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 2699.6197 - Payment to Insurance Agents and Brokers for Individual Members when Premium Collected by Program

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				This section applies to guaranteed associations with an effective date of
				coverage prior to September 1, 1998 that have not made an election pursuant to
				Section 2699.6116.
(1) Guaranteed associations may designate one
				or more insurance agents, as defined in Section
				31 of the
				Insurance Code, or brokers, as defined in Section
				33 of the
				Insurance Code, for guaranteed association members who participate in the
				program. When the program collects the individual member premium from the
				individual members it shall be as follows:
(A)
				Except as specified in (B) below, the individual member premium shall include
				an agent and broker fee if a designated insurance agent or, if none is
				designated, any other insurance agent as defined in Section
				31 of the
				Insurance Code or a designated broker or, if none was designated, any other
				insurance broker as defined in Section
				33 of the
				Insurance Code assisted the individual member in applying for the program, and
				if the individual member 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.
(B) The individual member premium shall
				include an agent or broker fee unless the individual member's application
				includes the individual member's certification that an agent or broker did not
				perform all of the following services:
1.
				Assist the individual member in completing the application,
2. Calculate or determine the cost of program
				participation for the individual member.
(C) The amount of the payment until the time
				of the qualified individual member's first annual requalification pursuant to
				Section 2699.6119 of this part shall be:
1. For qualified individual members the
				payment shall be $14 for the individual member per month and $4 per enrolled
				dependent per month.
(D)
1. Except as specified in (3) below, the
				individual member premium shall continue to include an agent and broker fee
				after the individual member's annual requalification pursuant to Section
				2699.6119.
2. The amount of the fee after the time of
				the qualified individual member's first annual requalification pursuant to
				Section 2699.6119 shall be $9 for the
				individual member and $4 for each enrolled dependent per month.
3. The individual member premium for an
				annual period shall normally include an agent or broker fee. However, such fee
				may be terminated commencing with the second year of enrollment for individual
				member who made application to the program prior to July 1, 1996 and with the
				third year of enrollment for individual members who applied on or after July 1,
				1996 and had an effective date of coverage before July 1, 1997, if the
				individual member requalification request includes the member's certification
				that the agent or broker provided neither of the following types of services:
i. Assist the individual member in completing
				the requalification and/or assist the individual member with the open
				enrollment process pursuant to Section
				2699.6139.
ii. Assist the individual member resolving
				enrollment, billing, claims or other program
				issues.
(E) The
				individual member may redirect any payment made pursuant to this section to
				another designated agent or broker or, if none is designated, any agent or
				broker by submitting written notice signed by the individual member 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.
(F) Payment to agents and brokers shall be
				terminated if one of the following occurs:
1.
				The agent or broker is no longer a licensed agent or broker.
2. The agent or broker materially violates
				any law or regulation regarding the sale of insurance or fails to comply with
				any court order.
3. The agent or
				broker commits any willful or dishonest act resulting in injury to the program,
				a participating carrier, or an enrollee.
(G) For individual members who apply on or
				after July 1, 1996, when agent or broker fees are terminated pursuant to
				(F)(1), (2), or (3) above within the first two years, the individual member
				shall pay the equivalent amount monthly 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.