PART 5. THE PUBLIC EMPLOYEES' MEDICAL AND HOSPITAL CARE ACT

Part 5 added by Stats. 2004, Ch. 69, Sec. 22.

§§ 22750–22948 · 165 sections

CHAPTER 1. Public Employees’ Health Benefits §§ 22750–22944.6 · 161 sections
1. ARTICLE 1. General Provisions §§ 22750–22755 · 4 sections
  - § 22750 This part may be cited as the Public Employees’ Medical and Hospital Care Act. As used in any contract or statute, the term “Meyers-Geddes State Employees’…
  - § 22751 It is the purpose of this part to do all of the following: (a) Promote increased economy and efficiency in state service. (b) Enable the state to attract and…
  - § 22753 The provisions of this part shall be controlling over any memorandum of understanding reached pursuant to Chapter 10 (commencing with Section 3500) of Division…
  - § 22755 The provisions of this part shall become operative with respect to employees and annuitants of the University of California upon filing with the board a…
2. ARTICLE 2. Definitions §§ 22760–22787 · 18 sections
  - § 22760 “Annuitant” means: (a) A person, other than a National Guard member defined in Section 20380.5, who has retired within 120 days of separation from employment…
  - § 22762 “Board” means the Board of Administration of the Public Employees’ Retirement System.
  - § 22764 “Carrier” means a private insurance company holding a valid outstanding certificate of authority from the Insurance Commissioner, a medical society or other…
  - § 22766 “Complementary annuitant premium” means the additional amount to be paid by an annuitant whose allowance falls below the premium required to maintain…
  - § 22768 “Contracting agency” means an entity that meets the eligibility criteria set forth in Section 22920 that has elected to be subject to this part pursuant to…
  - § 22770 “Domestic partner” means an adult in a domestic partnership, as defined in Section 22771, with an employee or annuitant of an employer subject to this part,…
  - § 22771 A “domestic partnership” means either of the following: (a) Two people who meet all of the criteria set forth in Section 297 or 299.2 of the Family Code. (b)…
  - § 22772 (a) “Employee” means: (1) An officer or employee of the state or of any agency, department, authority, or instrumentality of the state, including the…
  - § 22773 “Employer” means the state or any contracting agency that is subject to this part.
  - § 22774 “Exempt employee” means an employee exempt from civil service pursuant to subdivision (a), (c), (f), or (g) of Section 4 of Article VII of the California…
  - § 22775 “Family member” means an employee’s or annuitant’s spouse or domestic partner and any child, including an adopted child, a stepchild, or recognized natural…
  - § 22777 “Health benefit plan” means any program or entity that provides, arranges, pays for, or reimburses the cost of health benefits.
  - § 22778 “Medicare health benefit plan” means a health benefit plan that provides benefits in coordination with Medicare Parts A and B, including, but not limited to, a…
  - § 22779 “Out-of-state employee” means an employee permanently assigned to perform his or her duties outside of the state. An employee is permanently assigned…
  - § 22781 “Prefunding” means the making of periodic payments by an employer or employee to partially or completely fund or amortize the actuarially determined normal…
  - § 22783 “School employer” means a contracting agency that is a school district, county board of education, personnel commission of a school district, a county…
  - § 22785 “Special district” means a nonprofit, self-governed public agency located within the state, comprised solely of public employees, and performing a governmental…
  - § 22787 “System” means the California Public Employees’ Retirement System.
3. ARTICLE 3. The Board of Administration §§ 22790–22797 · 7 sections
  - § 22790 The provisions of this part shall be administered by the board. The members of the board shall receive no salary for performance of their duties and…
  - § 22792 All laws governing the organization, procedures, and administrative duties and responsibilities of the board shall be applicable to the board in its…
  - § 22793 The board shall, in accordance with this part, approve health benefit plans, and may contract with carriers offering health benefit plans.
  - § 22794 The board shall have all powers reasonably necessary to carry out the authority and responsibilities expressly granted or imposed upon it under this part.
  - § 22795 Irrespective of the provisions of Sections 1090 and 1091, a board member who is an officer of a life insurer may participate in all board activities in…
  - § 22796 (a) The board shall, pursuant to the Administrative Procedure Act, adopt all necessary rules and regulations to carry out the provisions of this part…
  - § 22797 (a) The board or an authorized representative may perform audits of each employer and may, at a specified time and place, require the employer to provide…
4. ARTICLE 4. Eligibility §§ 22800–22826 · 24 sections
  - § 22800 (a) An employee or annuitant is eligible to enroll in an approved health benefit plan, in accordance with this part and the regulations of the board. (b)…
  - § 22802 (a) An annuitant whose retirement allowance is not sufficient to pay his or her required contribution for the health benefit plan in which he or she is…
  - § 22803 An out-of-state employee shall be eligible for enrollment, in accordance with reasonable rules as the board may prescribe, to receive the benefits provided by…
  - § 22805 An employee receiving full-time service credit pursuant to Section 20900 may continue enrollment in a health benefit plan.
  - § 22806 (a) With respect to state officers and employees, a permanent intermittent employee who has an appointment of more than six months and works at least half-time…
  - § 22807 (a) Notwithstanding subdivision (b) of Section 22772, a contracting agency may, by resolution filed with the board, deem all permanent or regular employees,…
  - § 22807.5 Notwithstanding subdivision (b) of Section 22772, a contracting agency that is a community college district may, by resolution filed with the board, deem all…
  - § 22808 An employee enrolled in a health benefit plan under this part shall be entitled to have his or her coverage and the coverage of any family members continued…
  - § 22809 An employee of a contracting agency and his or her family members may continue enrollment in a health benefit plan under this part if the employee is granted a…
  - § 22810 A Member of the Legislature may enroll in a health benefit plan. The contributions of the member shall be the total cost of his or her coverage and the…
  - § 22811 Notwithstanding any other provision of this part, a former Member of the Legislature who has served six or more years as a Member of the Legislature may elect,…
  - § 22812 (a) A former legislative employee who separates from employment while enrolled in a health benefit plan provided by his or her employer, by reason of layoff,…
  - § 22814 (a) A judge who retires pursuant to Chapter 11 (commencing with Section 75000) of Title 8, but is not yet receiving a pension, may continue their coverage and…
  - § 22815 (a) The following persons are eligible for enrollment as provided in this section: (1) A Member of the Legislature or an elective officer of the state whose…
  - § 22816 (a) A person who meets all of the criteria of an annuitant, as defined in subdivision (f) or (g) of Section 22760, other than the condition of receiving a…
  - § 22817 (a) An annuitant, as defined in subdivision (f) or (g) of Section 22760, may, upon assuming payment of the employee contribution, enroll in a health benefit…
  - § 22818 (a) In order to receive any benefit provided by this part, an employee or annuitant shall provide, upon request of the board, any of the following: (1) Proof…
  - § 22819 (a) A family member of a deceased employee of a contracting agency who is validly enrolled or is eligible for enrollment hereunder on the date of the…
  - § 22819.1 (a) A family member of a deceased annuitant who retired from a contracting agency prior to the effective date of the agency’s contract to provide health…
  - § 22820 (a) Upon the death, on or after January 1, 2002, of a firefighter employed by a county, city, city and county, district, or other political subdivision of the…
  - § 22822 No person is eligible for enrollment in a health benefit plan pursuant to this part as a family member if he or she becomes a family member of a surviving…
  - § 22823 (a) Notwithstanding Section 10270.5 of the Insurance Code, an employee who is enrolled in a board-approved health benefit plan sponsored by an employee…
  - § 22825 (a) An annuitant is not eligible to participate in a health benefit plan offered by the California Association of Highway Patrolmen unless the annuitant was…
  - § 22826 For purposes of this part, service credit shall be determined according to the rules of the retirement system provided by the employer in which the employee…
5. ARTICLE 5. Enrollment and Coverage §§ 22830–22849 · 17 sections
  - § 22830 (a) An employee or annuitant, under eligibility rules as prescribed by board regulations, may enroll in a health benefit plan approved or maintained by the…
  - § 22831 (a) An annuitant may, as provided by regulations of the board, continue his or her enrollment, enroll within 60 days of retirement, enroll within 60 days of…
  - § 22832 A permanent intermittent employee and an employee who works less than full time may continue his or her enrollment while retired from state employment if he or…
  - § 22834 (a) An out-of-state employee who separates from service and becomes an annuitant may continue his or her enrollment in a board-approved out-of-state health…
  - § 22836 An employee enrolled in a health benefit plan who is removed or suspended without pay and later reinstated or restored to duty on the ground that the removal…
  - § 22837 In the case of the death of an employee after an application has been filed for the enrollment of family members, but prior to the effective date of coverage,…
  - § 22838 (a) An annuitant who reinstates from retirement pursuant to Article 7 (commencing with Section 21190) of Chapter 12 of Part 3 may, upon his or her subsequent…
  - § 22839 Thirty days prior to, or 60 days following, retirement and during the open enrollment period, a state employee enrolled in a flexible benefit plan administered…
  - § 22840 (a) Notwithstanding any other provision of law, a state employee participating in a flexible benefits program administered by the state, who either terminated…
  - § 22841 (a) A transfer of enrollment from one health benefit plan to another may be made by an employee or annuitant at times and under conditions as may be prescribed…
  - § 22842 A change in coverage based on a change in the family status of an employee, annuitant, or family member enrolled in a health benefit plan may be requested by…
  - § 22843 If an employee or annuitant has a spouse or a domestic partner who is an employee or annuitant, each spouse or domestic partner may enroll as an individual. No…
  - § 22844 (a) Employees, annuitants, and family members who become eligible to enroll on or after January 1, 1985, in Part A and Part B of Medicare shall not be enrolled…
  - § 22846 (a) The regulations of the board shall provide for the beginning and ending dates of coverage of employees, annuitants, and family members enrolled in a health…
  - § 22847 (a) Subject to subdivisions (b) and (c), if the eligible family members of a deceased peace officer or firefighter of a contracting agency, as described in…
  - § 22848 An employee or annuitant who is dissatisfied with any action or failure to act in connection with his or her coverage or the coverage of his or her family…
  - § 22849 (a) Notwithstanding Section 22846, the Legislature shall, upon the death of a legislative employee while in service, continue to pay employer contributions for…
6. ARTICLE 6. Health Benefit Plans and Contracts §§ 22850–22869 · 20 sections
  - § 22850 (a) The board may, without compliance with any provision of law relating to competitive bidding, enter into contracts with carriers offering health benefit…
  - § 22850.5 (a) In performing the duties prescribed by Section 22850, the board shall negotiate with carriers providing health benefit plans to add a core health plan…
  - § 22851 The board may enter into any joint purchasing arrangement with private or public entities, if the arrangement does all of the following: (a) Benefits persons…
  - § 22852 (a) A contract for a health benefit plan shall be for a uniform term of at least one year and may be made automatically renewable in the absence of notice of…
  - § 22853 (a) Each contract shall contain a detailed statement of benefits offered and shall include maximums, limitations, exclusions, and other definitions of benefits…
  - § 22853.1 (a) A health benefit plan or contract shall provide coverage for a vaccine for acquired immune deficiency syndrome (AIDS) that is approved for marketing by the…
  - § 22853.3 Commencing January 1, 2024, a health benefit plan or contract shall provide coverage for contraceptives and related services consistent with the requirements…
  - § 22853.4 Commencing January 1, 2024, a health benefit plan or contract shall provide coverage for vasectomies and related services consistent with the requirements…
  - § 22854 (a) The board, in considering a contract with any entity that seeks to enter into a contract under this article for the provision of health care benefits or…
  - § 22854.5 (a) A health benefit plan or contractor, or an entity offering services relating to the administration of health benefit plans to members and annuitants, shall…
  - § 22855 The board shall withdraw its approval of a health benefit plan if it finds that the plan or carrier is not in compliance with the standards prescribed…
  - § 22857 (a) Notwithstanding any other provision of law, the board may contract with carriers licensed and doing business in other states to provide health benefits for…
  - § 22859 (a) A health benefit plan or contract may not provide any of the following: (1) An exception for other coverage where the other coverage is entitlement to…
  - § 22860 It is the policy of the Legislature that benefits provided by a health benefit plan be integrated with the benefits provided by federal or state plans for…
  - § 22863 (a) The board shall make available to employees and annuitants eligible to enroll in a health benefit plan information that will enable the employees or…
  - § 22864 (a) Premiums charged for enrollment in a health benefit plan shall reasonably reflect the cost of the benefits provided. (b) This part does not limit the…
  - § 22865 Not later than 30 days prior to the approval of benefits and premium readjustments authorized under Section 22864, the board shall provide an initial estimate…
  - § 22866 (a) The board shall report to the Legislature and the Director of Finance on or before November 1, 2016, and annually thereafter, regarding the health benefits…
  - § 22867 The provisions of this article do not supersede, modify, or in any manner alter or impair the effect of any provision of Chapter 5 (commencing with Section…
  - § 22869 Information disseminated by the board pursuant to Section 22863, and compliance with regulations of the board adopted pursuant to subdivision (a) of Section…
7. ARTICLE 7. State Contributions §§ 22870–22889 · 32 sections
  - § 22870 (a) The state and each employee or annuitant shall contribute a portion of the cost of providing the benefit coverage afforded under the approved health…
  - § 22871 (a) The employer contribution, with respect to each employee or annuitant who is in the employment of or retired from service with the state, including an…
  - § 22871.3 (a) The employer contribution for each annuitant enrolled in a basic plan shall be an amount equal to 80 percent of the weighted average of the health benefit…
  - § 22871.5 (a) Notwithstanding Section 22871, the employer contribution with respect to each excluded employee, as defined by subdivision (b) of Section 3527, who is…
  - § 22871.6 (a) Notwithstanding Section 22871, subdivision (b) of Section 22871.5, or any other provision of this article, the employer contribution with respect to…
  - § 22871.7 (a) Notwithstanding Section 22871, subdivision (b) of Section 22871.5, or any other provision of this article, the employer contribution with respect to…
  - § 22871.8 (a) Notwithstanding Section 22871, subdivision (b) of Section 22871.5, or any other provision of this article, the employer contribution with respect to…
  - § 22871.9 (a) Notwithstanding Section 22871, subdivision (b) of Section 22871.5, or any other provision of this article, the employer contribution with respect to…
  - § 22871.10 (a) Notwithstanding Section 22871.9, or any other provision of this article, the employer contribution with respect to employees in State Bargaining Units 1,…
  - § 22872 If an out-of-state employee is enrolled in a health benefit plan, policy, contract, service agreement, or arrangement described in Section 22857 and elects to…
  - § 22873 (a) Notwithstanding Section 22871, a state employee first hired on or after January 1, 1985, may not be vested for the full employer contribution payable for…
  - § 22874 (a) Notwithstanding Sections 22870, 22871, and 22873, a state employee, defined by subdivision (c) of Section 3513, who becomes a state member of the system…
  - § 22874.1 (a) Notwithstanding Sections 22870, 22871, 22873, and 22874, a state employee, defined by subdivision (c) of Section 3513, who is employed by the state for the…
  - § 22874.2 (a) Notwithstanding Sections 22870, 22871, 22873, and 22874, a state employee, as defined by subdivision (c) of Section 3513, who is first employed by the…
  - § 22874.3 (a) Notwithstanding Sections 22870, 22871, 22873, and 22874, a state employee, defined by subdivision (c) of Section 3513, who is first employed by the state…
  - § 22874.4 (a) Notwithstanding Sections 22870, 22871, and 22873, a judicial branch employee who is first employed by the state and becomes a state member of the system on…
  - § 22874.5 (a) Notwithstanding Sections 22870, 22871, 22873, and 22874, a state employee, defined by subdivision (c) of Section 3513, who is first employed by the state…
  - § 22874.6 (a) Notwithstanding Section 22870, the following employees of the California State University shall not receive any portion of the employer contribution…
  - § 22874.7 (a) Notwithstanding Section 22870, an employee who is first employed by the California State University and becomes a member of the system on or after July 1,…
  - § 22874.8 (a) Notwithstanding Section 22870, an employee who is first employed by the California State University and becomes a member of the system on or after July 1,…
  - § 22874.9 (a) Notwithstanding Sections 22870, 22871, 22873, and 22874, a state employee, defined by subdivision (c) of Section 3513, who is first employed by the state…
  - § 22875 (a) Notwithstanding Sections 22870, 22871, 22873, and 22874, a state employee who becomes a state member of the system after January 1, 1990, and is either…
  - § 22875.5 (a) If the state has assumed from a public agency a function and the related personnel, service rendered by that personnel for compensation as employees or…
  - § 22876 (a) For the purpose of meeting the vesting requirements of Section 22873, employees of the County of Merced who became employees of the state as a result of…
  - § 22877 (a) As used in this section, the following definitions shall apply: (1) “Coinsurance” means the provision of a health benefit plan design that requires the… see note
  - § 22878 A health benefit plan offered by the California Association of Highway Patrolmen may rebate funds to participants enrolled in the basic and Medicare health…
  - § 22879 (a) The board shall pay monthly to an employee or annuitant who is enrolled in, or whose family member is enrolled in, a Medicare health benefit plan under…
  - § 22880 The contributions of each employee and annuitant shall be withheld from the monthly salary or retirement allowance payable to him or her. The employer…
  - § 22881 From the General Fund in the State Treasury, there is hereby appropriated monthly the employer contribution required of the state under Sections 22820, 22834,…
  - § 22883 (a) Each fund in the State Treasury, other than the General Fund and the Central Service Cost Recovery Fund, shall be charged a fair share of the employer…
  - § 22885 (a) The state shall, in addition to the contributions required by Section 22870, contribute additional amounts necessary to provide funds for the…
  - § 22889 Any person or entity subject to the requirements of this chapter shall comply with the standards set forth in Chapter 7 (commencing with Section 3750) of Part…
8. ARTICLE 8. Contracting Agency Contributions §§ 22890–22905 · 15 sections
  - § 22890 (a) The contracting agency and each employee or annuitant shall contribute a portion of the cost of providing the benefit coverage afforded under the health…
  - § 22892 (a) The employer contribution of a contracting agency shall begin on the effective date of enrollment and shall be the amount fixed from time to time by…
  - § 22893 (a) Notwithstanding Section 22892, the percentage of employer contribution payable for postretirement health benefits for an employee of a contracting agency…
  - § 22893.1 (a) Notwithstanding any other provision of this part, the percentage of employer contribution payable for postretirement health benefits for an employee of the…
  - § 22894 (a) Notwithstanding any other provision of this part, the City of San Diego, the employees’ exclusive representative, and unrepresented employees may agree…
  - § 22895 (a) Notwithstanding any other provision of this part, a school employer, the employees’ exclusive representative, and unrepresented employees may agree that…
  - § 22896 (a) Notwithstanding Section 22892, the percentage of employer contribution payable for postretirement health benefits for an employee of the Sacramento…
  - § 22897 (a) Notwithstanding any other provision of this part, a contracting agency and the employees’ exclusive representative may agree that the employer contribution…
  - § 22898 (a) Notwithstanding any other provision of this part, the percentage of employer contribution payable for postretirement health benefits for an employee of the…
  - § 22899 (a) The contributions required of a contracting agency, along with contributions withheld from salaries of its employees, shall be forwarded monthly, no later…
  - § 22900 (a) Notwithstanding any other provision of this part, the County of Mariposa and the employees’ exclusive representative may agree that the employer…
  - § 22901 Each contracting agency shall contribute to the Public Employees’ Contingency Reserve Fund, an amount sufficient to bear all of the administrative costs…
  - § 22902 (a) For the purposes of this section, the term “district” shall mean the San Francisco Bay Area Rapid Transit District. (b) Notwithstanding any other provision…
  - § 22904 (a) Notwithstanding any other provision of this part, the City of San Gabriel, the employees’ exclusive representative, and unrepresented employees may agree…
  - § 22905 Any person or entity subject to the requirements of this chapter shall comply with the standards set forth in Chapter 7 (commencing with Section 3750) of Part…
9. ARTICLE 9. Maintenance of Funds §§ 22910–22915 · 5 sections
  - § 22910 (a) There shall be maintained in the State Treasury the Public Employees’ Contingency Reserve Fund. The board may invest funds in the Public Employees’…
  - § 22910.5 (a) For purposes of this section, the following definitions shall apply: (1) “Local annuitant” means an annuitant other than a state annuitant. (2) “Local…
  - § 22911 (a) There shall be maintained in the State Treasury the Public Employees’ Health Care Fund to fund the health benefit plans administered or approved by the…
  - § 22913 (a) The Controller shall suitably identify and remit the state’s monthly contribution, as required by Section 22870, and the monthly amounts authorized to be…
  - § 22915 There is in the State Treasury the State Annuitants’ Vision Care Benefits Fund that is, upon appropriation by the Legislature, available to the board for…
10. ARTICLE 10. Contracting with Public Agencies §§ 22920–22939 · 11 sections
  - § 22920 The following entities are eligible to obtain a health benefit plan, as defined in Section 22777, subject to board approval: (a) A contracting agency, as…
  - § 22922 (a) A contracting agency and its employees and annuitants may obtain a health benefit plan, as defined in Section 22777, subject to board approval of a…
  - § 22927 Notwithstanding any other provision of this part, a contracting agency that is a city and county shall be subject to this part only with respect to employees…
  - § 22928 When a hospital becomes a contracting agency pursuant to subdivision (p) of Section 20057, its employees shall be deemed city employees for purposes of this…
  - § 22930 If the board administers a specialized health benefit plan, it may offer coverage in the specialized health benefit plan to a contracting agency that also…
  - § 22931 Annuitants that receive benefits under this part and are former certificated employees that retired from a school employer, including the spouses and surviving…
  - § 22932 A contracting agency shall perform the functions necessary to enroll its employees and submit reports as may be required by the board. A county superintendent…
  - § 22934 (a) A contracting agency that has elected to be subject to this part may not maintain any other health benefit plan or program offering hospital and medical…
  - § 22937 A contracting agency may elect, by amending its contract with the board, to participate in a Medicare reimbursement program for its employees, annuitants, or…
  - § 22938 A contracting agency that has elected to be subject to this part may elect to cease to be so subject by resolution adopted by a majority vote of its governing…
  - § 22939 The board may terminate the participation of a contracting agency if it fails for three months after a demand to perform any act required by this part or by…
11. ARTICLE 11. Prefunding Plan for Health Care Coverage for Annuitants §§ 22940–22944.6 · 8 sections
  - § 22940 (a) There is in the State Treasury the Annuitants’ Health Care Coverage Fund that is a trust fund and a retirement fund, within the meaning of Section 17 of…
  - § 22942 For purposes of this article, the following definitions shall apply: (a) “Annuitant” means any of the following: (1) An annuitant described in Section 22760.…
  - § 22943 An employer authorized by the board may elect to participate in the prefunding plan established by this article.
  - § 22944 The board may, in its discretion and upon terms and conditions set by the board, authorize an employer to participate in the prefunding plan established by…
  - § 22944.2 (a) A contract entered into between an employer and the board pursuant to Section 22944 shall not create, change, or vest the obligations of an employer or the…
  - § 22944.3 (a) Any amount that would otherwise be used to permanently increase compensation pursuant to Section 19827, effective on July 1, 2009, and on July 1, 2010,…
  - § 22944.5 (a) (1) The state and employees in State Bargaining Unit 2, 7, 8, 9, 10, 13, 18, or 19 shall prefund retiree health care, with the goal of reaching a…
  - § 22944.6 (a) (1) In addition to the appropriation required for state contributions to prefund retiree health care and other postemployment benefits pursuant to Section…
CHAPTER 2. Recovery of Medical Costs §§ 22945–22948 · 4 sections
- § 22945 (a) The purpose of this chapter is to establish the rights of the California Association of Highway Patrolmen Health Benefits Trust, the Peace Officers…
- § 22946 As used in this chapter: (a) “Health benefits trust” means the California Association of Highway Patrolmen Health Benefits Trust, the Peace Officers Research…
- § 22947 (a) A health benefits trust may assert a lien for health benefits paid on behalf of a participant against any settlement with, or arbitration award or judgment…
- § 22948 (a) A court or arbitrator having jurisdiction over a claim by a participant against a third party shall additionally have jurisdiction over apportionment of…