CHAPTER 9. The Private Health Care Voluntary Purchasing Alliance Act [10800. - 10887.]
Chapter 9 added by Stats. 1996, Ch. 916, Sec. 1.
§§ 10800–10887 · 36 sections
ARTICLE 1. General §§ 10800–10803 · 4 sections
- § 10800 This chapter shall be known as the Private Health Care Voluntary Purchasing Alliance Act.
- § 10801 The purpose of this chapter is to improve the competition in the pricing and delivering of health care coverage for employers and small employers. It does so…
- § 10802 This chapter is also intended to provide a meaningful choice of high quality, fairly priced health care providers, and health care coverage for participating…
- § 10803 It is envisioned that a purchasing alliance will contract with qualified group carriers to provide a meaningful choice of carriers providing health benefit…
ARTICLE 2. Definitions § 10810 · 1 section
- § 10810 As used in this chapter: (a) “Ancillary benefit plan” means a policy or contract written or administered by a participating carrier that covers dental or…
ARTICLE 3. Regulation §§ 10820–10826 · 8 sections
- § 10820 (a) The commissioner shall regulate the establishment and conduct of purchasing alliances as set forth in this chapter. (b) No person or entity may market,…
- § 10821 (a) An entity seeking to obtain a certificate of registration to act as a purchasing alliance shall complete and file with the commissioner an application…
- § 10821.5 (a) The purchasing alliance shall furnish an annual financial audit to the commissioner on the forms provided by the commissioner. The annual financial audit…
- § 10822 After the issuance or reissuance of a certificate of registration to act as a purchasing alliance, the holder shall continue to comply with the requirements as…
- § 10823 In addition to any other grounds specified in this chapter, the following constitute grounds for denial, nonrenewal, suspension, or revocation of an…
- § 10824 (a) The commissioner may take disciplinary action against a purchasing alliance if the commissioner determines that the purchasing alliance has committed any…
- § 10825 (a) A purchasing alliance whose certificate has been revoked or suspended for more than one year may petition the commissioner to reinstate the certificate as…
- § 10826 (a) Any person who violates any provision of this chapter, or who violates any rule or order adopted or issued pursuant to this chapter, shall be liable for a…
ARTICLE 4. Conflicts of Interest § 10830 · 1 section
- § 10830 No owner, officer, partner, or board members or members of their household nor any management personnel of the alliance may be employed by, be a consultant…
ARTICLE 5. Additional Powers of and Restrictions on Purchasing Alliances §§ 10840–10845 · 6 sections
- § 10840 A purchasing alliance shall do all of the following: (a) Set reasonable fees, which may vary by employer or small employer size, in the purchasing alliance…
- § 10841 (a) A purchasing alliance shall comply with all requirements pertaining to the underwriting, rating and renewal practices for small employers, pursuant to…
- § 10842 A purchasing alliance may do any of the following: (a) Contract with qualified independent third parties for any services necessary to carry out the powers and…
- § 10843 A purchasing alliance shall not do any of the following: (a) Purchase health care services, assume risk for the cost or provision of health services, or…
- § 10844 A purchasing alliance may offer coverage pursuant to Chapter 9.5 (commencing with Section 10900).
- § 10845 (a) The commissioner shall require every purchasing alliance, as a condition precedent to receiving and holding a certificate of registration, to file and…
ARTICLE 6. Participating Carriers §§ 10850–10856 · 6 sections
- § 10850 (a) In order to be eligible to be a participating carrier, a carrier shall demonstrate the following operating characteristics satisfactory to the board: (1)…
- § 10851 Every participating carrier shall: (a) Meet the standards established by the board pursuant to this chapter. (b) Provide any data required by the board. (c)…
- § 10853 In contracts with participating carriers, the purchasing alliance may establish performance standards for specific contractual elements and penalties for…
- § 10854 Nothing in this chapter shall prohibit a participating carrier from contracting with particular health care providers or types, classes, or categories of…
- § 10855 In the event the participating carrier elects to terminate its participating agreement with a purchasing alliance, the participating carrier shall do both of…
- § 10856 Nothing in this article shall be construed to limit the existing regulatory authority of the Department of Managed Health Care to regulate health care service…
ARTICLE 7. Contracts with Employers, Small Employers, and Participating Carriers §§ 10860–10861 · 2 sections
- § 10860 Contracts between the purchasing alliance and participating carriers shall specify how all premiums will be transmitted, and penalties and grace periods for…
- § 10861 Contracts between purchasing alliances and participating employers shall provide all of the following: (a) For administrative purposes, the purchasing alliance…
ARTICLE 8. Marketing §§ 10870–10873 · 4 sections
- § 10870 The board shall establish marketing standards to be used by participating carriers.
- § 10871 Any marketing, advertisement, or educational material for health benefit plans or ancillary benefit plans sold through the purchasing alliance shall be…
- § 10872 This article shall not be construed to prohibit or to compel the purchasing alliance or a participating carrier from using the services of an agent or broker.
- § 10873 (a) A participating carrier, agent, broker, contractor, or producer of a participating carrier, or independent insurance agent, broker, contractor, or producer…
ARTICLE 9. Solvency § 10880 · 1 section
- § 10880 In the event a purchasing alliance becomes insolvent, the commissioner shall maintain jurisdiction of the alliance for purposes of protection of the interests…
ARTICLE 10. Exemptions §§ 10885–10887 · 3 sections
- § 10885 Purchasing alliances shall be exempt from requirements of licensure as a health care service plan or solicitor under Chapter 2.2 (commencing with Section 1340)…
- § 10886 For purposes of carrier product disclosure, a purchasing alliance shall be considered an entity that provides administrative services, as is described in…
- § 10887 Except as provided in subdivision (c) of Section 10820, nothing in this chapter shall apply to a health care service plan licensed under the Knox-Keene Health…