reglab/statecodes huggingface dataset:
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 8 - Enrollment Assistance › Section 6660 - Training Standards

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				All individuals or entities who apply to become a Certified Enrollment Entity
				shall complete training for the management of Certified Enrollment Entities
				prior to any affiliated Certified Enrollment Counselors carrying out any
				Consumer Assistance functions.
(b)
				To ensure that all Certified Enrollment Counselors are prepared to serve both
				the individual Exchange, all individuals or entities who carry out Consumer
				Assistance functions shall complete training in the following subjects prior to
				carrying out any Consumer Assistance functions:
(1) QHPs (including the metal levels
				described at 45 C.F.R.
				§
											156.140(b)), and how
				they operate, including benefits covered, payment processes, rights and
				processes for appeals and grievances, and contacting individual
				plans;
(2) The range of insurance
				affordability programs, including Medicaid, the Children's Health Insurance
				Program, and other public programs;
(3) The tax implications of enrollment
				decisions and the available resources for consumers who require tax advice and
				assistance with tax preparation;
(4) Eligibility requirements for premium tax
				credits and cost-sharing reductions, and the impacts of premium tax credits on
				the cost of premiums;
(5) Contact
				information for appropriate federal, state, and local agencies for consumers
				seeking additional information about specific coverage options not offered
				through the Exchange;
(6) Basic
				concepts about health insurance and the Exchange; the benefits of having health
				insurance and enrolling through an Exchange; and the individual responsibility
				to have health insurance;
(7)
				Eligibility and enrollment rules and procedures, including how to appeal an
				eligibility determination;
(8)
				Providing culturally and linguistically appropriate services;
(9) Ensuring physical and other accessibility
				for people with a full range of disabilities;
(10) Understanding differences among health
				plans;
(11) Privacy and security
				requirements in 45 C.F.R.
				§
											155.260 for handling and safeguarding
				consumers' personally identifiable information;
(12) Working effectively with individuals
				with limited English proficiency, people with disabilities, people of any
				gender identity, people of any sexual orientation, and vulnerable, rural, and
				underserved populations;
(13)
				Customer service standards;
(14)
				Outreach and education methods and strategies;
(15) Applicable administrative rules,
				processes and systems related to Exchanges and QHPs; and
(16) Procedures for assisting consumers with
				voter registration in compliance with Chapter 6 of the California Elections
				Code.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 8 - Enrollment Assistance › Section 6666 - Conflict of Interest Standards

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Certified Enrollment Entities and
				Certified Enrollment Counselors shall not concurrently hold a license issued by
				the California Department of Insurance.
(b) Certified Enrollment Entities and
				Certified Enrollment Counselors shall not employ, be employed by or be in
				partnership with, or receive any remuneration arising out of functions
				performed under this Article from any individual or entity currently licensed
				by the California Department of Insurance.
(c) Certified Enrollment Entities and
				Certified Enrollment Counselors shall:
(1) Not
				be:
(A) Health insurance issuers or stop loss
				insurance issuers;
(B) Subsidiaries
				of health insurance issuers or stop loss insurance issuers;
(C) Associations that include members of, or
				lobby on behalf of, the insurance industry; or
(D) Recipients of any direct or indirect
				consideration from any health insurance issuer or stop loss insurance issuer in
				connection with the enrollment of any individuals or employees in a QHP or
				non-QHP.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 8 - Enrollment Assistance › Section 6668 - Compensation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Certified
				Enrollment Entities that are registered in the Navigator Program shall receive
				grants which will be individually negotiated with each Entity.
1. New section
				  filed 7-15-2013 as an emergency; operative 7-15-2013 (Register 2013, No. 29). A
				  Certificate of Compliance must be transmitted to OAL by 1-13-2014 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Repealed by operation of Government Code section
				  11346.1(g)
				  (Register 2014, No. 7).
3. New section filed 2-10-2014 as an
				  emergency pursuant to Government Code section
				  11346.1,
				  subdivision (h); operative 2-10-2014 (Register 2014, No. 7). A Certificate of
				  Compliance must be transmitted to OAL by 5-12-2014 or emergency language will
				  be repealed by operation of law on the following day.
4. New section
				  refiled 5-12-2014 as an emergency pursuant to Government Code section
				  11346.1,
				  subdivision (h); operative 5-12-2014 (Register 2014, No. 20). A Certificate of
				  Compliance must be transmitted to OAL by 8-11-2014 or emergency language will
				  be repealed by operation of law on the following day.
5. New section
				  refiled 7-21-2014 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats 2014, c. 31); operative 7-21-2014
				  (Register 2014, No. 30). A Certificate of Compliance must be transmitted to OAL
				  by 7-15-2015 pursuant to Government Code section
				  100504 or
				  emergency language will be repealed by operation of law on the following
				  day.
6. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government
				  Code section
				  100504(a)(6)
				  to change the date upon which a Certificate of Compliance must be transmitted
				  to OAL. Pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of
				  Compliance must be transmitted to OAL by 2-10-2017 or the language in the
				  emergency order of 7-21-2014 will be repealed by operation of law on the
				  following day (Register 2015, No. 38).
7. Certificate of Compliance
				  as to 7-21-2014 order, including further amendment of section and NOTE,
				  transmitted to OAL 11-6-2015 and filed 12-23-2015 (Register 2015, No.
				  52).
Note: Authority cited: Sections
					 100502 and
					 100504,
					 Government Code. Reference: Sections
					 100502 and
					 100503,
					 Government Code; and 45
					 C.F.R. §
												155.210.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 8 - Enrollment Assistance › Section 6670 - Suspension and Revocation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				Each of the following shall be justification for the Exchange to suspend or
				revoke the certification of any Certified Enrollment Entity or Certified
				Enrollment Counselor:
(1) Failure to comply
				with all applicable federal or state laws or regulations, including, but not
				limited to, Sections
				6664 and
				6666; and
(2) A potentially disqualifying
				administrative action or criminal record, which is substantially related to the
				qualifications, functions, or duties of the specific position of the entity or
				individual, under Sections
				6657 and
				6658.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 9 - Plan-Based Enrollers › Section 6700 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
In addition to the definitions in Section
				  6410 of Article 2 of this chapter,
				  for purposes of this Article, the following terms shall mean:
(a) Authorized Contact: The contact
				designated by the carrier to serve as the individual responsible for all
				Plan-Based Enrollment Program communications with the Exchange and who is also
				responsible for management of the program. Pursuant to this Article, the
				Authorized Contact may delegate a designee where allowed by the
				Exchange.
(b) Cold-Calling: The
				unsolicited outgoing phone calls of a Certified Plan-Based Enrollment Entity
				(PBEE) or Certified Plan-Based Enroller (PBE) as defined in Section
				6410 of Article 2 of this chapter,
				that were not prompted by a permissible lead, to an individual that has not
				expressed an interest in the PBEE's Qualified Health Plans (QHPs) in the
				Individual Exchange. Permissible leads are lists that are consumer opt-in and
				outreach to a PBEE's current or former members.
(c) Consumer: For the purposes of this
				article, Consumer shall mean the following targeted populations:
(1) Issuer's non-group members that meet the
				requirements of a Qualified Individual in Section
				6410 of Article 2 of this
				chapter;
(2) Issuer's members
				receiving coverage required by the Consolidated Omnibus Budget and
				Reconciliation Act of 1985 ("COBRA") and the California Continuation Benefits
				Replacement Act, or Health and Safety Code Section
				1366.20
				et seq. ("Cal-COBRA") that meet the requirements of a Qualified
				Individual;
(3) Issuer's current
				members meeting the requirements of a Qualified Individual, or those current
				members terminating their individual or group coverage including 25 year old
				dependents;
(4) Qualified
				Individuals interested in obtaining health care coverage through the Exchange;
				and
(5) Individuals eligible for
				other Insurance Affordability Programs, as defined in Section
				6410 of Article 2 of this chapter
				(e.g. Medi-Cal).
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 9 - Plan-Based Enrollers › Section 6702 - Certified Plan-Based Enrollment Program Eligibility Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The following
				entities and individuals are eligible to apply to participate in the Certified
				Plan-Based Enrollment Program (PBE Program) through the Exchange (Covered
				California):
(1) Qualified Health Plan
				Issuers, as defined in Section
				6410 of Article 2 of this chapter,
				under contract with the Exchange to provide at least one QHP through the
				Exchange that seek to provide enrollment assistance to Consumers.
(2) Issuer Application Assisters, as defined
				in 45 C.F.R. §
											155.20, and Captive Agents, as defined in
				Section 6410 of Article 2 of this chapter,
				that are employed or contracted by a PBEE.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 9 - Plan-Based Enrollers › Section 6704 - Program Application

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				An entity or individual who is eligible for the Certified Plan-Based Enrollment
				Program (PBE Program) may apply to become a Certified Plan Based Enrollment
				Entity (PBEE) or a Certified Plan-Based Enroller (PBE) according to the
				following process.
(1) The entity or
				individual shall submit all application information, documentation, and
				declarations required in this Section.
(2) The application shall demonstrate that
				the entity or individual is capable of carrying out at least those duties
				described in the PBEE eligibility requirements in this Article and has existing
				relationships, or could readily establish relationships, with Consumers, as
				defined in Section
				6700.
(3) The Exchange shall review the program
				application and, if applicable, request any missing information necessary to
				determine eligibility.
(4) Entities
				or individuals who have submitted a completed application and demonstrated
				ability to meet the above requirements shall be notified of available
				opportunities by the Exchange for the individual or entity (via the entity's
				Authorized Contact and his or her designees, if applicable) to complete the
				training requirements in Section
				6706. All individuals and entities
				(via the entity's Authorized Contact and his or her designees, if applicable)
				shall have 90 days to complete and pass the training and testing requirements
				in Section
				6706. Failure to complete training
				standards within 90 calendar days may result in the termination of the
				individual's or entity's certification application with the Exchange.
(5) All individuals who are seeking
				certification by the Exchange as PBEs of the PBEE shall meet the following
				requirements:
(A) Submit all information,
				documentation, and declarations required in subdivision (d) of this
				Section;
(B) Pass the PBE
				Fingerprinting and Criminal Record Check process in Section
				6708;
(C) Complete the required training in Section
				6706; and
(D) Pass the required certification exam
				administered by the Exchange pursuant to Section
				6706.
(6) Entities or individuals who complete and
				pass all certification requirements in subdivision (a) of this Section, as
				applicable, shall be certified as PBEEs or PBEs, respectively, by the Exchange
				and assigned a PBEE or PBE certification number.
(7) Entities and individuals who have been
				denied certification by the Exchange may appeal the denial of their
				certification through the process established by Section
				6718 or
				6708.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 9 - Plan-Based Enrollers › Section 6706 - Training and Certification Standards

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) All entities who apply to become a PBEE
				shall have their Authorized Contact and any designees complete certification
				training for the management of PBEs, prior to any affiliated PBEs carrying out
				any consumer assistance functions under this Article.
(b) To ensure that all PBEs are knowledgeable
				about the Individual Exchange, all individuals or entities who carry out
				enrollment assistance functions shall complete training in the following
				subjects prior to carrying out any enrollment assistance functions pursuant to
				this Article:
(1) QHPs (including the metal
				levels described at 45
				C.F.R. §
											156.140(b))
				and how they operate, including benefits covered, payment processes, rights and
				processes for appeals and grievances;
(2) The range of Insurance Affordability
				Programs, including Medi-Cal, and other public programs;
(3) The tax implications of enrollment
				decisions;
(4) Eligibility
				requirements for Advanced Premium Tax Credit (APTC), as defined in Section
				6410 of Article 2 of this chapter,
				and cost-sharing reductions, and the impacts of APTC on the cost of
				premiums;
(5) Contact information
				for appropriate federal, state, and local agencies for consumers seeking
				additional information about specific coverage options not offered through the
				Exchange;
(6) Basic concepts about
				health insurance and the Exchange; the benefits of having health insurance and
				enrolling through the Exchange; and the individual responsibility to have
				health insurance;
(7) Eligibility
				and enrollment rules and procedures, including how to appeal an eligibility
				determination;
(8) Providing
				culturally and linguistically appropriate services;
(9) Ensuring physical and other accessibility
				for people with a full range of disabilities;
(10) Understanding the Individual Exchange
				marketplace and differences among health plans;
(11) Privacy and security requirements in
				45 CFR §
											155.260 for handling and safeguarding
				consumers' personally identifiable information;
(12) Working effectively with, and not
				discriminating against, individuals of various racial and ethnic backgrounds,
				persons with limited English proficiency, people with a full range of
				disabilities, people of any gender identity, people of any sexual orientation,
				and vulnerable, rural, and underserved populations;
(13) Customer service standards;
(14) Outreach and education methods and
				strategies;
(15) Applicable
				administrative rules, processes and systems related to Exchanges and QHPs;
				and
(16) PBE voter registration
				protocol pursuant to Section
				6462 of Article 4 of this
				chapter.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 9 - Plan-Based Enrollers › Section 6708 - Certified Plan-Based Enroller Fingerprinting and Criminal Record Checks

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Individuals
				Required to Submit Fingerprinting.
(1) Issuer
				Application Assisters seeking certification as PBEs shall submit fingerprint
				images and associated criminal history information pursuant to Gov. Code 1043
				and Section
				6456(a)-(e) of
				Article 4 of this chapter.
(2)
				Captive Agents seeking certification as PBEs are required to be licensed in
				good standing with the California Department of Insurance and shall not be
				subject to the fingerprinting process described in subdivision
				(a)(1).
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 9 - Plan-Based Enrollers › Section 6712 - Conflict of Interest Standards

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) All PBEEs and PBEs shall:
(1) Only receive consideration pursuant to
				the exclusive agreement between the PBEE and the PBE in connection with the
				enrollment of any individuals in the PBEE's QHPs pursuant to this
				Article.
(2) Only make
				representations that are accurate and not misleading. Additionally, the PBE may
				only make representations regarding QHPs offered by the PBEE affiliated with
				the PBE.
(3) Disclose conflicts of
				interest to Consumers:
(A) A PBEE and its
				PBEs shall disclose to the consumer when contact is first initiated that the
				PBE is employed or contracted by a QHP Issuer and is only able to provide plan
				details and enrollment assistance for QHPs offered by the PBEE affiliated with
				the PBE.
(B) After a consumer is
				determined eligible for coverage through the Exchange, the PBE shall:
(i) Disclose to the consumer that the
				Individual Exchange offers other QHPs sold by other QHP Issuers, and
				stand-alone dental plans as defined in Section
				6410 of Article 2 of this chapter,
				that may meet the consumer's needs;
(ii) Provide information to consumers about
				the availability of the full range of QHP options and Insurance Affordability
				Programs for which they are eligible. It must be apparent to consumers that if
				determined eligible they would be free to choose among all QHPs offered in the
				Individual Exchange through the Service Center of the Exchange;
(iii) Provide information required in Section
				6710(a)(9);
				and
(iv) Inform the consumer that
				there may be an insurance agent of record in connection with any existing
				health insurance policy the consumer may currently have, and if the consumer
				acknowledges having an agent of record, offer to attach the agent to the
				consumer's enrollment in a QHP, unless:
1. The
				consumer is determined eligible for coverage through the Exchange, and the
				insurance agent of record is not authorized to sell QHPs in the Individual
				Exchange; or
2. The consumer would
				prefer not to seek further assistance from the consumer's insurance agent of
				record.
(4) At the consumer's request following the
				PBE's disclosures in either subdivision (a)(3)(A) or (a)(3)(B) of this Section,
				the PBE shall transfer the consumer to the Service Center of the Exchange for
				further enrollment assistance.
(5)
				Document that the PBE has provided the required disclosures in subdivision
				(a)(3)(A) or (a)(3)(B) of this Section and the consumer has acknowledged that
				the consumer:
(A) Understands the
				disclosures;
(B) Does not want to
				be referred to the Service Center of the Exchange; and
(C) Wants to receive information and
				enrollment assistance solely from the PBE.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 9 - Plan-Based Enrollers › Section 6714 - Compensation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) PBEEs will not
				receive compensation from the Exchange for application and enrollment
				assistance.
(b) PBEEs may
				compensate affiliated individual PBEs for enrollment assistance.
1. New section
				  filed 9-30-2013 as an emergency; operative 9-30-2013 (Register 2013, No. 40). A
				  Certificate of Compliance must be transmitted to OAL by 4-1-2014 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. New section refiled 4-1-2014 as an emergency; operative
				  4-1-2014 (Register 2014, No. 14). A Certificate of Compliance must be
				  transmitted to OAL by 6-30-2014 or emergency language will be repealed by
				  operation of law on the following day.
3. New section refiled
				  6-26-2014 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 7-1-2014
				  (Register 2014, No. 26). A Certificate of Compliance must be transmitted to OAL
				  by 9-30-2015 pursuant to Government Code section
				  100504 or
				  emergency language will be repealed by operation of law on the following
				  day.
4. New section refiled with amendments 10-2-2014 as an
				  emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 10-2-2014
				  (Register 2014, No. 40). A Certificate of Compliance must be transmitted to OAL
				  by 9-30-2015 pursuant to Government Code section
				  100504 or
				  emergency language will be repealed by operation of law on the following
				  day.
5. Editorial correction of HISTORY 3 (Register 2014, No.
				  51).
6. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government
				  Code section
				  100504(a)(6)
				  to change the date upon which a Certificate of Compliance must be transmitted
				  to OAL. Pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of
				  Compliance must be transmitted to OAL by 9-30-2016 or the language in the
				  emergency order of 10-2-2014 will be repealed by operation of law on the
				  following day (Register 2015, No. 38).
7. Certificate of Compliance
				  as to 10-2-2014 order, including further amendment of section, transmitted to
				  OAL 4-12-2016 and filed 5-23-2016; amendments effective 5-23-2016 pursuant to
				  Government Code section
				  11343.4(b)(3)
				  (Register 2016, No. 22).
Note: Authority cited: Sections
					 100503 and
					 100504,
					 Government Code. Reference: Section
					 100503,
					 Government Code; and 45 Code of Federal Regulations, Sections
					 155.415 and
					 156.1230.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 9 - Plan-Based Enrollers › Section 6716 - Suspension and Revocation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				Each of the following shall be justification for the Exchange to suspend or
				revoke the certification of any PBEE or PBE:
(1) Failure to comply with the requirements
				of this Article and all applicable federal and State laws;
(2) If the PBE is not a Captive Agent, a
				potentially disqualifying criminal record under Section
				6708 of Article 4 of this chapter;
				and
(3) If the PBE is a Captive
				Agent, failure to maintain a license in good standing with the California
				Department of Insurance.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 10 - Certified Insurance Agents › Section 6800 - Definitions. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New article
				  10 (sections
				  6800-6806) and section filed
				  9-30-2013 as an emergency; operative 9-30-2013 (Register 2013, No. 40). A
				  Certificate of Compliance must be transmitted to OAL by 4-1-2014 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. New article 10 (sections
				  6800-6806) and section refiled
				  4-1-2014 as an emergency; operative 4-1-2014 (Register 2014, No. 14). A
				  Certificate of Compliance must be transmitted to OAL by 6-30-2014 or emergency
				  language will be repealed by operation of law on the following
				  day.
3. New article 10 (sections
				  6800-6806) and section refiled
				  7-1-2014 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 7-1-2014
				  (Register 2014, No. 27). A Certificate of Compliance must be transmitted to OAL
				  by 9-30-2015 pursuant to Government Code section
				  100504 or
				  emergency language will be repealed by operation of law on the following
				  day.
4. New article 10 (sections
				  6800-6806) and section refiled
				  9-2-2014 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 9-2-2014
				  (Register 2014, No. 36). A Certificate of Compliance must be transmitted to OAL
				  by 9-30-2015 pursuant to Government Code section
				  100504 or
				  emergency language will be repealed by operation of law on the following
				  day.
5. Editorial correction of HISTORY 3 (Register 2014, No.
				  51).
6. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government
				  Code section
				  100504(a)(6)
				  to change the date upon which a Certificate of Compliance must be transmitted
				  to OAL. Pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of
				  Compliance must be transmitted to OAL by 9-30-2016 or the language in the
				  emergency order of 9-2-2014 will be repealed by operation of law on the
				  following day (Register 2015, No. 38).
7. Editorial correction of
				  HISTORY 5 (Register 2019, No. 39).
8. Repealed by operation of
				  Government Code section
				  11346.1(g)
				  (Register 2019, No. 39).
Note: Authority cited: Sections
					 100503 and
					 100504,
					 Government Code. Reference: Section
					 100503,
					 Government Code; and 45
					 C.F.R. Sections 155.205 and
					 155.220.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 10 - Certified Insurance Agents › Section 6802 - Eligible Individuals. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New section
				  filed 9-30-2013 as an emergency; operative 9-30-2013 (Register 2013, No. 40). A
				  Certificate of Compliance must be transmitted to OAL by 4-1-2014 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. New section refiled 4-1-2014 as an emergency; operative
				  4-1-2014 (Register 2014, No. 14). A Certificate of Compliance must be
				  transmitted to OAL by 6-30-2014 or emergency language will be repealed by
				  operation of law on the following day.
3. New section refiled
				  7-1-2014 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 7-1-2014
				  (Register 2014, No. 27). A Certificate of Compliance must be transmitted to OAL
				  by 9-30-2015 pursuant to Government Code section
				  100504 or
				  emergency language will be repealed by operation of law on the following
				  day.
4. New section refiled 9-2-2014 as an emergency pursuant to
				  Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 9-2-2014
				  (Register 2014, No. 36). A Certificate of Compliance must be transmitted to OAL
				  by 9-30-2015 pursuant to Government Code section
				  100504 or
				  emergency language will be repealed by operation of law on the following
				  day.
5. Editorial correction of HISTORY 3 (Register 2014, No.
				  51).
6. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government
				  Code section
				  100504(a)(6)
				  to change the date upon which a Certificate of Compliance must be transmitted
				  to OAL. Pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of
				  Compliance must be transmitted to OAL by 9-30-2016 or the language in the
				  emergency order of 9-2-2014 will be repealed by operation of law on the
				  following day (Register 2015, No. 38).
7. Editorial correction of
				  HISTORY 5 (Register 2019, No. 39).
8. Repealed by operation of
				  Government Code section
				  11346.1(g)
				  (Register 2019, No. 39).
Note: Authority cited: Sections
					 100503 and
					 100504,
					 Government Code. Reference: Section
					 100503,
					 Government Code; and 45
					 C.F.R. Section
					 155.220.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 10 - Certified Insurance Agents › Section 6804 - Agent Certification Application. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New section
				  filed 9-30-2013 as an emergency; operative 9-30-2013 (Register 2013, No. 40). A
				  Certificate of Compliance must be transmitted to OAL by 4-1-2014 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. New section, including amendment of subsection (d)(2),
				  refiled 4-1-2014 as an emergency; operative 4-1-2014 (Register 2014, No. 14). A
				  Certificate of Compliance must be transmitted to OAL by 6-30-2014 or emergency
				  language will be repealed by operation of law on the following
				  day.
3. New section refiled 7-1-2014 as an emergency pursuant to
				  Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 7-1-2014
				  (Register 2014, No. 27). A Certificate of Compliance must be transmitted to OAL
				  by 9-30-2015 pursuant to Government Code section
				  100504 or
				  emergency language will be repealed by operation of law on the following
				  day.
4. New section, including amendment of subsections (a)(1)(A)
				  and (d)(1)(B)-(d)(2), refiled 9-2-2014 as an emergency pursuant to Government
				  Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 9-2-2014
				  (Register 2014, No. 36). A Certificate of Compliance must be transmitted to OAL
				  by 9-30-2015 pursuant to Government Code section
				  100504 or
				  emergency language will be repealed by operation of law on the following
				  day.
5. Editorial correction of HISTORY 3 (Register 2014, No.
				  51).
6. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government
				  Code section
				  100504(a)(6)
				  to change the date upon which a Certificate of Compliance must be transmitted
				  to OAL. Pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of
				  Compliance must be transmitted to OAL by 9-30-2016 or the language in the
				  emergency order of 9-2-2014 will be repealed by operation of law on the
				  following day (Register 2015, No. 38).
7. Editorial correction of
				  HISTORY 5 (Register 2019, No. 39).
8. Repealed by operation of
				  Government Code section
				  11346.1(g)
				  (Register 2019, No. 39).
Note: Authority cited: Sections
					 100503 and
					 100504,
					 Government Code. Reference: Section
					 100503,
					 Government Code; and 45
					 C.F.R. Sections 155.220 and
					 155.260.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 10 - Certified Insurance Agents › Section 6806 - Training Standards. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New section
				  filed 9-30-2013 as an emergency; operative 9-30-2013 (Register 2013, No. 40). A
				  Certificate of Compliance must be transmitted to OAL by 4-1-2014 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. New section refiled 4-1-2014 as an emergency; operative
				  4-1-2014 (Register 2014, No. 14). A Certificate of Compliance must be
				  transmitted to OAL by 6-30-2014 or emergency language will be repealed by
				  operation of law on the following day.
3. New section refiled
				  7-1-2014 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 7-1-2014
				  (Register 2014, No. 27). A Certificate of Compliance must be transmitted to OAL
				  by 9-30-2015 pursuant to Government Code section
				  100504 or
				  emergency language will be repealed by operation of law on the following
				  day.
4. New section, including repealer of subsection (c), refiled
				  9-2-2014 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 9-2-2014
				  (Register 2014, No. 36). A Certificate of Compliance must be transmitted to OAL
				  by 9-30-2015 pursuant to Government Code section
				  100504 or
				  emergency language will be repealed by operation of law on the following
				  day.
5. Editorial correction of HISTORY 3 (Register 2014, No.
				  51).
6. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government
				  Code section
				  100504(a)(6)
				  to change the date upon which a Certificate of Compliance must be transmitted
				  to OAL. Pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of
				  Compliance must be transmitted to OAL by 9-30-2016 or the language in the
				  emergency order of 9-2-2014 will be repealed by operation of law on the
				  following day (Register 2015, No. 38).
7. Editorial correction of
				  HISTORY 5 (Register 2019, No. 39).
8. Repealed by operation of
				  Government Code section
				  11346.1(g)
				  (Register 2019, No. 39).
Note: Authority cited: Sections
					 100503 and
					 100504,
					 Government Code. Reference: Section
					 100503,
					 Government Code; and 45
					 C.F.R. Sections 155.220 and
					 155.260.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 11 - Certified Application Counselor Program › Section 6850 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For purposes of
				this Article, the following terms shall have the following associated meanings:
(1) Authorized Contact: The individual
				appointed by the Certified Application Entity to manage the agreement executed
				with the Exchange pursuant to this Article.
(2) Certified Application Counselor: An
				individual certified by the Exchange and affiliated with a Certified
				Application Entity pursuant to Section
				6856 to provide the duties
				specified in Section
				6864 of this Article.
(3) Certified Application Entity: An
				organization registered by the Exchange pursuant to Section
				6854 with affiliated individuals
				serving as Certified Application Counselors.
(4) Consumer Assistance: The programs and
				activities created under 45
				C.F.R. §
											155.205(d)
				(December 22, 2016), hereby incorporated by reference, to provide enrollment
				assistance to consumers.
(5)
				Primary Contact: The individual appointed by the Certified Application Entity
				to be the liaison with the Exchange.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 11 - Certified Application Counselor Program › Section 6852 - Certified Application Entities

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Except for the following, public or
				private entities who meet the requirements of this Article are eligible to
				apply to become a Certified Application Entity:
(1) Health Insurance Issuer, as defined in
				Section 6410 of Article 2 of this
				Chapter;
(2) Individuals registered
				as Certified Insurance Agents under Article 10 of this
				Chapter.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 11 - Certified Application Counselor Program › Section 6854 - Certified Application Entity Application

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An organization who is eligible pursuant
				to Section
				6852 may apply to become a
				Certified Application Entity according to the following process:
(1) The organization shall submit all
				information, documentation, and declarations required in subdivision (b) of
				this section.
(2) The application
				shall demonstrate that the organization is capable of carrying out at least
				those duties described in Section
				6864.
(3) The Exchange shall review the application
				and, if applicable, request any missing information.
(4) Organizations who have submitted a
				completed application and demonstrated ability to meet the above requirements
				shall:
(A) Be notified by the Exchange of
				available opportunities for the entity's Authorized Contact, or his or her
				designee, to complete the training requirements established pursuant to Section
				6860, subdivision (a);
				and
(B) Submit the following:
1. An executed agreement conforming to the
				roles and responsibilities defined in Section
				6864 and
				45 C.F.R. §
													155.225 (March 8, 2016), hereby incorporated
				by reference. Any person with the legal authority to bind the organization in
				contract may execute an agreement;
2. Proof of general liability insurance with
				coverage of not less than $1,000,000 per occurrence with the Exchange named as
				an additional insured.
(5) Organizations that complete the above
				requirements shall be registered as a Certified Application Entity by the
				Exchange and assigned a Certified Application Entity Number. If the Authorized
				Contact, or his or her designee, fails to complete the training standards
				described in Section
				6860, subdivision (a), within 90
				calendar days, the applicant shall be deregistered.
(6) Organizations who have been denied may
				appeal the denial of their Certified Application Entity application through the
				process set forth in Section
				6862.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 11 - Certified Application Counselor Program › Section 6856 - Certified Application Counselor Application

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An individual may become a Certified
				Application Counselor according to the following process:
(1) The Certified Application Entity shall
				notify the Exchange of the individual to be affiliated according to the process
				described in subdivision (c) of this section.
(2) The individual shall:
(A) Submit the following:
1. All information, documentation, and
				declarations required in subdivision (b) of this section; and
2. An executed agreement conforming to the
				roles and responsibilities defined in Section
				6864 and
				45 C.F.R. §
													155.225;
(B) Within 30 calendar days of completing the
				requirements in (a)(2)(A) of this section:
1.
				Submit fingerprinting images in accordance with Section
				6858(a);
2. Disclose to the Exchange all criminal
				convictions and administrative actions taken against the applicant;
3. Complete the required training established
				in Section
				6860; and
4. Pass the required certification exam
				administered by the Exchange pursuant to Section
				6860.
(3) Individuals who complete the above
				requirements, pass the Certified Application Counselor fingerprinting and
				criminal record check described in Section
				6858, and have no administrative
				actions taken against them which are substantially related to the
				qualifications, functions, or duties of the specific position sought, shall be
				certified as Certified Application Counselors by the Exchange.
(4) Applicants who have been denied for
				reasons other than failure to pass the Certified Application Counselor
				fingerprinting and criminal record check may appeal the denial of their
				Certified Application Counselor application through the process established by
				Section 6862.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 11 - Certified Application Counselor Program › Section 6858 - Certified Application Counselor Fingerprinting and Criminal Record Checks; Appeals

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				Individuals Required To Submit Fingerprinting Images.
(1) Individuals seeking certification under
				this Article shall submit fingerprint images and associated criminal history
				information pursuant to Government Code Section
				1043 and
				Section 6456(a)-(e) of
				Article 4 of this Chapter.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 11 - Certified Application Counselor Program › Section 6860 - Training Standards

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				All entities who apply to become a Certified Application Entity shall complete
				training for the management of Certified Application Entities prior to any
				affiliated Certified Application Counselors carrying out any Consumer
				Assistance functions.
(b) All
				Certified Application Counselors shall complete training in the following
				subjects prior to carrying out any Consumer Assistance functions under this
				article:
(1) QHPs (including the metal levels
				described at 45 C.F.R.
				§
											156.140(b) (April 18,
				2017), hereby incorporated by reference) and how they operate, including
				benefits covered, payment processes, rights and processes for appeals and
				grievances, and contacting individual plans;
(2) The full range of insurance affordability
				programs, including Medicaid, the Children's Health Insurance Program, and
				other public programs;
(3) The tax
				implications of enrollment decisions;
(4) Eligibility requirements for premium tax
				credits and cost-sharing reductions, and the impacts of premium tax credits on
				the cost of premiums;
(5) Contact
				information for appropriate federal, state, and local agencies for consumers
				seeking additional information about specific coverage options not offered
				through the Exchange;
(6) Basic
				concepts about health insurance and the Exchange and the benefits of having
				health insurance and enrolling through an Exchange;
(7) Eligibility and enrollment rules and
				procedures, including how to appeal an eligibility determination;
(8) Providing culturally and linguistically
				appropriate services;
(9) Ensuring
				accessibility for people with any disability;
(10) Understanding differences among health
				plans;
(11) Privacy and security
				standards applicable under 45 C.F.R. §
											155.260
				(September 6, 2016), hereby incorporated by reference, for handling and
				safeguarding consumers' personally identifiable information;
(12) Working effectively with individuals
				with limited English proficiency, people with disabilities, people of any
				gender identity, people of any sexual orientation, and vulnerable, rural, and
				underserved populations;
(13)
				Customer service standards;
(14)
				Outreach and education methods and strategies;
(15) Applicable administrative rules,
				processes, and systems related to Exchanges and QHPs;
(16) Procedures for assisting consumers with
				voter registration in compliance with Section
				6462 of Article 4; and
(17) The individual responsibility to have
				health insurance.
California Code of Regulations › Title 10 - Investment › Chapter 12 - California Health Benefit Exchange › Article 11 - Certified Application Counselor Program › Section 6862 - Appeals Process

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				Other than a determination made pursuant to Section
				6858, Certified Application
				Counselor Fingerprinting and Criminal Record Checks, a decision that an
				individual or entity is not eligible or qualified to participate or continue to
				participate in a program under this Article may be appealed to the Exchange in
				accordance with the requirements of this section.
(b) The Exchange shall allow an applicant to
				request an appeal within 60 calendar days of the date of the notice of
				eligibility determination.
(c) The
				first phase of the Appeals Process shall include an informal review by the
				Exchange. The Exchange shall consider the information used to determine the
				appellant's eligibility as well as any additional relevant evidence presented
				during the course of the appeal. The Exchange shall make an informal resolution
				decision within 45 calendar days from the receipt of the appeal. The Exchange
				shall notify the appellant in writing of the decision.
(d) If the appellant is satisfied with the
				outcome of the informal resolution decision, the appeal may be withdrawn. If
				the appeal is not withdrawn, it shall be automatically escalated to the second
				phase of the Appeals Process. During the second phase, an independent unit
				within the Exchange that had no involvement in the original eligibility or
				qualification determination or informal resolution decision shall review the
				eligibility or qualification of the appellant de novo. The appellant shall be
				allowed to present additional evidence during the second phase. The Exchange
				shall consider all relevant evidence presented during the course of the appeal
				and notify the appellant in writing of the final decision within 60 calendar
				days from the receipt of the initial appeal.
1. New section
				  filed 7-6-2015 as an emergency pursuant to Government Code section
				  100504(a)(6),
				  as modified by Senate Bill 75 (Stats. 2015, c. 18); operative 7-6-2015
				  (Register 2015, No. 28). A Certificate of Compliance must be transmitted to OAL
				  by 7-6-2018 pursuant to Government Code section
				  100504(a)(6)
				  or emergency language will be repealed by operation of law on the following
				  day.
2. Editorial correction of HISTORY 1 (Register 2018, No.
				  37).
3. New section filed 6-7-2019; operative 6-7-2019 pursuant to
				  Government Code section
				  11343.4(b)(3)
				  (Register 2019, No. 23).
4. Editorial correction of HISTORY 1
				  (Register 2019, No. 39).
Note: Authority cited: Section
					 100504,
					 Government Code. Reference: Section
					 100502,
					 Government Code.