CHAPTER 8. Small Employer Health Insurance [10700. - 10752.8.]

Heading of Chapter 8 renumbered from Chapter 14 (as added by Stats. 1992, Ch. 1128) by Stats. 1993, Ch. 113, Sec. 6.

§§ 10700–10752.8 · 73 sections

1. ARTICLE 1. Definitions §§ 10700–10701 · 2 sections

   • § 10700 As used in this chapter: (a) “Agent or broker” means a person or entity licensed under Chapter 5 (commencing with Section 1621) of Part 2 of Division 1. (b)…
   • § 10701 (a) For purposes of this chapter, “health benefit plan” does not include policies or certificates of specified disease or hospital confinement indemnity…
2. ARTICLE 2. Small Employer Carrier Requirements §§ 10702–10718.7 · 22 sections

   • § 10702 All carriers writing, issuing, or administering health benefit plans that cover employees of small employers shall be subject to this chapter if any one of the…
   • § 10702.1 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…
   • § 10703 The commissioner shall have the authority to determine whether a health benefit plan is covered by this chapter, and to determine whether an employer is a…
   • § 10704 The commissioner may issue regulations that are necessary to carry out the purposes of this chapter. Prior to the public comment period required on the…
   • § 10705 Upon the effective date of this act: (a) No group or individual policy or contract or certificate of group insurance or statement of group coverage providing…
   • § 10705.1 (a) Between July 26, 1993, and October 24, 1993, as well as 60 days prior to the expiration of an existing contract that expires prior to July 1, 1994, or, for…
   • § 10706 Every carrier shall file with the commissioner the reasonable participation requirements and employer contribution requirements that are to be included in its…
   • § 10706.5 (a) After a small employer submits a completed application, the carrier shall, within 30 days notify the employer of the employer’s actual rates in accordance…
   • § 10707 Except in the case of a late enrollee, or for satisfaction of a preexisting condition clause in the case of initial coverage of an eligible employee, a carrier…
   • § 10708 (a) (1) Preexisting condition provisions of health benefit plans shall not exclude coverage for a period beyond six months following the individual’s effective…
   • § 10709 (a) No health benefit plan may exclude late enrollees from coverage for more than 12 months from the date of the late enrollee’s application for coverage. No…
   • § 10711 No carrier shall be required by the provisions of this chapter: (a) To offer coverage to, or accept applications from, a small employer as defined in paragraph…
   • § 10712 (a) A carrier shall not be required to offer coverage or accept applications for benefit plan designs pursuant to this chapter where the commissioner…
   • § 10713 All health benefit plans written, issued, or administered by carriers on or after the effective date of this chapter, and all health benefit plans in force on…
   • § 10714 Premiums for benefit plan designs written, issued, or administered by carriers on or after the effective date of this act, shall be subject to the following…
   • § 10715 Carriers shall apply standard employee risk rates consistently with respect to all small employers.
   • § 10716 In connection with the offering for sale of any benefit plan design to small employers: Each carrier shall make a reasonable disclosure, as part of its…
   • § 10717 (a) No carrier shall provide or renew coverage subject to this chapter until it has done all of the following: (1) A statement has been filed with the…
   • § 10718 (a) In addition to any other remedy permitted by law, the commissioner shall have the administrative authority to assess penalties against carriers, insurance…
   • § 10718.5 (a) (1) In addition to any other remedy permitted by law, whenever the commissioner shall have reason to believe that any carrier, production agent, or other…
   • § 10718.55 (a) Carriers may enter into contractual agreements with qualified associations, as defined in subdivision (b), under which these qualified associations may…
   • § 10718.7 Notwithstanding any other provision of law, no provision of this chapter shall be construed to limit the applicability of any other provision of the Insurance…
3. ARTICLE 3. Voluntary Reinsurance Mechanism §§ 10719–10729 · 13 sections

   • § 10719 The California Small Group Reinsurance Fund is hereby authorized to be created solely to allow carriers to share in financing the cost of covering high risk…
   • § 10719.1 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…
   • § 10720 (a) The fund shall be governed by a board of directors, which shall initially be elected by small employer carriers and small employer health care service…
   • § 10720.1 The fund shall have the general powers and authority granted under the laws of California to insurance companies and health care service plans licensed to…
   • § 10721 The fund shall provide for the financing of its reinsurance and operating costs, including actuarially sound reserves for unpaid losses, by charging members a…
   • § 10722 If assessments exceed actual losses and administrative expenses of the fund, the excess shall be held at interest and used by the fund to offset future losses…
   • § 10723 Any unsatisfied net liability or outstanding assessment owed by an insolvent member participating in the fund shall be assumed by and apportioned among the…
   • § 10724 Carriers choosing to participate shall comply with all requirements for participation established by the fund.
   • § 10725 The fund’s board of directors shall establish the rules, conditions, and procedures pertaining to the reinsurance of members’ risks by the fund.
   • § 10726 Nothing in this article relieves members of participating in the fund from complying with the underwriting and rating provisions included in Article 1…
   • § 10727 The fund shall be exempt from any and all taxes.
   • § 10728 For purposes of agreements entered into pursuant to this article, the fund, and its officers, directors, agents, and employees shall have no liability for any…
   • § 10729 The fund shall establish rules, conditions, and procedures relating to the indemnification of any person or member of the fund made a party to any claim,…
4. ARTICLE 4. Purchasing Pool for Small Employers §§ 10730–10750 · 25 sections

   • § 10730 (a) The Voluntary Alliance Uniting Employers Purchasing Program is hereby created and shall be administered by the Major Risk Medical Insurance Board. (b) No…
   • § 10731 The board may do any of the following: (a) Enter into contracts with carriers to provide health benefits coverage to eligible employees and their dependents.…
   • § 10731.2 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…
   • § 10732 The board shall establish geographic areas within which participating carriers may offer health coverage to eligible employees and dependents.
   • § 10733 On or after the effective date of this chapter, the board shall enter into contracts with carriers for the purpose of providing health benefits coverage to…
   • § 10733.5 Notwithstanding any other provision of law, an employer purchasing coverage through the program shall not be determined to be no longer eligible to participate…
   • § 10734 (a) Notwithstanding any other provision of law, the board shall not be subject to licensure or regulation by the Department of Insurance or the Department of…
   • § 10735 The board shall contract with a broad range of carriers in an area, if available, to ensure that enrollees have a choice from among a reasonable number and…
   • § 10737 The board shall use appropriate and efficient means to notify small employers of the availability of sponsored health coverage from the program.
   • § 10738 The board shall make available to small employers marketing materials that accurately summarize the benefits plans and rates that are offered by the carrier…
   • § 10739 Unless authorized by the board, no participating carrier shall, in an area served by the program, directly, or through an employee, agent, or contractor,…
   • § 10740 Participating carriers may contract with agents or brokers to provide marketing and servicing of health benefits coverage offered through the program. Any…
   • § 10741 The board shall enforce conditions of participation in the program for small employers and enrollees which shall conform with the requirements of this chapter.
   • § 10742 The board shall establish a mechanism to collect premiums from small employers, including remittance of the share of the premium paid by the enrollee.
   • § 10743 The board may prohibit employers or employees who drop coverage after enrolling in the pool from reenrolling in the program for up to 12 months.
   • § 10744 The board shall arrange to pay contractors as specified in program contracts.
   • § 10745 The board shall pay participating carriers their contracted rates.
   • § 10746 Participating carriers shall offer rates to small employers or enrollees in the program that, at a minimum, are consistent with the program regulations and…
   • § 10747 The board may adjust payments made to a carrier if the board finds that the carrier has a significantly disproportionate share of high- or low-risk enrollees.…
   • § 10748 If a small employer, employee, or dependent of a small employer is dissatisfied with any action or failure to act which has occurred in connection with…
   • § 10748.5 No later than three years from the effective date of this article, the board shall issue a request for proposals that solicits nonprofit entities to submit…
   • § 10748.6 The board shall accept and review proposals submitted from nonprofit entities for assumption of administrative and financial responsibility of the program at…
   • § 10748.7 There is in the program a five-member small employer advisory panel to be appointed by the board to provide consultation to the board on program design and…
   • § 10749 There is created a Voluntary Alliance Uniting Employers Fund which shall consist of moneys collected pursuant to this article and any funds loaned by the board…
   • § 10750 This chapter shall not apply to a health benefit plan that is subject to Chapter 8.01 (commencing with Section 10753) or Chapter 8.02 (commencing with Section…
5. ARTICLE 5. Stop-Loss Insurance §§ 10752–10752.8 · 11 sections

   • § 10752 As used in this article, the following definitions shall apply: (a) “Attachment point” means the amount of health claims incurred by a small employer in a…
   • § 10752.1 A stop-loss insurer shall not exclude any employee or dependent on the basis of an actual or expected health status-related factor. Health status-related…
   • § 10752.2 A stop-loss insurer shall renew, at the option of the small employer, all stop-loss insurance policies written, issued, administered, or renewed on or after…
   • § 10752.3 A stop-loss insurance policy issued, reissued, or renewed on or after January 1, 2014, and prior to January 1, 2016, to a small employer shall not contain any…
   • § 10752.4 A stop-loss insurance policy issued, reissued, or renewed on or after January 1, 2016, to a small employer shall not contain any of the following provisions:…
   • § 10752.43 Sections 10752.3 and 10752.4 do not apply to a stop-loss insurance policy provided to a small employer that was in effect prior to September 1, 2013. A…
   • § 10752.46 On April 1, 2014, and on April 1 annually thereafter, a stop-loss insurer shall report to the Department of Insurance the number of small employer stop-loss…
   • § 10752.5 The commissioner may adopt regulations as may be necessary to carry out the purposes of this article. In adopting regulations, the commissioner shall comply…
   • § 10752.6 A stop-loss insurer that violates the provisions of this article is subject to the remedies and administrative penalties applicable to insurers in Sections…
   • § 10752.7 Nothing in this article shall affect the ongoing operations of multiple employer welfare arrangements regulated pursuant to Article 4.7 (commencing with…
   • § 10752.8 The provisions of this article are severable. If any provision of this article or its application is held invalid, that invalidity shall not affect other…