reglab/housing_qa huggingface dataset:
CA Govt Code § 22852 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 6 - Health Benefit Plans and Contracts|Section 22852.

22852.  (a) A contract for a health benefit plan shall be for a uniform term of at least one year and may be made automatically renewable in the absence of notice of termination by either party. Every contract for administrative services with respect to the operation of a self-funded, partially self-funded, or minimum premium health benefit plan administered by the board shall be on terms as the board deems necessary or desirable.(b) The board shall determine the beginning and ending dates of a contract with the carrier of a health benefit plan and with an entity providing services in connection with the administration of a health benefit plan.(c) Irrespective of an agreed upon termination date, the board may extend a contract for a reasonable period of time, subject to agreed upon terms and conditions.(Amended by Stats. 2019, Ch. 330, Sec. 19. (SB 782) Effective January 1, 2020.)
CA Govt Code § 22853 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 6 - Health Benefit Plans and Contracts|Section 22853.

22853.  (a) Each contract shall contain a detailed statement of benefits offered and shall include maximums, limitations, exclusions, and other definitions of benefits as the board deems necessary or desirable.(b) Except as otherwise provided by this part, a health benefit plan or contract may not exclude any person on account of physical condition, age, race, or other status. Except as otherwise provided by this part, transfer of enrollment to a health benefit plan shall be open to all employees and annuitants in accordance with Section 22841.(c) A health benefit plan or contract shall offer to each employee or annuitant whose enrollment in the plan is terminated other than by cancellation of enrollment, voluntary separation from employment, or dismissal from employment for cause, the option to convert to an individual health benefits policy, without regard to health status, but within the time limit approved by the board. An employee or annuitant that exercises this option shall pay the full periodic charges of the individual policy according to the terms and conditions prescribed by the carrier and approved by the board.(d) A health benefit plan or contract shall provide grievance procedures to protect the rights of employees and annuitants.(e) The board shall provide a sufficient number of health benefit plans that provide chiropractic services so that every employee and annuitant has a reasonable opportunity to enroll in a health benefit plan that provides chiropractic services without prior referral by a physician.(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
CA Govt Code § 22853.1 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 6 - Health Benefit Plans and Contracts|Section 22853.1.

22853.1.  (a) A health benefit plan or contract shall provide coverage for a vaccine for acquired immune deficiency syndrome (AIDS) that is approved for marketing by the federal Food and Drug Administration and that is recommended by the United States Public Health Service.(b) This section does not require a health benefit plan or contract to provide coverage for any clinical trials relating to an AIDS vaccine or for any AIDS vaccine that has been approved by the federal Food and Drug Administration in the form of an investigational new drug application.(c) Nothing in this section is to be construed in any manner to limit or impede the board’s power or responsibility to purchase the vaccine at the most cost-effective price.(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
CA Govt Code § 22854 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 6 - Health Benefit Plans and Contracts|Section 22854.

22854.  (a) The board, in considering a contract with any entity that seeks to enter into a contract under this article for the provision of health care benefits or services, may consider all of the following:(1) Whether the applicant is of reputable and responsible character. The board may consider any available information that the applicant has demonstrated a pattern and practice of violations of state or federal laws and regulations.(2) Whether the applicant has the ability to provide, or arrange to provide for, health care benefits or services. The board may consider any of the following:(A) Any prior history of providing, or arranging to provide for, health care services or benefits in this state, the applicant’s history of substantial compliance with the requirements imposed under that license, and applicable federal laws, regulations, and requirements.(B) Any prior history in this state or any other state, of providing, or arranging to provide for, health care services or benefits authorized to receive Medicare Program reimbursement or Medicaid Program reimbursement, the applicant’s history of substantial compliance with that state’s requirements, and applicable federal laws, regulations, and requirements.(C) Any prior history of providing, or arranging to provide for, health services as a licensed health professional or an individual or entity contracting with a health care service plan or insurer, and the applicant’s history of substantial compliance with state requirements, and applicable federal law, regulations, and requirements.(b) The board may also require the entity described in subdivision (a) to furnish other information or documents for the purposes of this section.(Added by Stats. 2006, Ch. 758, Sec. 1. Effective January 1, 2007.)
CA Govt Code § 22855 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 6 - Health Benefit Plans and Contracts|Section 22855.

22855.  The board shall withdraw its approval of a health benefit plan if it finds that the plan or carrier is not in compliance with the standards prescribed therefor, that the plan or carrier has not paid or will be unable to pay claims accrued or to accrue, or for other good cause as shown. The board shall provide reasonable notice of its intention to withdraw approval of a health benefit plan to any carrier, employee organization, or organization of physicians that may be directly interested, to the persons enrolled in the health benefit plan, and to other persons and organizations as the board may deem proper. The notice shall state the effective date of, and reason for, the withdrawal of board approval. The approval of a health benefit plan may not be withdrawn until after the notice and after all interested parties have been afforded reasonable opportunity for public hearing on the question. The hearings shall be conducted, insofar as practicable, pursuant to Chapter 5 (commencing with Section 11500) of Part 1 of Division 3.(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
CA Govt Code § 22857 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 6 - Health Benefit Plans and Contracts|Section 22857.

22857.  (a) Notwithstanding any other provision of law, the board may contract with carriers licensed and doing business in other states to provide health benefits for employees and annuitants who reside outside of this state. The contracts shall be on terms as the board deems necessary or desirable. The health benefit plans are not necessarily required to meet the minimum requirements of the board, as specified in board regulations, but shall provide appropriate safeguards for members.(b) An out-of-state employee may enter into a group health benefit plan provided by an out-of-state health maintenance organization, group insurance policy, group service agreement, membership or subscription contract, or other similar group arrangement provided by a carrier for the purpose of providing, arranging, paying for, or reimbursing the cost of health benefits and that is in operation in the community or area where the employee’s duties are usually performed. These contracts, plans, agreements, arrangements, or policies shall meet with the approval of, or meet standards approved by, the board.(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
CA Govt Code § 22859 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 6 - Health Benefit Plans and Contracts|Section 22859.

22859.  (a) A health benefit plan or contract may not provide any of the following:(1) An exception for other coverage where the other coverage is entitlement to Medi-Cal or medicaid benefits.(2) An exception for Medi-Cal or medicaid benefits.(3) A benefits reduction if the person has entitlement to Medi-Cal or medicaid benefits.(4) An exception for enrollment because of an applicant’s entitlement to Medi-Cal or medicaid benefits.(b) Each health benefit plan shall be considered in determining the third-party liability for medical expenses incurred by a Medi-Cal or a medicaid recipient.(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
CA Govt Code § 22860 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 6 - Health Benefit Plans and Contracts|Section 22860.

22860.  It is the policy of the Legislature that benefits provided by a health benefit plan be integrated with the benefits provided by federal or state plans for health care services for the aged in which there is federal or state financial participation. The board shall adopt rules and regulations necessary to implement this section. Notwithstanding any other provision of this part, those rules and regulations may establish exclusions and limitations with respect to benefits, different rates within health benefit plans for employees or annuitants eligible for benefits under other plans, or enrollment of those employees or annuitants in separate plans.(Amended by Stats. 2005, Ch. 22, Sec. 86. Effective January 1, 2006.)
CA Govt Code § 22863 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 6 - Health Benefit Plans and Contracts|Section 22863.

22863.  (a) The board shall make available to employees and annuitants eligible to enroll in a health benefit plan information that will enable the employees or annuitants to exercise an informed choice among the available health benefit plans. Each employee or annuitant enrolled in a health benefit plan shall be issued an appropriate document setting forth or summarizing the services or benefits to which the employee, annuitant, or family members are entitled to thereunder, the procedure for obtaining benefits, and the principal provisions of the health benefit plan.(b) The board shall compile and provide data regarding age, sex, family composition, and geographical distribution of employees and annuitants and make continuing study of the operation of this part, including, but not limited to, surveys and reports on health benefit plans, medical and hospital benefits, the standard of care available to employees and annuitants, and the experience of health benefit plans receiving contributions under this part with respect to matters such as gross and net cost, administrative cost, and utilization of benefits.(c) The board shall, with the advice of and in consultation with persons or organizations having special skills or experience in the provision of health care services, study methods of evaluating and improving the quality and cost of health care services provided under this part.(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
CA Govt Code § 22864 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 6 - Health Benefit Plans and Contracts|Section 22864.

22864.  (a) Premiums charged for enrollment in a health benefit plan shall reasonably reflect the cost of the benefits provided.(b) This part does not limit the board’s authority to do any of the following:(1) Enter into contracts with carriers providing compensation based on carrier performance.(2) Credit premiums to an employer for expenditures that the board determines are likely to improve the health status of employees and annuitants or otherwise reduce health care costs.(3) Adjust the premiums charged under any health benefit plan or contract to reflect regional variations in the cost of health care services and other relevant factors. Any adjustment of these premiums shall be at the sole discretion of the board and shall only apply to the premiums charged to employees and annuitants of contracting agencies. The board may require a contracting agency and its employees and annuitants to pay the premium rate established pursuant to this paragraph, which may be different than the health benefit plan or contract premium rate that would otherwise be applicable to that agency.(4) Adjust premiums as part of programs for health promotion and disease prevention.(5) Develop procedures for risk adjustment of premiums across plans that encourage plans to offer benefits based upon medical and administrative efficiency and quality of care rather than on the employee’s or annuitant’s health status or service areas with low-risk populations. Any risk adjustment program or procedure shall be at the sole discretion of the board.(Amended by Stats. 2012, Ch. 445, Sec. 2. (AB 2142) Effective January 1, 2013.)
CA Govt Code § 22865 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 6 - Health Benefit Plans and Contracts|Section 22865.

22865.  Not later than 30 days prior to the approval of benefits and premium readjustments authorized under Section 22864, the board shall provide an initial estimate of proposed changes and costs in writing to the Joint Legislative Budget Committee, the chairpersons of the committees and subcommittees in each house of the Legislature that consider the Public Employees’ Retirement System’s budget and activities, the Controller, the Trustees of the California State University, the Department of Human Resources, the Director of Finance, and the Legislative Analyst.(Amended by Stats. 2016, Ch. 86, Sec. 162. (SB 1171) Effective January 1, 2017.)
CA Govt Code § 22867 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 6 - Health Benefit Plans and Contracts|Section 22867.

22867.  The provisions of this article do not supersede, modify, or in any manner alter or impair the effect of any provision of Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code or any provision of the Insurance Code. This article shall be interpreted and applied in a manner consistent with those provisions of the Business and Professions Code and the Insurance Code.(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
CA Govt Code § 22869 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 6 - Health Benefit Plans and Contracts|Section 22869.

22869.  Information disseminated by the board pursuant to Section 22863, and compliance with regulations of the board adopted pursuant to subdivision (a) of Section 22846 and Sections 22800 and 22831, shall be deemed to satisfy the requirements of Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code.(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
CA Govt Code § 22870 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 7 - State Contributions|Section 22870.

22870.  (a) The state and each employee or annuitant shall contribute a portion of the cost of providing the benefit coverage afforded under the approved health benefit plan in which the employee or annuitant is enrolled.(b) An annuitant is entitled to only one employer contribution. If more than one annuitant is receiving an allowance as the survivor of the same employee or annuitant, there shall be only one employer contribution with respect to all of those annuitants.(c) The contribution of each employee and annuitant shall be the total cost per month of the benefit coverage afforded him or her under the health benefit plan or plans in which he or she is enrolled less the portion thereof to be contributed by the employer. The employer contribution for each employee or annuitant shall commence on the effective date of enrollment.(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
CA Govt Code § 22871 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 7 - State Contributions|Section 22871.

22871.  (a) The employer contribution, with respect to each employee or annuitant who is in the employment of or retired from service with the state, including an academic position with the California State University, or is a survivor of that person, shall be adjusted by the Legislature in the annual Budget Act. Those adjustments shall be based on the principle that the employer contribution for each employee or annuitant shall be an amount equal to 100 percent of the weighted average of the health benefit plan premiums for an employee or annuitant enrolled for self-alone, during the benefit year to which the formula is applied, for the four health benefit plans that had the largest state enrollment, excluding family members, during the previous benefit year. For each employee or annuitant with enrolled family members, the employer shall contribute an additional 90 percent of the weighted average of the additional premiums required for enrollment of those family members, during the benefit year to which the formula is applied, in the four health benefit plans that had the largest state enrollment, excluding family members, during the previous benefit year. Only the enrollment of, and premiums paid by, state employees and annuitants enrolled in a basic health benefit plan shall be counted for purposes of calculating the employer contribution under this section.(b) If the provisions of this section are in conflict with the provisions of a memorandum of understanding reached pursuant to Section 3517.5 or Chapter 12 (commencing with Section 3560) of Division 4 of Title 1, the memorandum of understanding shall be controlling without further legislative action, except that if those provisions require the expenditure of funds, the provisions may not become effective unless approved by the Legislature.(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
CA Govt Code § 22871.5 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 7 - State Contributions|Section 22871.5.

22871.5.  (a) Notwithstanding Section 22871, the employer contribution with respect to each excluded employee, as defined by subdivision (b) of Section 3527, who is otherwise eligible shall be determined by the Department of Human Resources subject to the appropriation of funds by the Legislature.(b) Notwithstanding Section 22871, the employer contribution with respect to each state employee, as defined by subdivision (c) of Section 3513, who is otherwise eligible shall be determined through the collective bargaining process subject to the appropriation of funds by the Legislature.(Amended by Stats. 2012, Ch. 665, Sec. 155. (SB 1308) Effective January 1, 2013.)
CA Govt Code § 22871.6 (2021)
2021 California Code|Government Code - GOV|TITLE 2 - GOVERNMENT OF THE STATE OF CALIFORNIA|DIVISION 5 - PERSONNEL|PART 5 - THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT|CHAPTER 1 - Public Employees Health Benefits|ARTICLE 7 - State Contributions|Section 22871.6.

22871.6.  (a) Notwithstanding Section 22871, subdivision (b) of Section 22871.5, or any other provision of this article, the employer contribution with respect to employees in State Bargaining Unit 9 shall be as described in subdivision (b).(b) Effective January 1, 2004, the employer contribution for each employee shall be an amount equal to 80 percent of the weighted average of the basic health benefit plan premiums for an active state civil service employee enrolled for self alone, during the benefit year to which the formula is applied, for the four basic health benefit plans that had the largest active state civil service enrollment, excluding family members, during the previous benefit year. For each employee with enrolled family members, the employer shall contribute an additional 80 percent of the weighted average of the additional premiums required for enrollment of those family members, during the benefit year to which the formula is applied, in the four basic health benefit plans that had the largest active state civil service enrollment, excluding family members, during the previous benefit year.(c) The employer contribution provided under this section is not applicable unless and until the effective date of the employee’s enrollment in an approved health benefit plan.(d) If the provisions of this section are in conflict with the provisions of a memorandum of understanding reached pursuant to Section 3517.5 or Chapter 12 (commencing with Section 3560) of Division 4 of Title 1, the memorandum of understanding shall be controlling without further legislative action, except that if those provisions require the expenditure of funds, the provisions may not become effective unless approved by the Legislature.(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)