California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6194 - Payment to Insurance Agents and Brokers for Sole Employers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) This subsection
				applies to sole employers who have an effective date of coverage prior to
				September 1, 1998 who have not made an election pursuant to Section
				2699.6116.
(1) Except as specified in (2) below, the
				employer premium shall include an agent and broker fee if an insurance agent as
				defined in Section
				31 of the
				Insurance Code or broker as defined in Section
				33 of the
				Insurance Code assisted the sole employer in applying for the program, and if
				the sole employer is determined to be qualified as a result of the application,
				and the agent or broker requests such payment in writing as part of the
				application and includes his or her name, license number, tax identification
				number, and address.
(2) The
				employer premium shall include an agent or broker fee unless the sole
				employer's application includes the employer's certification that an agent or
				broker did not perform all of the following services:
(A) Assist the sole employer in completing
				the application,
(B) Calculate or
				determine the cost of program participation for the sole employer,
(C) Assist the sole employer in enrolling the
				sole employees of the sole employer.
(3) For sole employers who have made
				application to the program prior to July 1, 1996, the amount of the payment
				until the time of the qualified sole employer's first annual requalification
				pursuant to Section
				2699.6117 shall be:
(A) For qualified sole employers that have,
				at the time of application, 2-25 enrollees, the payment shall be $50 for the
				sole employer per month and $4 per enrollee per month.
(B) For qualified sole employers that have
				26-50 enrollees at the time of application the payment shall be $75 for the
				sole employer per month and $4 per enrollee per month.
(C) For qualified sole employers that have 51
				or more enrollees at the time of application the payment shall be $100 for the
				sole employer per month and $4 per enrollee per month.
(4) For sole employers who have made
				application to the program on or after July 1, 1996, the amount of the payment
				until the time of the qualified sole employer's first annual requalification
				pursuant to Section
				2699.6117 shall be:
(A) For qualified sole employers that have,
				at the time of the application, 2-9 enrollees, the payment shall be $50 for the
				sole employer per month and $4 per enrollee per month.
(B) For qualified sole employers that have,
				at the time of the application, 10-20 enrollees, the payment shall be $75 for
				the sole employer per month and $4 per enrollee per month.
(C) For qualified sole employers that have,
				at the time of the application, 21-30 enrollees, the payment shall be $100 for
				the sole employer per month and $4 per enrollee per month.
(D) For qualified sole employers that have,
				at the time of the application,
				31-40
				enrollees, the payment shall be $125 for the sole employer per month and $4 per
				enrollee per month.
(E) For
				qualified sole employers that have, at the time of the application, 41-50
				enrollees, the payment shall be $150 for the sole employer per month and $4 per
				enrollee per month.
(F) For
				qualified sole employers that have, at the time of the application, 51 or more
				enrollees, the payment shall be $175 for the sole employer per month and $4 per
				enrollee per month.
(5)
(A) Except as specified in (D) below, the
				sole employer premium shall continue to include an agent and broker fee after
				the employer's annual requalification pursuant to Section
				2699.6117.
(B) For sole employers who had an effective
				date of coverage before July 1, 1997, the amount of the agent or broker fees
				after the time of the qualified sole employer's first annual requalification
				pursuant to Section
				2699.6117 shall be as follows:
1. For qualified sole employers that have
				2-25 enrollees at the time of application the payment shall be $30 for the sole
				employer per month and $4 per enrollee per month.
2. For qualified sole employers that have
				26-50 enrollees at the time of application the payment shall be $40 for the
				sole employer per month and $4 per enrollee per month.
3. For qualified sole employers that have 51
				or more enrollees at the time of application the payment shall be $50 for the
				sole employer per month and $4 per enrollee per month.
(C) For sole employers who had an effective
				date of coverage on or after July 1, 1997, the amount of the agent or broker
				fees after the time of the qualified sole employer's first annual
				requalification pursuant to Section
				2699.6117 shall be as follows:
1. For qualified sole employers that have, at
				the time of the application, 2-9 enrollees, the payment shall be $30 for the
				sole employer per month and $4 per enrollee per month.
2. For qualified sole employers that have, at
				the time of the application, 10-20 enrollees, the payment shall be $50 for the
				sole employer per month and $4 per enrollee per month.
3. For qualified sole employers that have, at
				the time of the application, 21-30 enrollees, the payment shall be $70 for the
				sole employer per month and $4 per enrollee per month.
4. For qualified sole employers that have, at
				the time of the application, 31-40 enrollees, the payment shall be $80 for the
				sole employer per month and $4 per enrollee per month.
5. For qualified sole employers that have, at
				the time of the application, 41-50 enrollees, the payment shall be $100 for the
				sole employer per month and $4 per enrollee per month.
6. For qualified sole employers that have, at
				the time of the application, 51 or more enrollees, the payment shall be $115
				for the sole employer per month and $4 per enrollee per
				month.
(D) The employer
				premium for an annual period shall normally include an agent or broker fee.
				However, such fees may be terminated commencing with the second year of
				enrollment for sole employers who made application to the program prior to July
				1, 1996, and with the third year of enrollment for sole employers who applied
				on or after July 1, 1996 and had an effective date of coverage before July 1,
				1997, if the sole employer's requalification request includes the employer's
				certification that an agent or broker provided neither of the following types
				of services:
1. Assist the sole employer in
				completing the requalification and/or assist the sole employer's enrollees with
				the open enrollment process pursuant to Section
				2699.6139.
2. Assist the sole employer or enrollees in
				resolving enrollment, billing, claims or other program
				issues.
(6) The
				sole employer may redirect any payment made pursuant to this section to another
				agent or broker by submitting written notice signed by the employer to the
				program and providing the program with the information required under (a)(1) of
				this section. The effective date of the redirection shall be within ninety (90)
				calendar days following receipt of the notice.
(7) Payment to agents and brokers shall be
				terminated if one of the following occurs:
(A) The agent or broker is no longer a
				licensed agent or broker.
(B) The
				agent or broker materially violates any law or regulation regarding the sale of
				insurance or fails to comply with any court order.
(C) The agent or broker commits any willful
				or dishonest act resulting in injury to the program, a participating carrier,
				or an enrollee.
(8) For
				sole employers who apply on or after July 1, 1996, when agent or broker fees
				are terminated pursuant to (7)(A), (B) or (C) above within the first two years,
				the sole employer shall pay the equivalent monthly amount to the program as
				part of the program participation fee in accordance with Section
				2699.6307, for the remainder of
				the first two years of enrollment.