Terms Used In California Codes > Health and Safety Code > Division 2 > Chapter 2.2 > Article 3.16 - Nongrandfathered Small Employer Plans

• Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
• Affiliation period: means a period that, under the terms of the health care service plan contract, must expire before health care services under the contract become effective. See California Health and Safety Code 1357.500
• Awarding department: means any state agency, department, governmental entity, or other officer or entity empowered by law to enter into contracts on behalf of the State of California. See California Public Contract Code 10115.1
• Child: means a child described in §. See California Health and Safety Code 1357.500
• Common law: The legal system that originated in England and is now in use in the United States. It is based on judicial decisions rather than legislative action.
• Construction manager: means a partnership, corporation, or other legal entity that is a licensed contractor pursuant to Chapter 9 (commencing with Section 7000) of Division 3 of . See California Public Contract Code 10112.1
• Contract: A legal written agreement that becomes binding when signed.
• Contract: includes any agreement or joint development agreement to provide labor, services, material, supplies, or equipment in the performance of a contract, franchise, concession, or lease granted, let, or awarded for and on behalf of the State of California. See California Public Contract Code 10115.1
• Contractor: means any person or persons, regardless of race, color, sex, ethnic origin or ancestry, or any firm, partnership, corporation, or combination thereof, whether or not a minority or women business enterprise, who submits a bid and enters into a contract with a representative of a state agency, department, governmental entity, or other officer empowered by law to enter into contracts on behalf of the State of California. See California Public Contract Code 10115.1
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Creditable coverage: means :

  California Health and Safety Code 1357.500

• Department: means the Department of Water Resources. See California Public Contract Code 10112.1
• Dependent: means the spouse or registered domestic partner, or child, of an eligible employee, subject to applicable terms of the health care service plan contract covering the employee, and includes dependents of guaranteed association members if the association elects to include dependents under its health coverage at the same time it determines its membership composition pursuant to subdivision (m). See California Health and Safety Code 1357.500
• Dependent: A person dependent for support upon another.
• Director: means "State Director of Health Services. See California Health and Safety Code 21
• Eligible employee: means either of the following:

  California Health and Safety Code 1357.500

• Enrollee: means a person who is enrolled in a plan and who is a recipient of services from the plan. See California Health and Safety Code 1345
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Evidence of coverage: means any certificate, agreement, contract, brochure, or letter of entitlement issued to a subscriber or enrollee setting forth the coverage to which the subscriber or enrollee is entitled. See California Health and Safety Code 1345
• Exchange: means the California Health Benefit Exchange created by §. See California Health and Safety Code 1357.500
• Family: means the subscriber and his or her dependent or dependents. See California Health and Safety Code 1357.500
• Grandfathered health plan: has the meaning set forth in Section 1251 of PPACA. See California Health and Safety Code 1357.500
• Guaranteed association: means a nonprofit organization comprised of a group of individuals or employers who associate based solely on participation in a specified profession or industry, accepting for membership any individual or employer meeting its membership criteria, and that (1) includes one or more small employers as defined in subparagraph (A) of paragraph (1) of subdivision (k), (2) does not condition membership directly or indirectly on the health or claims history of any person, (3) uses membership dues solely for and in consideration of the membership and membership benefits, except that the amount of the dues shall not depend on whether the member applies for or purchases insurance offered to the association, (4) is organized and maintained in good faith for purposes unrelated to insurance, (5) has been in active existence on January 1, 1992, and for at least five years prior to that date, (6) has included health insurance as a membership benefit for at least five years prior to January 1, 1992, (7) has a constitution and bylaws, or other analogous governing documents that provide for election of the governing board of the association by its members, (8) offers any plan contract that is purchased to all individual members and employer members in this state, (9) includes any member choosing to enroll in the plan contracts offered to the association provided that the member has agreed to make the required premium payments, and (10) covers at least 1,000 persons with the health care service plan with which it contracts. See California Health and Safety Code 1357.500
• Health benefit plan: means a health care service plan contract that provides medical, hospital, and surgical benefits for the covered eligible employees of a small employer and their dependents. See California Health and Safety Code 1357.500
• In force business: means an existing health benefit plan contract issued by the plan to a small employer. See California Health and Safety Code 1357.500
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• licensed: refers to , a license as a plan pursuant to Section 1353. See California Health and Safety Code 1345
• Minority business enterprise: means a business concern that meets all of the following criteria:

  California Public Contract Code 10115.1

• Nongrandfathered small employer health care service plan contract: means a small employer health care service plan contract that is not a grandfathered health plan. See California Health and Safety Code 1357.500
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Person: means any person, individual, firm, association, organization, partnership, business trust, foundation, labor organization, corporation, limited liability company, public agency, or political subdivision of the state. See California Health and Safety Code 1345
• plan: refers to health care service plans and specialized health care service plans. See California Health and Safety Code 1345
• Plan contract: means a contract between a plan and its subscribers or enrollees or a person contracting on their behalf pursuant to which health care services, including basic health care services, are furnished. See California Health and Safety Code 1345
• PPACA: means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder. See California Health and Safety Code 1357.500
• Preexisting condition provision: means a contract provision that excludes coverage for charges or expenses incurred during a specified period following the enrollee's effective date of coverage, as to a condition for which medical advice, diagnosis, care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage. See California Health and Safety Code 1357.500
• project: includes the erection, construction, alteration, repair, or improvement of any state structure, building, road, or other state improvement of any kind that will exceed a total cost calculated pursuant to subdivision (b). See California Public Contract Code 10105
• Project: means public works necessary for the construction, maintenance, or operation of elements of State Water Facilities, as defined in §. See California Public Contract Code 10112.1
• Provider: means any professional person, organization, health facility, or other person or institution licensed by the state to deliver or furnish health care services. See California Health and Safety Code 1345
• Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
• Rating period: means the period for which premium rates established by a plan are in effect and shall be no less than 12 months from the date of issuance or renewal of the plan contract. See California Health and Safety Code 1357.500
• Registered domestic partner: means a person who has established a domestic partnership as described in §. See California Health and Safety Code 1357.500
• Service area: means a geographical area designated by the plan within which a plan shall provide health care services. See California Health and Safety Code 1345
• Small employer: means any of the following:

  California Health and Safety Code 1357.500

• Small employer health care service plan contract: means a health care service plan contract issued to a small employer. See California Health and Safety Code 1357.500
• Solicitation: means any presentation or advertising conducted by, or on behalf of, a plan, where information regarding the plan, or services offered and charges therefor, is disseminated for the purpose of inducing persons to subscribe to, or enroll in, the plan. See California Health and Safety Code 1345
• Solicitor: means any person who engages in the acts defined in subdivision ( l). See California Health and Safety Code 1345
• Solicitor firm: means any person, other than a plan, who through one or more solicitors engages in the acts defined in subdivision ( l). See California Health and Safety Code 1345
• specialized health care service plan: means either of the following:

  California Health and Safety Code 1345

• Spouse: includes "registered domestic partner" as required by §. See California Health and Safety Code 12.2
• State: means the State of California, unless applied to the different parts of the United States. See California Health and Safety Code 23
• Subscriber: means the person who is responsible for payment to a plan or whose employment or other status, except for family dependency, is the basis for eligibility for membership in the plan. See California Health and Safety Code 1345
• User fees: Fees charged to users of goods or services provided by the government. In levying or authorizing these fees, the legislature determines whether the revenue should go into the treasury or should be available to the agency providing the goods or services.
• Waiting period: means a period that is required to pass with respect to an employee before the employee is eligible to be covered for benefits under the terms of the contract. See California Health and Safety Code 1357.500
• Women business enterprise: means a business concern that meets all of the following criteria:

  California Public Contract Code 10115.1