shall furnish an annual financial audit to the commissioner on the forms provided by the commissioner.
• § 10822 — After the issuance or reissuance of a certificate of registration to act as a purchasing alliance, the holder shall continue to comply with the requirements as to its business set forth in this chapte
• § 10823 — In addition to any other grounds specified in this chapter, the following constitute grounds for denial, nonrenewal, suspension, or revocation of an application or existing certificate of registration
• § 10824 — (a) The commissioner may take disciplinary action against a purchasing alliance if the commissioner determines that the purchasing alliance has committed any of the acts set forth in Section 10823.
• § 10825 — (a) A purchasing alliance whose certificate has been revoked or suspended for more than one year may petition the commissioner to reinstate the certificate as provided by Section 11522 of the Governme
• § 10826 — (a) Any person who violates any provision of this chapter, or who violates any rule or order adopted or issued pursuant to this chapter, shall be liable for a civil penalty not to exceed two thousand
• § 10830 — No owner, officer, partner, or board members or members of their household nor any management personnel of the alliance may be employed by, be a consultant for, be a member of the board of directors o
• § 10840 — A purchasing alliance shall do all of the following: (a) Set reasonable fees, which may vary by employer or small employer size, in the purchasing alliance that will finance reasonable and necessary c
• § 10841 — (a) A purchasing alliance shall comply with all requirements pertaining to the underwriting, rating and renewal practices for small employers, pursuant to subdivisions (a) and (b) of Section 1357.
• § 10842 — A purchasing alliance may do any of the following: (a) Contract with qualified independent third parties for any services necessary to carry out the powers and duties authorized or required by this ch
• § 10843 — A purchasing alliance shall not do any of the following: (a) Purchase health care services, assume risk for the cost or provision of health services, or otherwise contract with health care providers f
• § 10844 — A purchasing alliance may offer coverage pursuant to Chapter 9.
• § 10845 — (a) The commissioner shall require every purchasing alliance, as a condition precedent to receiving and holding a certificate of registration, to file and maintain in the commissioner’s office a writi
• § 10850 — (a) In order to be eligible to be a participating carrier, a carrier shall demonstrate the following operating characteristics satisfactory to the board: (1) Be licensed and approved as a carrier and
• § 10851 — Every participating carrier shall: (a) Meet the standards established by the board pursuant to this chapter.
• § 10853 — In contracts with participating carriers, the purchasing alliance may establish performance standards for specific contractual elements and penalties for failure to fulfill specific contractual obliga
• § 10854 — Nothing in this chapter shall prohibit a participating carrier from contracting with particular health care providers or types, classes, or categories of health care providers or setting reimbursement
• § 10855 — In the event the participating carrier elects to terminate its participating agreement with a purchasing alliance, the participating carrier shall do both of the following: (a) Provide advance notice
• § 10856 — Nothing in this article shall be construed to limit the existing regulatory authority of the Department of Managed Health Care to regulate health care service plans or of the Department of Insurance t
• § 10860 — Contracts between the purchasing alliance and participating carriers shall specify how all premiums will be transmitted, and penalties and grace periods for payments.
• § 10861 — Contracts between purchasing alliances and participating employers shall provide all of the following: (a) For administrative purposes, the purchasing alliance shall be the policyholder or contracthol
• § 10870 — The board shall establish marketing standards to be used by participating carriers.
• § 10871 — Any marketing, advertisement, or educational material for health benefit plans or ancillary benefit plans sold through the purchasing alliance shall be approved by the board prior to its use.
• § 10872 — This article shall not be construed to prohibit or to compel the purchasing alliance or a participating carrier from using the services of an agent or broker.
• § 10873 — (a) A participating carrier, agent, broker, contractor, or producer of a participating carrier, or independent insurance agent, broker, contractor, or producer may not engage, directly or indirectly,
• § 10880 — In the event a purchasing alliance becomes insolvent, the commissioner shall maintain jurisdiction of the alliance for purposes of protection of the interests of the alliance enrollees.
• § 10885 — Purchasing alliances shall be exempt from requirements of licensure as a health care service plan or solicitor under Chapter 2.
• § 10886 — For purposes of carrier product disclosure, a purchasing alliance shall be considered an entity that provides administrative services, as is described in paragraph (1) of subdivision (d) of Section 10
• § 10887 — Except as provided in subdivision (c) of Section 10820, nothing in this chapter shall apply to a health care service plan licensed under the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.
• § 109 — Workers’ compensation insurance includes insurance against loss from liability imposed by law upon employers to compensate employees and their dependents for injury sustained by the employees arising
• § 1090 — An insurer which is insolvent, retiring from business in this state other than by merger or consolidation into an admitted insurer with the commissioner’s prior written consent, or the required paid-i
• § 10900 — As used in this chapter: (a) “Benefit plan design” means a specific health coverage policy issued by a carrier to individuals, to trustees of associations that cover individuals.
• § 10901 — Every carrier offering health benefit plans to individuals shall comply with the provisions of this chapter and the rules adopted thereunder.
• § 10901.1 — Nothing in this chapter shall be construed to preclude the application of this chapter to either of the following: (a) an association, trust, or other organization acting as a health care service plan
• § 10901.2 — (a) Commencing January 1, 2001, a carrier shall fairly and affirmatively offer, market, and sell the health benefit plan designs described in subdivision (d) of Section 10785 that are sold to individu
• § 10901.3 — (a) (1) After the federally eligible defined individual submits a completed application form for a health benefit plan, the carrier shall, within 30 days, notify the individual of the individual’s act
• § 10901.4 — A carrier may not exclude any federally eligible defined individual, or his or her dependents, who would otherwise be entitled to health care services, on the basis of an actual or expected health con
• § 10901.7 — (a) The commissioner may require a carrier to discontinue the offering of health benefit plans or the acceptance of applications from any individual upon a determination by the commissioner that the p
• § 10901.8 — All health benefit plans offered to a federally eligible defined individual shall be renewable with respect to the individual and dependents at the option of the enrolled individual except in cases of
• § 10901.9 — (a) Commencing January 1, 2001, premiums for health benefit plans offered, delivered, amended, or renewed by carriers shall be subject to the following requirements: (1) The premium for new business f
• § 10902 — Carriers shall apply premiums consistently with respect to all federally eligible defined individuals who apply for coverage.
• § 10902.1 — In connection with the offering for sale of any health benefit plan designed to an individual, each carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of all
• § 10902.2 — Nothing in this chapter shall be construed to require a health benefit plan to offer a contract to an individual if the carrier does not otherwise offer contracts to individuals.
• § 10902.3 — (a) At least 20 business days prior to renewing or amending a health benefit plan contract subject to this chapter, or at least 20 business days prior to the initial offering of a health benefit plan
• § 10902.5 — The commissioner may issue regulations that are necessary to carry out the purposes of this chapter.
• § 1091 — The retiring insurer shall pay to the commissioner a fee of one thousand seven hundred ninety-four dollars ($1,794) for filing the documents initiating approval proceedings under this article.
• § 10930 — For purposes of this chapter, the following definitions shall apply: (a) “Consumer operated and oriented plan” means a nonprofit member organization or nonprofit member corporation that has been estab
• § 10930.1 — (a) The commissioner shall have the authority to issue a certificate of authority as a disability insurer to a CO-OP that has been organized as a nonprofit member organization or nonprofit member corp
• § 10930.2 — A domestic or foreign insurer admitted as a CO-OP insurer shall be subject to the same “paid-in capital” or “capital paid-in” requirements as are imposed on domestic and foreign mutual insurers pursua
• § 10930.3 — (a) A domestic or foreign CO-OP admitted as a CO-OP insurer shall be subject to all of the provisions of this code that are applicable to insurers issuing policies of health insurance in the state and
• § 10930.4 — (a) A solvency loan obtained by a CO-OP shall be treated as a surplus note and shall be subject to the same requirements as are imposed on mutual insurers pursuant to Article 4 (commencing with Sectio
• § 10930.5 — The provisions of Section 699.
• § 10930.6 — (a) A CO-OP shall be subject at all times to the prohibitions in PPACA against converting or selling to a for-profit or nonconsumer-operated entity at any time after receiving a solvency loan.
• § 10930.7 — A CO-OP insurer is insolvent if its surplus becomes less than the amount of paid-in capital required of a capital stock company to qualify to transact the class of disability and health insurance.
• § 10930.8 — In addition to any applicable requirements in this code for maintaining a certificate of authority, a CO-OP is required at all times to be in full compliance with the requirements of PPACA governing C
• § 10930.9 — The department may adopt regulations implementing this chapter pursuant to the Administrative Procedure Act (Chapter 3.
• § 10950 — As used in this chapter: (a) “Child” means any individual under 19 years of age.
• § 10951 — (a) (1) During each open enrollment period, every carrier offering health benefit plans in the individual market, other than individual grandfathered plan coverage, shall offer to the responsible part
• § 10952 — This chapter shall not apply to health benefit plans for coverage of Medicare services pursuant to contracts with the United States government, Medicare supplement policies, Medi-Cal contracts with th
• § 10953 — (a) Upon the effective date of this chapter, a carrier shall fairly and affirmatively offer, market, and sell all of the carrier’s health benefit plans that are offered and sold to a child or the resp
• § 10954 — (a) A carrier may use the following characteristics of an eligible child for purposes of establishing the rate of the health benefit plan for that child, where consistent with federal regulations unde
• § 10957 — No carrier shall be required to offer a health benefit plan or accept applications for the contract pursuant to this chapter in the case of any of the following: (a) To a child, if the child who is to
• § 10958 — The commissioner may require a carrier to discontinue the offering of contracts or acceptance of applications from any individual or child or responsible party for a child upon a determination by the
• § 10959 — (a) All health benefit plans offered to a child or on behalf of a child to a responsible party for a child shall conform to the requirements of Section 10127.
• § 10960 — On or before July 1, 2011, the commissioner may issue guidance to health plans regarding compliance with this chapter and such guidance shall not be subject to the Administrative Procedure Act (Chapte
• § 10960.5 — (a) This chapter shall become inoperative on January 1, 2014, or the 91st calendar day following the adjournment of the 2013–14 First Extraordinary Session, whichever date is later.
• § 10965 — For purposes of this chapter, the following definitions shall apply: (a) “Child” means a child described in Section 22775 of the Government Code and subdivisions (n) to (p), inclusive, of Section 599.
• § 10965.01 — (a) For purposes of this chapter, “health benefit plan” does not include policies or certificates of specified disease or hospital confinement indemnity provided that the carrier offering those polici
• § 10965.02 — For the purposes of determining eligibility for small employer coverage, a sole proprietor and the sole proprietor’s spouse are not considered employees with respect to a sole proprietorship that cons