CHAPTER 4. California Major Risk Medical Insurance Program [15870. - 15895.]

Chapter 4 added by Stats. 2014, Ch. 31, Sec. 90.

§§ 15870–15895 · 30 sections

1. ARTICLE 1. General §§ 15870–15872.5 · 3 sections

   • § 15870 For the purposes of this chapter, the following terms have the following meanings: (a) “Applicant” means an individual who applies for major risk medical…
   • § 15872 The California Major Risk Medical Insurance Program is hereby established within, and shall be administered by, the department.
   • § 15872.5 This chapter shall become operative on July 1, 2014.
2. ARTICLE 2. Powers and Duties §§ 15873–15877 · 3 sections

   • § 15873 The department shall have the authority: (a) To establish eligibility criteria, notwithstanding Section 15884, and determine the eligibility of applicants. (b)…
   • § 15876 Plan rates for major risk medical benefits approved for the program shall not be excessive, inadequate, or unfairly discriminatory, but shall be adequate to…
   • § 15877 (a) The department shall direct the participating health plans to inform all program subscribers of the December 31, 2024, transition of coverage as follows:…
3. ARTICLE 3. Policies Issued by the Department §§ 15878–15880 · 3 sections

   • § 15878 The department may place a lien on compensation or benefits recovered or recoverable by a subscriber from any party or parties responsible for the compensation…
   • § 15879 Except as provided in Article 3.5 (commencing with Section 14124.70) of Chapter 7 of Part 3, benefits received under this article or Article 4 (commencing with…
   • § 15880 Benefits under this article or Article 4 (commencing with Section 15881) shall be subject to required subscriber copayments and deductibles as the department…
4. ARTICLE 4. Participating Health Plans §§ 15881–15883 · 3 sections

   • § 15881 The department shall provide coverage through participating health plans and may contract for the processing of applications, the enrollment of subscribers,…
   • § 15882 The department may provide or purchase stop-loss coverage under which the program and participating health plans share the risk for health plan expenses which…
   • § 15883 The department shall withdraw its approval of any participating health benefits plan for noncompliance with program standards, nonpayment of claims, or other…
5. ARTICLE 5. Subscriber Eligibility and Enrollment §§ 15884–15888.5 · 10 sections

   • § 15884 (a) Each resident of the state meeting the eligibility criteria of this section and who is unable to secure adequate private health coverage is eligible to…
   • § 15884.5 (a) It shall constitute unfair competition for purposes of Chapter 5 (commencing with Section 17200) of Part 2 of Division 7 of the Business and Professions…
   • § 15885 The department may permit the exclusion of coverage or benefits for charges or expenses incurred by a subscriber during the first six months of enrollment in…
   • § 15885.5 If more than one participating health plan is offered, the department shall make available to applicants eligible to enroll in the program sufficient…
   • § 15886 After the applicant notifies the department in writing of his or her choice of participating health plan, the department shall assist the applicant in…
   • § 15886.5 A subscriber may request a change in coverage based upon a change in the family status of any dependent, by filing an application within 30 days after the…
   • § 15887 Health coverage secured through the program shall permit a covered dependent of a subscriber to elect to continue the same coverage upon the death of the…
   • § 15887.5 A transfer of enrollment from one participating health plan to another may be made by a subscriber at times and under conditions as may be prescribed by the…
   • § 15888 If a subscriber is dissatisfied with any action or failure to act which has occurred in connection with a participating plan’s coverage, the subscriber shall…
   • § 15888.5 Subscribers and their dependents who become eligible for Medicare Part A and Part B, excluding those on Medicare solely because of end-stage renal disease,…
6. ARTICLE 6. Plan Rates and Compensation from the Fund §§ 15890–15891.5 · 4 sections

   • § 15890 Upon enrollment as a subscriber in the program, the subscriber shall be responsible for payment of the subscriber contribution. Termination of coverage by a…
   • § 15890.5 Each health plan contracting with the department pursuant to Article 4 (commencing with Section 15881) shall submit annually to the department rates which it…
   • § 15891 (a) The department shall establish program contribution amounts for each category of risk for each participating health plan. The program contribution amounts…
   • § 15891.5 A participating health plan may charge subscriber contributions under this article that do not exceed the difference between its plan rate for the category of…
7. ARTICLE 7. Major Risk Medical Insurance Fund §§ 15893–15895 · 4 sections

   • § 15893 (a) There is hereby continued in existence in the State Treasury a special fund known as the Major Risk Medical Insurance Fund that is, notwithstanding Section…
   • § 15894 (a) Except as provided in Section 15894.5, the department shall authorize the expenditure of money in the fund to cover program expenses, including program…
   • § 15894.5 (a) From money appropriated by the Legislature to the fund, the department may expend sufficient funds to carry out the purposes of this chapter and of Section…
   • § 15895 Any moneys remaining in the fund at the end of any fiscal year may be carried forward to the next succeeding fiscal year.