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 2699.6107 - Participation Requirements for Sole Employers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Qualified sole employers shall be
				eligible to participate in the program to provide health benefits coverage for
				sole employees and their dependents.
(b) To be a qualified sole employer, a sole
				employer shall be a sole employer as defined as of the effective date of
				coverage and shall meet the following requirements:
(1) Inform all potential sole employees of
				the employer's intention to purchase coverage through the program and provide
				them the opportunity to apply for coverage.
(2) Provide all potential sole employees with
				at least thirty (30) calendar days to decide whether to apply for coverage and
				choose their health benefit plan; this shall be done for all potential sole
				employees in a consistent time and manner.
(3) Inform all potential sole employees of
				the amount the employer will contribute toward the purchase of
				coverage.
(4) For each potential
				sole employee who declines to apply for coverage or who fails to request
				coverage for all of his or her dependents, the employer shall do one of the
				following:
(A) For an employee waiving
				because the employee and/or the employee's dependents have health coverage
				under the terms of another employer benefit plan or coverage under the federal
				Medicare program pursuant to Title XVIII, the employer shall obtain from the
				employee a certification that the employee is waiving because the employee
				and/or his or her dependents have coverage under another health benefit
				plan.
(B) For any employee
				declining coverage who fails to make the certification in (A) above, require
				the employee to sign a written statement, the content of which will be provided
				by the program, which informs the employee that failure to enroll for coverage
				during the enrollment period will result in the employee being unable to enroll
				himself or herself or dependents with the program until the program's next open
				enrollment period. The form is contained in the HIPC application
				booklet.
(5) Maintain at
				the sole employer's principal place of business copies of the certifications
				and written statements required by (4) above for a period of one (1)
				year.
(6)
(A) For 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, for every employee who
				enrolls in the program, the sole employer shall contribute an amount equal to
				at least 50% of the monthly "employee only" rate of the lowest "employee only"
				rate available to the eligible employee.
(B) For sole employers who have an effective
				date of coverage on or after September 1, 1998, and sole employers who made an
				election pursuant to Section
				2699.6116, for every employee who
				enrolls in the program, the sole employer shall contribute an amount equal to
				at least 50% of the lowest available monthly employee only comprehensive
				individual medical premium.
(7) For sole employers of four (4) or more
				eligible employees, at least 70% of the eligible employees shall be enrolled in
				the program unless the sole employer contributes 100% of the "employee only"
				rate in which case 100% of the eligible employees shall be enrolled in the
				program. For sole employers of two (2) or three (3) eligible employees, all of
				the eligible employees shall be enrolled in the program. At the time of the
				initial application, this determination shall be made as of the effective day
				of coverage for the group.
(8) One
				hundred percent of the eligible employees enrolling in the program shall be
				covered by workers' compensation insurance except those eligible employees who
				are not legally required to be covered by workers' compensation
				insurance.
(9) Inform the program
				when an eligible sole employee or dependent ceases to be eligible by the end of
				the month in which the event occurs.