reglab/statecodes huggingface dataset:
2023 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 4 - Eligibility › Section 22819.

22819. (a) A family member of a deceased employee of a contracting agency who is validly enrolled or is eligible for enrollment hereunder on the date of the employee’s death is deemed to be an annuitant under Section 22760, pursuant to regulations prescribed by the board.
(b) A contracting agency shall remit the amounts required under Section 22901 as well as the total amount of the premium required from the employer and enrollees hereunder in accordance with regulations of the board. Enrollment of the annuitant and eligible family members shall be continuous following the death of the employee, or the effective date of enrollment, so long as the surviving family members meet the eligibility requirements of Section 22775 and regulations pertinent thereto. Failure to timely pay the required premiums and costs or the cancellation of coverage by the annuitant shall terminate coverage without the option to reenroll. The contracting agency may elect to require the family members to pay all or any part of the employer premium for enrollment.
(c) This section shall apply to a contracting agency only upon the filing with the board of a resolution of its governing board electing to be subject to this section.
(Amended by Stats. 2005, Ch. 418, Sec. 19. Effective January 1, 2006.)
2023 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 4 - Eligibility › Section 22819.1.

22819.1. (a) A family member of a deceased annuitant who retired from a contracting agency prior to the effective date of the agency’s contract to provide health coverage under this part, and who was validly enrolled in the agency’s health plan on the day prior to the effective date of the contract under this part, but who does not receive an allowance in place of the annuitant, is deemed to be an annuitant for purposes of Section 22760, pursuant to regulations prescribed by the board.
(b) A contracting agency shall remit the amounts required under Section 22901 as well as the total amount of the premium required from the employer and enrollees in accordance with regulations of the board. Enrollment of the eligible family members shall be continuous following the death of the annuitant, or the effective date of enrollment, as applicable, so long as the surviving family members meet the eligibility requirements of Section 22775 and any regulations promulgated with respect to that section. Either a failure to timely pay the required premiums and associated costs of the coverage or the cancellation of coverage shall terminate the coverage without the option to reenroll. The contracting agency may elect to require the family members to pay all or any part of the employer premium for enrollment.
(c) This section shall apply to a contracting agency only upon the filing with the board of a resolution of its governing board electing to be subject to this section.
(Added by Stats. 2010, Ch. 639, Sec. 24. (SB 1139) Effective January 1, 2011.)
2023 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 4 - Eligibility › Section 22822.

22822. No person is eligible for enrollment in a health benefit plan pursuant to this part as a family member if he or she becomes a family member of a surviving spouse of a deceased member of the system after the date of the member’s death.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 4 - Eligibility › Section 22823.

22823. (a) Notwithstanding Section 10270.5 of the Insurance Code, an employee who is enrolled in a board-approved health benefit plan sponsored by an employee organization that is the exclusive representative pursuant to the Ralph C. Dills Act (Chapter 10.3 (commencing with Section 3512) of Division 4 of Title 1) and who terminates his or her membership in the respective employee organization shall become ineligible for enrollment in the health benefit plan.
(b) Notwithstanding subdivision (a), the employee may continue enrollment in the employee organization health benefit plan until he or she is notified by the employee organization of the loss of eligibility. Upon notification of the loss of eligibility, the employee within 60 days may change his or her enrollment to another health benefit plan for which the employee is eligible.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 4 - Eligibility › Section 22825.

22825. (a) An annuitant is not eligible to participate in a health benefit plan offered by the California Association of Highway Patrolmen unless the annuitant was enrolled in the California Highway Patrolmen Health Benefits Trust for a minimum of five years as an active employee.
(b) Notwithstanding subdivision (a), an annuitant that retires for disability before becoming eligible for service retirement may enroll in a health benefit plan offered by the California Association of Highway Patrolmen if otherwise eligible.
(c) Former members of the California State Police are eligible to participate in a health benefit plan offered by the California Association of Highway Patrolmen, pursuant to subdivision (a) or (b). Former members of the California State Police who transferred to the California Highway Patrol and retired before January 1, 2003, are exempt from the five-year requirement.
(d) This section only applies to persons who first became employees of the California Highway Patrol on or after January 1, 1994.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 4 - Eligibility › Section 22826.

22826. For purposes of this part, service credit shall be determined according to the rules of the retirement system provided by the employer in which the employee participates. In the case of elected officials not eligible for participation in a retirement system, service credit shall be determined according to the number of years in office. In the elected official’s final year of office, a completed term of office shall be sufficient to earn one year of service credit for that final year of office.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 5 - Enrollment and Coverage › Section 22830.

22830. (a) An employee or annuitant, under eligibility rules as prescribed by board regulations, may enroll in a health benefit plan approved or maintained by the board either as an individual or for self and family.
(b) Enrollment shall serve as authorization of the deduction of the contributions required under this part from the salary of an employee or allowance of an annuitant.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 5 - Enrollment and Coverage › Section 22831.

22831. (a) An annuitant may, as provided by regulations of the board, continue his or her enrollment, enroll within 60 days of retirement, enroll within 60 days of the death of the member, or enroll during any future open enrollment period without discrimination as to premium rates or benefit coverage. If the survivor of an annuitant is also an annuitant as defined in this part, he or she may enroll within 60 days of the annuitant’s death or during any future open enrollment period, as provided by regulations of the board.
(b) Board rules and regulations shall provide whatever provisions necessary to eliminate or minimize the impact of adverse selection because of the enrollment of annuitants that would affect any health benefit plans approved or maintained. This may include the reimbursement of surcharges for late enrollment in Part B of Medicare if the board determines that payment of the surcharge would be less costly than continued enrollment in a basic plan.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 5 - Enrollment and Coverage › Section 22832.

22832. A permanent intermittent employee and an employee who works less than full time may continue his or her enrollment while retired from state employment if he or she was enrolled prior to separation from state employment, and he or she lost eligibility prior to separation but continued his or her coverage under federal law.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 5 - Enrollment and Coverage › Section 22834.

22834. (a) An out-of-state employee who separates from service and becomes an annuitant may continue his or her enrollment in a board-approved out-of-state health benefit plan or may transfer to any other health benefit plan approved or maintained by the board, in which the employee would otherwise be eligible to enroll. He or she must enroll in that health benefit plan within 60 days in order for health benefits to continue.
(b) An annuitant who leaves this state and elects to reside in another state in which a health benefit plan is approved or maintained by the board may transfer his or her enrollment to that health benefit plan and shall be entitled to the employer contribution as provided in this part.
(c) When an out-of-state employee receiving benefits pursuant to Section 22803 is permanently reassigned to perform his or her duties within the state, the benefits may be continued only until the employee has had reasonable opportunity to enroll in a health benefit plan within the state that is approved or maintained by the board.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 5 - Enrollment and Coverage › Section 22836.

22836. An employee enrolled in a health benefit plan who is removed or suspended without pay and later reinstated or restored to duty on the ground that the removal or suspension was unjustified, unwarranted, or illegal may not be deprived of coverage or benefits for the interim. Any contributions otherwise payable by the employer that were actually paid by the employee shall be restored to the same extent and effect as though the removal or suspension had not taken place, and any other equitable adjustments necessary and proper under the circumstances shall be made in premiums, claims, and other charges.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 5 - Enrollment and Coverage › Section 22837.

22837. In the case of the death of an employee after an application has been filed for the enrollment of family members, but prior to the effective date of coverage, the family members are deemed to have been covered on the date of the death of the employee. If one of the family members becomes an annuitant, enrollment shall continue without discrimination as to premium rates or benefit coverage.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 5 - Enrollment and Coverage › Section 22838.

22838. (a) An annuitant who reinstates from retirement pursuant to Article 7 (commencing with Section 21190) of Chapter 12 of Part 3 may, upon his or her subsequent retirement, elect to enroll in a health benefit plan approved or maintained by the board as an annuitant of the employer from which he or she was eligible to receive a postretirement health benefit contribution payable by that employer during his or her prior retirement, if both of the following apply:
(1) The subsequent retirement of that person occurs within 120 days after separation from employment or, if applicable, consistent with the provisions of subdivision (b) of Section 22893.
(2) That person is not eligible for a postretirement health benefit contribution from the employer from which he or she subsequently retires or the postretirement health benefit contribution payable by that employer is less than the contribution payable by that employer during his or her prior retirement.
(b) The postretirement health benefit contribution payable by an employer under this section shall be in lieu of a contribution payable to the annuitant by any other employer under this part.
(c) For purposes of calculating the employer postretirement health benefit contribution, the credited service of a person who enrolls as an annuitant pursuant to this section shall not include service performed for any other employer during his or her reinstatement from retirement.
(d) This section shall apply irrespective of whether the person receives health care coverage under this part during his or her reinstatement from retirement.
(e) An annuitant who is eligible to enroll pursuant to this section may enroll within 60 days after his or her subsequent retirement or during a future open enrollment period, as provided by regulation of the board, without discrimination as to premium rates or benefits coverage.
(f) This section shall only apply to an annuitant who, after reinstatement, subsequently retires on or after January 1, 2014.
(Added by Stats. 2013, Ch. 525, Sec. 2. (AB 410) Effective January 1, 2014.)
2023 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 5 - Enrollment and Coverage › Section 22839.

22839. Thirty days prior to, or 60 days following, retirement and during the open enrollment period, a state employee enrolled in a flexible benefit plan administered by the state shall be given the option to enroll in a health benefit plan approved or maintained by the board and receive the applicable employer contribution, if the state employee would otherwise qualify as an annuitant.
(Amended by Stats. 2009, Ch. 130, Sec. 33. (AB 966) Effective January 1, 2010.)
2023 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 5 - Enrollment and Coverage › Section 22840.

22840. (a) Notwithstanding any other provision of law, a state employee participating in a flexible benefits program administered by the state, who either terminated enrollment in a health benefit plan approved or maintained by the board in reliance on other medical coverage or who was enrolled in a board-approved health benefit plan for self only, may enroll in a health benefit plan without regard to the open enrollment period for either of the following purposes:
(1) For self only or self and all eligible dependents, if the flexible cash option is discontinued.
(2) To add all eligible dependents, upon loss of coverage, where the flexible cash option has not been selected.
(b) Enrollment shall be requested within 60 calendar days of the loss of other coverage and submitted to the system by the employer. The effective date of enrollment shall be the first day of the month following the loss of other coverage. Enrollment shall entitle the employee to receive the benefit of the applicable employer contribution.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 5 - Enrollment and Coverage › Section 22841.

22841. (a) A transfer of enrollment from one health benefit plan to another may be made by an employee or annuitant at times and under conditions as may be prescribed by regulations of the board.
(b) In the case of a health benefit plan in which services are provided by a limited panel of physicians associated with the plan, it is recognized that it may be impossible or impractical to maintain acceptable physician-patient relationships with particular employees, annuitants, or family members. In those cases, the employee or annuitant may submit the question of ability to maintain adequate physician-patient relationships for consideration under the grievance procedure provided pursuant to subdivision (d) of Section 22853. If the grievance procedure results in a determination that an adequate physician-patient relationship cannot reasonably be maintained, then the employee or annuitant may, in accordance with regulations of the board, change his or her enrollment to another health benefit plan without regard to physical condition, age, race, or other status.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 5 - Enrollment and Coverage › Section 22842.

22842. A change in coverage based on a change in the family status of an employee, annuitant, or family member enrolled in a health benefit plan may be requested by the employee or annuitant by filing an application within 30 days after the occurrence of the change in family status or at other times and according to conditions as may be prescribed by regulations of the board.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 5 - Enrollment and Coverage › Section 22843.

22843. If an employee or annuitant has a spouse or a domestic partner who is an employee or annuitant, each spouse or domestic partner may enroll as an individual. No person may be enrolled both as an employee or annuitant and as a family member. A family member may be enrolled in respect to only one employee or annuitant.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 5 - Enrollment and Coverage › Section 22844.

22844. (a) Employees, annuitants, and family members who become eligible to enroll on or after January 1, 1985, in Part A and Part B of Medicare shall not be enrolled in a basic health benefit plan. If the employee, annuitant, or family member is enrolled in Part A and Part B of Medicare, he or she may enroll in a Medicare health benefit plan.
(b) Employees, annuitants, and family members enrolled in a prescription drug plan under Part D of Medicare shall not be enrolled in a board-approved health benefit plan. This subdivision does not apply to an individual enrolled in a board-approved or offered health benefit plan that provides a prescription drug plan or qualified prescription drug coverage under Part D of Medicare as part of its benefit design.
(c) This section does not apply to employees and family members that are specifically excluded from enrollment in a Medicare health benefit plan by federal law or federal regulation.
(d) The board shall not grant any further exemptions to this section after July 1, 2015.
(Amended by Stats. 2015, Ch. 28, Sec. 5. (SB 98) Effective June 24, 2015.)
2023 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 5 - Enrollment and Coverage › Section 22846.

22846. (a) The regulations of the board shall provide for the beginning and ending dates of coverage of employees, annuitants, and family members enrolled in a health benefit plan. The regulations may permit coverage to continue, in addition to any temporary extension of coverage otherwise authorized under this part, until the end of the pay period in which an employee is separated from service or until the end of the month in which an annuitant ceases to be entitled to an allowance. In case of the death of an employee or annuitant, the regulations may permit a temporary extension of the coverage of family members for a period of more than 30 days.
(b) Notwithstanding any other provision of this part, an employee terminating his or her service by voluntary separation or due to dismissal for cause, prior to eligibility for retirement, may extend enrollment until the end of the month following the month in which his or her service is terminated.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 5 - Enrollment and Coverage › Section 22847.

22847. (a) Subject to subdivisions (b) and (c), if the eligible family members of a deceased peace officer or firefighter of a contracting agency, as described in subdivision (a) of Section 22820, are validly enrolled under this part on the date of the employee’s death, the contracting agency shall continue to pay the employer contribution applicable to active employees for the continued enrollment of those eligible family members for a period not to exceed 120 days, beginning in the month of the employee’s death.
(b) A contracting agency shall remit the amounts required under Section 22901 as well as the total amount of premium required from the employer under this part in accordance with regulations of the board. Enrollment of the eligible family members shall be continuous following the death of the employee.
(c) Notwithstanding subdivision (a), the contracting agency’s obligation to pay the employer contribution pursuant to this section shall terminate upon either of the following:
(1) Enrollment of the eligible family members pursuant to Section 22820.
(2) A final determination of the board that the deceased employee’s family members are not eligible to enroll or continue enrollment under this part.
(d) During the period that enrollment is continued pursuant to this section, the surviving spouse or eldest eligible family member shall retain the rights and obligations that otherwise would be applicable to the employee under this part.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 5 - Enrollment and Coverage › Section 22848.

22848. An employee or annuitant who is dissatisfied with any action or failure to act in connection with his or her coverage or the coverage of his or her family members under this part shall have the right of appeal to the board and shall be accorded an opportunity for a fair hearing. The hearings shall be conducted, insofar as practicable, pursuant to the provisions of Chapter 5 (commencing with Section 11500) of Part 1 of Division 3.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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 5 - Enrollment and Coverage › Section 22849.

22849. (a) Notwithstanding Section 22846, the Legislature shall, upon the death of a legislative employee while in service, continue to pay employer contributions for health benefits for a period not to exceed 120 days beginning in the month of the employee’s death. The surviving spouse or other eligible family member shall be advised of all rights and obligations during this period regarding the continuation of health benefits as an annuitant by the Public Employees’ Retirement System.
(b) This section shall apply to employees of the Legislature to the extent that the benefits have been elected. The employer for purposes of this section is the Senate or the Assembly as is applicable to the employee at death while in legislative service. The Senate Committee on Rules or the Assembly Committee on Rules, depending on the employment status of the decedent, shall provide the advisements required by subdivision (a).
(Added by Stats. 2022, Ch. 189, Sec. 1. (SB 835) Effective January 1, 2023.)
2023 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 22850.5.

22850.5. (a) In performing the duties prescribed by Section 22850, the board shall negotiate with carriers providing health benefit plans to add a core health plan option to the existing portfolio of health plans or to implement other measures to achieve ongoing cost savings beginning in the 2012–13 fiscal year, or both.
(b) For purposes of this section, a “core health plan” means a plan that includes all of the following:
(1) A plan that provides coverage for essential benefits at lower premiums, for both the state and the employee, than existing benefit plan options.
(2) A plan that may include fewer benefits and higher employee cost sharing than those provided in existing health benefit plan options.
(3) A plan option that is available for participants beginning in the 2012 open enrollment period for the 2013 calendar year.
(Added by Stats. 2011, Ch. 11, Sec. 12. (SB 80) Effective March 24, 2011.)
2023 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 22851.

22851. The board may enter into any joint purchasing arrangement with private or public entities, if the arrangement does all of the following:
(a) Benefits persons receiving health coverage under this part.
(b) Does not restrict the authority of the board or the state.
(c) Does not jeopardize the system’s tax status or its governmental plan status.
(Added by Stats. 2004, Ch. 69, Sec. 22. Effective June 24, 2004.)
2023 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.)
2023 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.)
2023 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.)
2023 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 22853.3.

22853.3. Commencing January 1, 2024, a health benefit plan or contract shall provide coverage for contraceptives and related services consistent with the requirements under Section 1367.25 of the Health and Safety Code and Section 10123.196 of the Insurance Code.
(Added by Stats. 2022, Ch. 630, Sec. 10. (SB 523) Effective January 1, 2023.)
2023 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 22853.4.

22853.4. Commencing January 1, 2024, a health benefit plan or contract shall provide coverage for vasectomies and related services consistent with the requirements under Section 1367.255 of the Health and Safety Code and Section 10123.1945 of the Insurance Code.
(Added by Stats. 2022, Ch. 630, Sec. 11. (SB 523) Effective January 1, 2023.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)
2023 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.)