(a) No plan shall be required by the provisions of this article:

(1) To offer coverage under a small employer‘s health care service plan contract to an otherwise eligible employee or dependent, when the eligible employee or dependent does not work or reside within the plan’s approved service area, except as provided in Chapter 7 (commencing with Section 3750) of Part 1 of Division 9 of the Family Code.

Terms Used In California Health and Safety Code 1357.610

  • Contract: A legal written agreement that becomes binding when signed.
  • 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 (n). See California Health and Safety Code 1357.600
  • 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 1357.600

  • 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
  • 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 1357.600

  • 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 1357.600

(2) To offer coverage under a small employer’s health care service plan contract to an eligible employee, as defined in paragraph (2) of subdivision (b) of Section 1357.600, who within 12 months of application for coverage terminated from a small employer health care service plan contract offered by the plan.

(b) Nothing in this article shall be construed to limit the director‘s authority to develop and implement a plan of rehabilitation for a health care service plan whose financial viability or organizational and administrative capacity has become impaired.

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

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