reglab/statecodes huggingface dataset:
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6209 - Enrollee Share of Cost for Health Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Every participating carrier shall require copayments and
				  deductibles for health benefits provided to enrollees subject to the
				  following:
(a) For enrollees in health
				maintenance organizations, exclusive provider organizations, preferred provider
				organizations, health maintenance organizations with a point of service option,
				and exclusive provider organizations with a point of service option, the sum of
				the in-network copayments and deductibles shall not exceed $2,000 in a benefit
				year for an enrollee or $4,000 in a benefit year for an enrolled sole employee
				and enrolled dependents or for a guaranteed association member and enrolled
				dependents for covered benefits and services provided by a provider who
				contracts with the carrier to provide health care benefits and services. In any
				benefit year that an enrollee has paid the maximum copayments described in
				Section 2699.6209(b)(4)(B)(1)(a)
				or Section
				2699.6209(b)(4)(D)(1)(a),
				the enrollee shall be deemed to have met the maximum in -network copayment
				requirement described in this section. For enrollees in indemnity plans the sum
				of all copayments and deductibles shall not exceed $2,000 in a benefit year for
				an enrollee or $4,000 in a benefit year for an enrolled sole employee and
				enrolled dependents or for a guaranteed association member and enrolled
				dependents for covered benefits and services.
(b) Participating carriers shall offer two
				options for enrollee share of cost: a standard option and a preferred option.
(1) In the case of participating carriers
				which are health maintenance organizations or exclusive provider organizations:
(A) A preferred option shall consist of the
				following elements:
1. A $5 copayment per
				visit for office or home visits, with the following exceptions:
a. treatment for infertility, including
				tests, shall be subject to a copayment of 50% of the carrier's contracted or
				scheduled rate of payment, and
b.
				outpatient mental health visits shall be subject to a $20 per visit
				copayment;
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6211 - Enrollee Share of Cost for Dental Health Benefit

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Every participating dental health carrier
				shall require copayments for the dental benefits listed in Subsection
				2699.6201(a) of
				these regulations provided to enrollees subject to the following:
(1) In the case of dental health benefit
				plans offered by participating carriers which are pre-paid dental
				organizations:
(A) No copayments are charged
				for benefits listed under Subsection
				2699.6201(a)(1),
				"Diagnostic and Preventive Benefits", with the following exceptions:
1. Emergency oral exams are subject to a $15
				copayment.
2. Palliative treatment
				is subject to a copayment of $10 per office visit.
3. Specialist consultations are subject to a
				copayment of $30.
4. Roentgenology
				is only subject to copayments as follows:
a.
				Full mouth x-rays--$5 per set.
b.
				Panoramic films--$5 per set.
5. Dental sealant treatments are subject to a
				copayment of $5 per tooth.
6. Space
				maintainers are subject to a $50 copayment.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6213 - Pre-Existing Condition Exclusions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Participating carriers who are health
				maintenance organizations, exclusive provider organizations, health maintenance
				organizations offering a point of service option or exclusive provider
				organization's offering a point of service option may not subject enrollees to
				a pre-existing condition exclusion period.
(b) Participating carriers who are preferred
				provider organizations or who offer an indemnity plan in the program may
				subject enrollees to a pre-existing condition exclusion period. During the
				pre-existing condition exclusion period, no benefits or services related to a
				pre-existing condition shall be covered.
(c) The pre-existing condition exclusion
				period shall be six (6) months following the individual's effective date of
				coverage.
(d) In determining
				whether a preexisting condition provision applies to any person, a
				participating carrier shall credit the time the person was covered under
				qualifying prior coverage, provided the person becomes eligible for coverage
				under the succeeding plan contract within 30 days of termination of prior
				coverage, exclusive of any waiting period, and applies for coverage with the
				succeeding plan contract within the applicable enrollment period. However, if a
				person's employment has ended, the availability of health coverage offered
				through employment or sponsored by an employer has terminated, or an employer's
				contribution toward health coverage has terminated, a plan shall credit the
				time the person was covered under qualifying prior coverage if the person
				becomes eligible for health coverage offered through employment or sponsored by
				an employer within one hundred eighty (180) calendar days, exclusive of any
				waiting period, and applies for coverage under the succeeding health benefit
				plan within the applicable period.
1. Renumbering
				  of former section
				  2699.634 to section
				  2699.6213 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
2. New subsection (a) and subsection
				  relettering filed 5-2-96; operative 6-1-96 (Register 96, No. 18).
3.
				  Amendment of subsection (d) filed 5-5-97; operative 7-1-97 (Register 97, No.
				  19).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10741,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6215 - Waiting Periods for Specific Dental Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Enrollees of the dental benefits plans provided through the
				  Program who have not had qualifying prior dental coverage for the 6 consecutive
				  months prior to enrollment in the program shall be subject to a waiting period
				  of 6 months, for benefits listed under Sub-sections
				  2699.6201(a)(6) and
				  (7). A waiting period of 12 months shall
				  apply to all enrollees for benefits listed under Subsection
				  2699.6201(a)(8).
				  However, participating dental plans shall credit time enrolled in dental
				  benefits through the program with other participating dental plans toward this
				  waiting period.
1. New section
				  filed 5-23-94 as an emergency; operative 5-23-94 (Register 94, No. 21). A
				  Certificate of Compliance must be transmitted to OAL by 9-20-94 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 5-23-94 order transmitted to
				  OAL 9-16-94 and filed 10-27-94 (Register 94, No. 43).
3. Amendment
				  filed 4-25-96; operative 5-25-96 (Register 96, No.
				  17).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10741,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6217 - Benefit Appeals

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
When a small employer, employee, or dependent is dissatisfied
				  with any action, or inaction, of the program's participating carrier or
				  participating dental carrier with which he or she is enrolled, the person shall
				  resolve the dispute with the participating carrier or participating carrier
				  according to its established policies and procedures.
1. Renumbering
				  and amendment of former section
				  2699.635 to section
				  2699.6217 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
2. Amendment filed 5-23-94 as an
				  emergency; operative 5-23-94 (Register 94, No. 21). A Certificate of Compliance
				  must be transmitted to OAL by 9-20-94 or emergency language will be repealed by
				  operation of law on the following day.
3. Certificate of Compliance
				  as to 5-23-94 order transmitted to OAL 9-16-94 and filed 10-27-94 (Register 94,
				  No. 43).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10733,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6241 - Waiting Period for Sole Employees. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New section
				  filed 5-5-93 as an emergency; operative 7-1-93 (Register 93, No. 19). A
				  Certificate of Compliance must be transmitted to OAL 10-29-93 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 5-5-93 order transmitted to
				  OAL 8-27-93 and filed 10-12-93 (Register 93, No. 42).
3. Amendment
				  of section heading and text filed 12-30-93 as an emergency; operative 12-30-93
				  (Register 93, No. 53). A Certificate of Compliance must be transmitted to OAL
				  by 4-28-94 or emergency language will be repealed by operation of law on the
				  following day.
4. Certificate of Compliance as to 12-30-93 order
				  including renumbering and amending former section
				  2699.6241 to section
				  2699.6135 transmitted to OAL
				  4-25-94 and filed 5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6241.5 - Waiting Period for Guaranteed Association Members. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New section
				  filed 12-30-93 as an emergency; operative 12-30-93 (Register 93, No. 53). A
				  Certificate of Compliance must be transmitted to OAL by 4-28-94 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 12-30-93 order including
				  renumbering and amending former section
				  2699.6241.5 to section
				  2699.6137 transmitted to OAL
				  4-25-94 and filed 5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6242 - Open Enrollment Period for Sole Employers. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New section
				  filed 5-5-93 as an emergency; operative 7-1-93 (Register 93, No. 19). A
				  Certificate of Compliance must be transmitted to OAL 10-29-93 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 5-5-93 order transmitted to
				  OAL 8-27-93 and filed 10-12-93 (Register 93, No. 42).
3. Amendment
				  of section heading and text filed 12-30-93 as an emergency; operative 12-30-93
				  (Register 93, No. 53). A Certificate of Compliance must be transmitted to OAL
				  by 4-28-94 or emergency language will be repealed by operation of law on the
				  following day.
4. Certificate of Compliance as to 12-30-93 order
				  including renumbering and amending former section
				  2699.6242 to section
				  2699.6139 transmitted to OAL
				  4-25-94 and filed 5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6242.5 - Open Enrollment Period for Guaranteed Association Members. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New section
				  filed 12-30-93 as an emergency; operative 12-30-93 (Register 93, No. 53). A
				  Certificate of Compliance must be transmitted to OAL by 4-28-94 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 12-30-93 order including
				  renumbering and amending former section
				  2699.6242.5 to section
				  2699.6141 transmitted to OAL
				  4-25-94 and filed 5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6243 - Other Enrollment Additions for Sole Employees and Dependents. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New section
				  filed 5-5-93 as an emergency; operative 7-1-93 (Register 93, No. 19). A
				  Certificate of Compliance must be transmitted to OAL 10-29-93 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 5-5-93 order, including
				  amendment of subsections (a)(3) and (b)(2), transmitted to OAL 8-27-93 and
				  filed 10-12-93 (Register 93, No. 42).
3. Amendment of section
				  heading and text filed 12-30-93 as an emergency; operative 12-30-93 (Register
				  93, No. 53). A Certificate of Compliance must be transmitted to OAL by 4-28-94
				  or emergency language will be repealed by operation of law on the following
				  day.
4. Certificate of Compliance as to 12-30-93 order including
				  renumbering and amending former section
				  2699.6243 to section
				  2699.6145 transmitted to OAL
				  4-25-94 and filed 5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10743,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6243.5 - Other Enrollment Additions for Member Employers. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New section
				  filed 12-30-93 as an emergency; operative 12-30-93 (Register 93, No. 53). A
				  Certificate of Compliance must be transmitted to OAL by 4-28-94 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 12-30-93 order including
				  renumbering and amending former section
				  2699.6243.5 to section
				  2699.6147 transmitted to OAL
				  4-25-94 and filed 5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6243.6 - Other Enrollment Additions for Individual Members. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New section
				  filed 12-30-93 as an emergency; operative 12-30-93 (Register 93, No. 53). A
				  Certificate of Compliance must be transmitted to OAL by 4-28-94 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 12-30-93 order including
				  renumbering and amending former section
				  2699.6243.6 to section
				  2699.6149 transmitted to OAL
				  4-25-94 and filed 5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10743,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6244 - Enrollment. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New section
				  filed 5-5-93 as an emergency; operative 7-1-93 (Register 93, No. 19). A
				  Certificate of Compliance must be transmitted to OAL 10-29-93 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 5-5-93 order transmitted to
				  OAL 8-27-93 and filed 10-12-93 (Register 93, No. 42).
3. Amendment
				  filed 12-30-93 as an emergency; operative 12-30-93 (Register 93, No. 53). A
				  Certificate of Compliance must be transmitted to OAL by 4-28-94 or emergency
				  language will be repealed by operation of law on the following
				  day.
4. Certificate of Compliance as to 12-30-93 order including
				  renumbering and amending former section
				  2699.6244 to section
				  2699.6153 transmitted to OAL
				  4-25-94 and filed 5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10733,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6261 - Disenrollment of Sole Employees. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New section
				  filed 5-5-93 as an emergency; operative 7-1-93 (Register 93, No. 19). A
				  Certificate of Compliance must be transmitted to OAL 10-29-93 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 5-5-93 order transmitted to
				  OAL 8-27-93 and filed 10-12-93 (Register 93, No. 42).
3. Amendment
				  of section heading and text filed 12-30-94 as an emergency; operative 12-30-93
				  (Register 93, No. 53). A Certificate of Compliance must be transmitted to OAL
				  by 4-28-94 or emergency language will be repealed by operation of law on the
				  following day.
4. Certificate of Compliance as to 12-30-93 order
				  including renumbering and amending former section
				  2699.6261 to section
				  2699.6177 transmitted to OAL
				  4-25-94 and filed 5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10743,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6261.5 - Disenrollment of Member Employees and Dependents. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New section
				  filed 12-30-93 as an emergency; operative 12-30-93 (Register 93, No. 53). A
				  Certificate of Compliance must be transmitted to OAL by 4-28-94 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 12-30-93 order including
				  renumbering and amending former section
				  2699.6261.5 to section
				  2699.6181 transmitted to OAL
				  4-25-94 and filed 5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10743,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6262.5 - Disenrollment of Individual Members and Dependents. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New section
				  filed 12-30-93 as an emergency; operative 12-30-93 (Register 93, No. 53). A
				  Certificate of Compliance must be transmitted to OAL by 4-28-94 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 12-30-93 order including
				  renumbering and amending former section
				  2699.6262.5 to section
				  2699.6183 transmitted to OAL
				  4-25-94 and filed 5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10743,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 3 - Benefits › Section 2699.6271 - Cobra Benefits. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New section
				  filed 5-5-93 as an emergency; operative 7-1-93 (Register 93, No. 19). A
				  Certificate of Compliance must be transmitted to OAL 10-29-93 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 5-5-93 order transmitted to
				  OAL 8-27-93 and filed 10-12-93 (Register 93, No. 42).
3. Renumbering
				  of former section
				  2699.6271 to section
				  2699.6191 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 4 - Employer Premiums › Section 2699.6300 - Risk Categories

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Health benefits plan rates shall be based exclusively on the
				  following risk categories:
(a)
				Geographic region of sole employee's or guaranteed association member's
				residence.
(1) The six geographic regions for
				sole employee's or guaranteed association members residing within the State of
				California shall be as follows:
(A) Area 1
				shall include the counties of Alpine, Amador, Butte, Calaveras, Colusa, Del
				Norte, El Dorado, Glenn, Humboldt, Inyo, Kings, Lake, Lassen, Mendocino, Modoc,
				Mono, Monterey, Nevada, Placer, Plumas, San Benito, Shasta, Sierra, Siskiyou,
				Sutter, Tehama, Trinity, Tulare, Tuolumne, Yuba, and Yolo.
(B) Area 2 shall include the counties of
				Fresno, Imperial, Kern, Madera, Mariposa, Merced, Napa, Sacramento, San
				Joaquin, San Luis Obispo, Santa Cruz, Solano, Sonoma, and Stanislaus.
(C) Area 3 shall include the counties of
				Alameda, Contra Costa, Marin, San Francisco, San Mateo, and Santa
				Clara.
(D) Area 4 shall include the
				counties of Orange, Santa Barbara, and Ventura.
(E) Area 5 shall include the county of Los
				Angeles.
(F) Area 6 shall include
				the counties of Riverside, San Bernardino, and San Diego.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 4 - Employer Premiums › Section 2699.6301 - Risk Categories for Dental Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Dental benefits plan rates shall be based exclusively on the
				  following risk categories:
(a)
				Geographic region of sole employee's or guaranteed association member's
				residence within the state of California. The six geographic regions shall be
				as specified in Subsection
				2699.6300(a)(1).
(b) Family size category of enrolled sole
				employee or guaranteed association member. The four (4) family size categories
				shall be as specified in Subsection
				2699.6300(c).
1. New section
				  filed 5-23-94 as an emergency; operative 5-23-94 (Register 94, No. 21). A
				  Certificate of Compliance must be transmitted to OAL by 9-20-94 or emergency
				  language will be repealed by operation of law on the following
				  day.
2. Certificate of Compliance as to 5-23-94 order transmitted to
				  OAL 9-16-94 and filed 10-27-94 (Register 94, No.
				  43).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10746,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 4 - Employer Premiums › Section 2699.6303 - Annual Health Benefit Plan Rates

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Health benefit plan rates and dental benefit plan rates shall
				  be established for each rating period and the rating period for the program
				  shall be a twelve (12) month period.
1. Renumbering
				  of former section
				  2699.641 to section
				  2699.6303 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
2. Amendment filed 5-23-94 as an
				  emergency; operative 5-23-94 (Register 94, No. 21). A Certificate of Compliance
				  must be transmitted to OAL by 9-20-94 or emergency language will be repealed by
				  operation of law on the following day.
3. Certificate of Compliance
				  as to 5-23-94 order transmitted to OAL 9-16-94 and filed 10-27-94 (Register 94,
				  No. 43).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 4 - Employer Premiums › Section 2699.6305 - Change of Risk Category

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) When an enrolled sole employee, member
				employee, or individual member changes age groups as specified in Section
				2699.6300(b) the
				rate change shall go into effect at the beginning of the next rating
				period.
(b) When an enrolled sole
				employee, member employee, or individual member changes geographic region of
				residence as specified in Section
				2699.6300(a) but
				is not transferring from one participating carrier or participating dental
				carrier to another, or changes family size category as specified in Section
				2699.6300(c), the
				change in the employer premium or individual member premium shall be calculated
				for and included in the next employer premium or individual member premium
				following the change.
1. Renumbering
				  and amendment of former section
				  2699.642 to section
				  2699.6305 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
2. Amendment filed 5-23-94 as an
				  emergency; operative 5-23-94 (Register 94, No. 21). A Certificate of Compliance
				  must be transmitted to OAL by 9-20-94 or emergency language will be repealed by
				  operation of law on the following day.
3. Certificate of Compliance
				  as to 5-23-94 order transmitted with amendment of subsection (b) to OAL 9-16-94
				  and filed 10-27-94 (Register 94, No. 43).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 4 - Employer Premiums › Section 2699.6307 - Program Participation Fee

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) This subsection applies to sole employers
				and guaranteed associations with effective dates of coverage prior to September
				1, 1998 who have not made an election pursuant to Section
				2699.6116.
(1) The program shall establish a program
				participation fee to be paid as part of the employer premium or individual
				member premium. The program shall include an amount to be paid for
				participation for dental coverage if the employer or individual member
				participates in the dental benefits option. The amount of the fee shall be
				sufficient to cover necessary administrative costs in connection with the
				program. Small employers enrolling after July 1, 1996 and before July 1, 1997
				who do not utilize the services of an agent or broker shall pay, as an
				additional part of their program participation fee, a monthly amount equal to
				the monthly amounts specified in subsections
				2699.6194(a)(4)
				and 2699.6196(a)(1)(D)
				for the first year and subsections
				2699.6194(a)(5)(B)
				and 2699.6196(a)(1)(E)2.
				for the second year to compensate for the program's application, open
				enrollment and requalification assistance. Small employers enrolling on or
				after July 1, 1997 who do not utilize the services of an agent or a broker
				shall pay, as an additional part of their program participation fee, a monthly
				amount equal to the monthly amount specified in subsections
				2699.6194(a)(4)
				and 2699.6196(a)(1)(D)
				for the first year and subsections
				2699.6194(a)(5)(C)
				and 2699.6195(a)(1)(E)3.
				for the second year to compensate for these services.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 4 - Employer Premiums › Section 2699.6309 - Notification of Rate Changes

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The program shall notify guaranteed associations,
				  participating employers and participating individual members of plan rates no
				  later than thirty (30) calendar days prior to the start of the rating period
				  for which the rates are in effect.
1. Renumbering
				  of former section
				  2699.644 to section
				  2699.6309 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
2. Amendment filed 5-23-94 as an
				  emergency; operative 5-23-94 (Register 94, No. 21). A Certificate of Compliance
				  must be tranmitted to OAL by 9-20-94 or emergency language will be repealed by
				  operation of law on the following day.
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 4 - Employer Premiums › Section 2699.6311 - Premium Payment to Program

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Premium payment procedures for sole employers and for member
				  employers and for individual members which submit premiums directly to the
				  program shall be as follows:
(a)
				Participating employers and participating individual members shall submit their
				employer premium or individual member premium to the program each month so that
				it is received no later than the due date set by the program.
(b) Each month the program shall notify
				participating employers or participating individual members of the employer
				premium or individual member premium due to the program, the due date of the
				employer premium or individual member premium, and the enrollees for whom
				payment is included in the employer premium or individual member premium. This
				notification shall be made at least fifteen (15) calendar days in advance of
				the employer premium due date.
(c)
				The participating employer's or participating individual member's obligation to
				submit the employer premium or individual member premium required by paragraph
				(a) above is not contingent upon receipt of the notice specified in paragraph
				(b) above. If the participating employer or participating individual member
				does not receive the notice specified in paragraph (b) above, the participating
				employer or participating individual member shall made a good faith effort to
				determine the amount of the employer premium or individual member premium and
				shall submit a payment of that amount.
(d) The due date for employer premiums and
				individual premiums is the first day covered by the premium.
1. Renumbering
				  of former section
				  2699.645 to section
				  2699.6311 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10742,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 4 - Employer Premiums › Section 2699.6313 - Overdue Payments; Late Fees; Disqualification for Participating Employers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				Participating employers whose employer premiums are not paid in full by the due
				date shall be considered to be overdue. No act or failure to act on the part of
				a guaranteed association that is collecting premiums for the guaranteed
				association's members shall encumber the program from proceeding as herein set
				forth.
(b) The program shall notify
				participating employers of the overdue premium payment and the potential of
				disqualification from the program within fifteen (15) calendar days following
				the due date.
(c) Overdue employer
				premiums shall be subject to a late fee equal to 5% of the employer
				premium.
(d) Employer premiums more
				than thirty-one (31) calendar days overdue shall result in the participating
				employer being disqualified pursuant to Section
				2699.6167(a)(2)
				or Section
				2699.6173(a)(3).
				The final date of coverage for participating employers who are disqualified
				pursuant to Section
				2699.6167(a)(2)
				or Section
				2699.6173(a)(3)
				shall be retroactive to the last day for which the employer premium was paid in
				full.
1. Renumbering
				  and amendment of former section
				  2699.646 to section
				  2699.6313 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 4 - Employer Premiums › Section 2699.6315 - Overdue Payments; Late Fees; Disqualification for Individual Members

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A participating
				individual member whose individual member premium is not paid in full by the
				due date shall be considered to be overdue. No act or failure to act on the
				part of a guaranteed association that is collecting premium for the guaranteed
				association's members shall encumber the program from proceeding as herein set
				forth.
(b) The program shall notify
				participating individual members of the overdue premium payment and the
				potential of disqualification from the program within fifteen (15) calendar
				days following the due date.
(c)
				Overdue employer premiums or individual member premiums shall be subject to a
				late fee equal to 5% of the employer or individual member premium.
(d) Individual member premiums more than
				thirty-one (31) calendar days overdue shall result in the member employer or
				individual member being disqualified pursuant to Section
				2699.6175. The final date of
				coverage for member employers or individual members who are disqualified
				pursuant to Section
				2699.6173 or
				2699.6175 shall be retroactive to
				the last day for which individual member premium was paid in full.
1. Renumbering
				  and amendment of former section
				  2699.646.5 to section
				  2699.6315 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 4 - Employer Premiums › Section 2699.6317 - Program Reinstatement Fee

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The program reinstatement fee shall be equal to 10% of the
				  employer premium or individual premium.
1. Renumbering
				  of former section
				  2699.6461 to section
				  2699.6317 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 4 - Employer Premiums › Section 2699.6319 - Reinstatement Following Disqualification for Non-Payment of Premium

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Unless
				precluded by subsection (c) below, participating employers and individual
				members disqualified for nonpayment of their monthly premium may reinstate in
				the program if the participating employer or individual member remits the
				employer or individual member premium, the late fee, the program reinstatement
				fee, and the subsequent month's employer or individual member premium and any
				applicable late fee to the program no later than fifteen (15) calendar days
				following the issuance of the notice of disenrollment for nonpayment of
				premium. Payment to the program shall be made either directly or through a
				qualified guaranteed association according to normal premium payment
				practice.
(b) If an amount is
				received pursuant to (a) above later than fifteen (15) calendar days following
				the issuance of the notice, of disenrollment for nonpayment, then the program
				shall return the amount within 20 calendar days of receiving it.
(c) A participating employer or individual
				member shall not be reinstated more than twice in a twelve month period of
				time.
1. Renumbering
				  of former section
				  2699.6462 to section
				  2699.6319 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 4 - Employer Premiums › Section 2699.6321 - Participating Employer Payment Requirement

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A participating employer shall pay the
				employer premium unless the employer requests disqualification pursuant to
				Section 2699.6167(a)(3).
(b) A participating employer shall pay each
				individual premium until the effective date of disenrollment.
1. Renumbering
				  and amendment of former section
				  2699.6463 to section
				  2699.6321 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 4 - Employer Premiums › Section 2699.6323 - Individual Member Payment Requirement

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
An individual member shall pay the individual member premium
				  due for the individual member and dependents, if any, until the effective date
				  of disenrollment.
1. Renumbering
				  and amendment of former section
				  2699.6463.5 to section
				  2699.6323 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Section
					 10731,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 5 - Appeals › Section 2699.6400 - Appeals to the Board

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Certain program decisions may be appealed to the Board. If a
				  guaranteed association, member employer, member employee, individual member,
				  sole employer, or sole employee believes that a written decision on one of the
				  following specified issues was made in violation of the program statutes or
				  regulations, or other written representation of program policy made to the
				  entity or individual by the program or the Board, that entity or individual may
				  file an appeal with the Board.
Decisions that may be appealed are:
1. A decision that an association or employer
				is not qualified to participate or continue to participate in the
				program.
2. A decision that an
				association member or employee, or dependent of either, is not eligible for
				enrollment or continuing enrollment in the program.
3. A decision as to the effective date of
				health plan coverage.
1. Relocation
				  of article heading and renumbering and amendment of former section
				  2699.650 to section
				  2699.6400 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
2. Repealer and new section filed
				  5-5-97; operative 7-1-97 (Register 97, No. 19).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10748,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 5 - Appeals › Section 2699.6401 - Filing an Appeal

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An
				appeal shall be filed in writing with the Executive Director within sixty (60)
				calendar days of the date of the notice of the decision being
				appealed.
(b) An appeal shall
				include all of the following:
(1) A copy of
				any decision being appealed, or a written statement of the action or failure to
				act being appealed;
(2) A statement
				specifically describing the issues which are disputed by the
				appellant;
(3) A statement
				specifically describing the program statute or regulation, or other written
				representation of program policy, that the appellant believes the program
				violated.
(4) A statement of the
				resolution requested by the appellant; and
(5) Any other relevant information the
				appellant wants to include.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 5 - Appeals › Section 2699.6403 - Administrative Review

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Any
				appellant who files an appeal pursuant to Section
				2699.6400 shall receive an initial
				administrative review of the appeal.
(b) Administrative reviews of appeals shall
				be conducted in two steps. Each appeal will be reviewed by the program to
				determine if the requested resolution is required by the statutes and
				regulations governing the program, or required in order to be consistent with a
				written representation of program policy made by the program or the Board. If
				so, the appropriate action will be taken and the appellant will be notified. If
				not, the appellant will be so notified and informed that they may request
				review by the Executive Director. Such a request must be filed in writing with
				the Executive Director within 30 days of the date of the notice of the program
				determination, and shall include the information specified in Subsection
				2699.6401(b).
(c) In conducting an administrative review of
				an appeal, the Executive Director may contact the appellant and/or the
				participating health plan for further information.
(d) The Executive Director's decision shall
				be in writing.
(e) The appellant
				retains the right to request an administrative hearing if the appellant is not
				satisfied with the decision of the Executive Director. Such a request shall be
				filed within thirty (30) calendar days of receipt of the Executive Director's
				decision. It shall include a clear and concise statement of what action is
				being appealed, and the reason(s) the Executive Director's decision is not
				correct.
1. Renumbering
				  of former section
				  2699.652 to section
				  2699.6403 filed 5-27-94; operative
				  5-27-94 (Register 94, No. 21).
2. Amendment of subsection (e) filed
				  1-10-95 as an emergency; operative 1-10-95 (Register 95, No. 2). A Certificate
				  of Compliance must be transmitted to OAL 5-10-95 or emergency language will be
				  repealed by operation of law on the following day.
3. Certificate of
				  Compliance as to 1-10-95 order transmitted to OAL 4-25-95 and filed 6-7-95
				  (Register 95, No. 23).
4. Amendment of subsections (a) and (b) and
				  amendment of NOTE filed 5-5-97; operative 7-1-97 (Register 97, No.
				  19).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10748,
					 Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 5 - Appeals › Section 2699.6404 - Program Review

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
In addition to the appeal process established above, the
				  Board has established a program review process. If a guaranteed association,
				  member employer, member employee, individual member, sole employer, or sole
				  employee is not eligible to file an appeal pursuant to Section
				  2699.6400, but wants to have any
				  program decision reviewed, the person or entity may request that the program
				  review the decision. A review pursuant to this section is separate from and
				  independent of an appeal pursuant to Section
				  2699.6400 and a person or entity
				  that files a request pursuant to this section shall not thereby gain any right
				  of appeal. Pursuant to Section
				  2699.6217, any dissatisfaction
				  with an action of a participating carrier or participating dental carrier shall
				  be resolved with the carrier rather than by requesting program
				  review.
1. New section
				  filed 5-5-97; operative 7-1-97 (Register 97, No.
				  19).
Note: Authority cited: Section
					 10731,
					 Insurance Code. Reference: Sections
					 10731 and
					 10748,
					 Insurance Code.