(a) A health care service plan providing or arranging for the provision of basic health care services to small employers shall be subject to this article if either of the following conditions are met:

(1) Any portion of the premium is paid by a small employer, or any covered individual is reimbursed, whether through wage adjustments or otherwise, by a small employer for any portion of the premium.

Terms Used In California Health and Safety Code 1357.602

  • Basic health care services: includes ambulance and ambulance transport services provided through the "911" emergency response system. See California Health and Safety Code 1345
  • Contract: A legal written agreement that becomes binding when signed.
  • department: means State Department of Health Services. See California Health and Safety Code 20
  • plan: refers to health care service plans and specialized health care service plans. See California Health and Safety Code 1345
  • Small employer: means any of the following:

    California Health and Safety Code 1357.600

  • specialized health care service plan: means either of the following:

    California Health and Safety Code 1345

  • State: means the State of California, unless applied to the different parts of the United States. See California Health and Safety Code 23

(2) The plan contract is treated by the small employer or any of the covered individuals as part of a plan or program for the purposes of Section 106 or 162 of the Internal Revenue Code.

(b) This article shall not apply to health care service plan contracts for coverage of Medicare services pursuant to contracts with the United States government, Medicare supplement, Medi-Cal contracts with the State Department of Health Care Services, long-term care coverage, or specialized health care service plan contracts.

(Added by Stats. 2012, Ch. 852, Sec. 6. (AB 1083) Effective January 1, 2013.)

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