TITLE 22. CALIFORNIA HEALTH BENEFIT EXCHANGE [100500. - 100523.]
Title 22 added by Stats. 2010, Ch. 659, Sec. 2.
§§ 100500–100523 · 32 sections
- § 100500 (a) There is in state government the California Health Benefit Exchange, an independent public entity not affiliated with an agency or department, which shall…
- § 100501 For purposes of this title, the following definitions shall apply: (a) “Board” means the board described in subdivision (a) of Section 100500. (b) “Bridge plan… see note
- § 100501.1 For purposes of this title, the following definitions shall apply: (a) “Insurance affordability program” means a program that is one of the following: (1) The…
- § 100502 The board shall, at a minimum, do all of the following to implement Section 1311 of the federal act: (a) Implement procedures for the certification,…
- § 100503 In addition to meeting the minimum requirements of Section 1311 of the federal act, the board shall do all of the following: (a) (1) Determine the criteria and… see note
- § 100503.1 The board shall ensure that the Internet Web site maintained under subdivision (c) of Section 100502 provides a direct link to the formulary, or formularies,…
- § 100503.2 The board shall use the information received pursuant to Section 12712.5 of the Insurance Code to provide an individual a notice that he or she may be eligible…
- § 100503.3 (a) The Exchange, in consultation with stakeholders and the Legislature, shall develop options for providing financial assistance to help low- and…
- § 100503.4 (a) Upon receipt of an individual’s electronic account pursuant to subdivision (h) of Section 15926 of the Welfare and Institutions Code from the insurance…
- § 100503.5 (a) The Exchange shall provide payments equaling the cost of providing coverage of services described in Section 18023(b)(1)(B)(i) of Title 42 of the United…
- § 100503.6 (a) If a qualified health plan is required to cover state-mandated gender-affirming care benefits determined to be in addition to essential health benefits…
- § 100503.7 (a) (1) If the board requires, or has previously required in its contracts with qualified health plans, a qualified health plan to report on cost reduction…
- § 100503.8 The board shall engage in health oversight activities relating to Exchange operations, including, but not limited to, audits, investigations, inspections,…
- § 100503.9 (a) (1) Beginning no later than September 1, 2023, and at least monthly thereafter, subject to the restrictions in paragraph (5) of subdivision (b), the…
- § 100504 (a) The board may do the following: (1) With respect to individual coverage made available in the Exchange, collect premiums and assist in the administration…
- § 100504.5 (a) To the extent approved by the appropriate federal agency, for the purpose of implementing the option in paragraph (7) of subdivision (a) of Section 100504,…
- § 100504.6 (a) The Exchange shall have the authority to adopt regulations to implement the provisions of Section 100504.5. Prior to the adoption of regulations, the board…
- § 100505 (a) The board shall establish and use a competitive process to select participating carriers and any other contractors under this title. Any contract entered…
- § 100506 (a) The board shall establish an appeals process for prospective and current enrollees of the Exchange that complies with all requirements of the federal act…
- § 100506.1 An applicant or enrollee has the right to appeal any of the following: (a) Any action or inaction related to the individual’s eligibility for or enrollment in…
- § 100506.2 (a) The entity making an eligibility or enrollment determination described in Section 100506.1 shall provide notice of the appeals process at the time of…
- § 100506.3 (a) The board shall enter into a contract with the State Department of Social Services to serve as the Exchange appeals entity designated to hear appeals of…
- § 100506.4 (a) (1) Except as provided in paragraph (2), the State Department of Social Services, acting as the appeals entity, shall allow an applicant or enrollee to…
- § 100506.5 For appeals of redetermination of Exchange advance premium tax credits, cost-sharing reductions, or state financial assistance, upon receipt of notice from the…
- § 100507 (a) Notwithstanding any other provision of law, the Exchange shall not be subject to licensure or regulation by the Department of Insurance or the Department…
- § 100508 (a) Notwithstanding subdivision (b), records of the Exchange that reveal either of the following shall be exempt from disclosure under the California Public…
- § 100510 (a) No individual or entity shall hold himself, herself, or itself out as representing, constituting, or otherwise providing services on behalf of the Exchange…
- § 100520 (a) The California Health Trust Fund is hereby created in the State Treasury for the purpose of this title, Title 24 (commencing with Section 100700), and…
- § 100520.5 (a) The Health Care Affordability Reserve Fund is hereby created in the State Treasury. (b) Notwithstanding any other law, the Controller may use the funds in…
- § 100521 (a) The board shall ensure that the establishment, operation, and administrative functions of the Exchange do not exceed the combination of federal funds,…
- § 100522 (a) (1) The Exchange shall apply to the United States Department of Health and Human Services for a waiver authorized under Section 1332 of the federal act as…
- § 100523 (a) Beginning July 1, 2023, the Exchange shall administer a program of financial assistance to help Californians obtain and maintain health benefits through…