California Code of Regulations › Title 10 - Investment › Chapter 5.7 - Voluntary Alliance Uniting Employers Purchasing Pool (the Health Insurance Plan of California) › Article 2 - Participation Requirements, Application and Enrollment › Section 2699.6196 - Payment to Insurance Agents and Brokers for Member Employers when Premium Collected by Program

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				This section applies to guaranteed associations with an effective date of
				coverage prior to September 1, 1998 that have not made an election pursuant to
				Section 2699.6116.
(1) Guaranteed associations may designate one
				or more insurance agents, as defined in Section
				31 of the
				Insurance Code, or brokers, as defined in Section
				33 of the
				Insurance Code, for guaranteed association members who participate in the
				program. When the program collects the employer premium from the member
				employers of the guaranteed association premium collection shall be as follows:
(A) Except as specified in (B) below, the
				employer premium shall include an agent and broker fee if a designated
				insurance agent or, if none is designated, any other insurance agent as defined
				in Section
				31 of the
				Insurance Code or a designated broker or, if none was designated, any other
				insurance broker as defined in Section
				33 of the
				Insurance Code assisted the member employer in applying for the program, and if
				the member employer is determined to be qualified as a result of the
				application, and the agent or broker requests such payment in writing as part
				of the application and includes his or her name, license number, tax
				identification number, and address.
(B) The employer premium shall include an
				agent or broker fee unless the member employer's application includes the
				member employer's certification that an agent or broker did not perform all of
				the following services:
1. Assist the member
				employer in completing the application,
2. Calculate or determine the cost of program
				participation for the member employer,
3. Assist the member employer in enrolling
				the sole employees of the member employer.
(C) For member employers who have made
				application to the program prior to July 1, 1996, the amount of the payment
				until the time of the qualified member employer's first annual requalification
				pursuant to Section
				2699.6119 shall be:
1. For qualified member employers that have,
				at the time of application, 2-25 enrollees, the payment shall be $50 for the
				member employer per month and $4 per enrollee per month.
2. For qualified member employers that have
				26-50 enrollees at the time of application the payment shall be $75 for the
				member employer per month and $4 per enrollee per month.
3. For qualified member employers that have
				51 or more enrollees at the time of application the payment shall be $100 for
				the member employer per month and $4 per enrollee per
				month.
(D) For member
				employers who have made application to the program on or after July 1, 1996,
				the amount of the payment until the time of the member employer's first annual
				requalification pursuant to Section
				2699.6119 shall be:
1. For qualified member employers that have,
				at the time of application, 2-9 enrollees, the payment shall be $50 for the
				member employer per month and $4 per enrollee per month.
2. For qualified member employers that have,
				at the time of application, 10-20 enrollees, the payment shall be $75 for the
				member employer per month and $4 per enrollee per month.
3. For qualified member employers that have,
				at the time of application, 21-30 enrollees, the payment shall be $100 for the
				member employer per month and $4 per enrollee per month.
4. For qualified member employers that have,
				at the time of application,
				31-40
				enrollees, the payment shall be $125 for the member employer per month and $4
				per enrollee per month.
5. For
				qualified member employers that have, at the time of application, 41-50
				enrollees, the payment shall be $150 for the member employer per month and $4
				per enrollee per month.
6. For
				qualified member employers that have, at the time of application, 51 or more
				enrollees, the payment shall be $175 for the member employer per month and $4
				per enrollee per month.
(E)
1.
				Except as specified in (4) below, the member employer premium shall continue to
				include an agent and broker fee after the employer's annual requalification
				pursuant to Section
				2699.6119.
2. For member employers who had an effective
				date of coverage before July 1, 1997, the amount of the agent or broker fees
				after the time of the qualified member employer's first annual requalification
				pursuant to Section
				2699.6119 shall be as follows:
a. For qualified member employers that have,
				at the time of application 2-25 enrollees, the payment shall be $30 for the
				member employer per month and $4 per enrollee per month.
b. For qualified member employers that have
				26-50 enrollees at the time of application the payment shall be $40 for the
				member employer per month and $4 per enrollee per month.
c. For qualified member employers that have
				51 or more enrollees at the time of application the payment shall be $50 for
				the member employer per month and $4 per enrollee per
				month.
3. For member
				employers who had an effective date of coverage on or after July 1, 1997, the
				amount of the agent or broker fees after the time of the qualified member
				employer's first annual requalification pursuant to Section
				2699.6117 shall be as follows:
a. For qualified member employers that have,
				at the time of the application, 2-9 enrollees, the payment shall be $30 for the
				sole employer per month and $4 per enrollee per month.
b. For qualified member employers that have,
				at the time of the application, 10-20 enrollees, the payment shall be $50 for
				the sole employer per month and $4 per enrollee per month.
c. For qualified member employers that have,
				at the time of the application, 21-30 enrollees, the payment shall be $70 for
				the sole employer per month and $4 per enrollee per month.
d. For qualified member employers that have,
				at the time of the application, 31-40 enrollees, the payment shall be $80 for
				the sole employer per month and $4 per enrollee per month.
e. For qualified member employers that have,
				at the time of the application, 41-50 enrollees, the payment shall be $100 for
				the sole employer per month and $4 per enrollee per month.
f. For qualified member employers that have,
				at the time of the application, 51 or more enrollees, the payment shall be $115
				for the sole employer per month and $4 per enrollee per
				month.
4. The employer
				premium for an annual period shall normally include an agent or broker fee.
				However, such fee may be terminated commencing with the second year of
				enrollment for member employers who made application to the program prior to
				July 1, 1996, and with the third year of enrollment for member employers who
				applied on or after July 1, 1996 and had an effective date of coverage before
				July 1, 1997, if the member employer's requalification request includes the
				employer's certification that an agent or broker provided neither of the
				following types of services:
a. Assist the
				member employer in completing the requalification and/or assist the member
				employer's enrollees with the open enrollment process pursuant to Section
				2699.6139.
b. Assist the member employer or enrollees in
				resolving enrollment, billing, claims or other program
				issues.
(F) The
				member employer may redirect any payment made pursuant to this section to
				another designated agent or broker or, if none is designated, any agent or
				broker, by submitting written notice signed by the employer to the program and
				providing the program with the information required under (a)(1)(A) of this
				section. The effective date of the redirection shall be within ninety (90)
				calendar days following receipt of the notice.
(G) Payment to agents and brokers shall be
				terminated if one of the following occurs:
1.
				The agent or broker is no longer a licensed agent or broker.
2. The agent or broker materially violates
				any law or regulation regarding the sale of insurance or fails to comply with
				any court order.
3. The agent or
				broker commits any willful or dishonest act resulting in injury to the program,
				a participating carrier, or an enrollee.
(H) For member employers who apply on or
				after July 1, 1996, when agent or broker fees are terminated pursuant to
				(G)(1), (2), or (3) above within the first two years, the member employer shall
				pay the equivalent monthly amount to the program as part of the program
				participation fee in accordance with Section
				2699.6307, for the remainder of
				the first two years of enrollment.