California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 1 - Definitions › Section 2699.6000 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) "Benefit year"
				means the twelve (12) month period commencing July 1 of each year at 12:01
				a.m.
(b) "Board" means the Managed
				Risk Medical Insurance Board.
(c)
				"Comprehensive individual dental premium" means the individual dental plan rate
				for an enrolled employee or individual member and enrolled dependents, agent
				and program participation fees.
(d)
				"Comprehensive individual medical premium" means the individual medical plan
				rate for an enrolled employee or individual member and enrolled dependents,
				agent and program participation fees.
(e) "Dental coverage" means the state of
				being eligible to receive specified dental benefits under the terms of a dental
				benefits plan.
(f) "Dental benefit
				plan" means a policy or a contract written or administered by a participating
				dental carrier that arranges or provides health care benefits for
				enrollees.
(g) "Dental benefits
				premium" means that portion of the employer premium or individual member
				premium that is owed each month by the participating employer or individual
				member to the program for coverage of dental benefits. It includes any portion
				of the participation fee that is for participation in the dental benefits
				option.
(h) "Dental carrier" means
				any disability insurance company, health care service plan, specialized health
				care service plan, or any other entity that writes, issues, or administers
				group health benefit plans that cover sole employees or guaranteed association
				members.
(i) "Carrier" means any
				disability insurance company, health care service plan, nonprofit hospital
				service plan, or any other entity that writes, issues, or administers group
				health benefit plans that cover the employees of sole employers or guaranteed
				association members.
(j) "Coverage"
				means the state of being eligible to receive specified health benefits under
				the terms of a health benefit plan.
(k) "Dependent" means a sole employee's or
				guaranteed association member's spouse and any unmarried dependent child who is
				an adopted child, a stepchild, or a recognized natural child. A child attains
				the status of "dependent" at birth or upon legal adoption. A child shall be
				considered to be adopted upon the sole employee or guaranteed association
				member receiving physical custody of the child to be adopted. A stepchild
				attains the status of "dependent" upon the sole employee's or guaranteed
				association member's marriage to the natural or adopted stepchild's parent. A
				child ceases to be a "dependent" upon marriage, or attainment of age 23,
				whichever first occurs; except that an unmarried child who at the time of
				attaining age 23 is incapable of self-support because of physical or mental
				disability which existed continuously from a date prior to attainment of age 23
				continues in dependent status until termination of such incapacity.
(l) "Disenroll" means termination of coverage
				in the program for an enrolled sole employee and dependents, if any, or
				guaranteed association member and dependents, if any.
(m) "Eligible employee" means a sole employee
				or a member employee. An employee is not an eligible employee until the
				employee has completed any employer imposed waiting period.
(n) "Employer imposed waiting period" means
				the period of time an employer requires a new employee to wait before being
				sponsored for coverage.
(o)
				"Employer premium" means either:
(1) For
				participating 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, and participating
				member employers whose guaranteed association has an effective date of coverage
				prior to September 1, 1998, and did not make an election pursuant to Section
				2699.6116, the dollar amount owed
				each month by the participating employer to the program. It includes program
				participation fees, any required late fees, any required reinstatement fees,
				any required agent, or broker fees, and the sum of individual premiums. It
				includes the sum of individual premiums for dental benefits if the employer has
				elected to participate for dental benefits.
(2) For participating sole employers who have
				an effective date of coverage on or after September 1, 1998, or who have made
				an election pursuant to Section
				2699.6116, and participating
				member employers whose guaranteed association has an effective date of coverage
				on or after September 1, 1998, or made an election pursuant to Section
				2699.6116, the dollar amount owed
				each month by the participating employer to the program. It includes the sum of
				comprehensive individual medical premiums and the sum of comprehensive
				individual dental premiums if the employer has elected to participate for
				dental benefits. It includes any required late fees and any required
				reinstatement fees.