California Health and Safety Code 1399.828 – (a) Upon the effective date of this article, a health care …
(a) Upon the effective date of this article, a health care service plan shall fairly and affirmatively offer, market, and sell all of the plan’s health care service plan contracts that are offered and sold to a child or the responsible party for a child in each service area in which the plan provides or arranges for the provision of health care services during any open enrollment period, to late enrollees, and during any other period in which state or federal law, rules, regulations, or guidance expressly provide that a health care service plan shall not condition offer or acceptance of coverage on any preexisting condition.
(b) No health care service plan or solicitor shall, directly or indirectly, engage in the following activities:
Terms Used In California Health and Safety Code 1399.828
- Child: means any individual under 19 years of age. See California Health and Safety Code 1399.825
- Contract: A legal written agreement that becomes binding when signed.
- Open enrollment period: means the annual open enrollment period, subsequent to the initial open enrollment period, applicable to each individual child that is the month of the child's birth date. See California Health and Safety Code 1399.825
- 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
- Responsible party for a child: means an adult having custody of the child or with responsibility for the financial needs of the child, including the responsibility to provide health care coverage. See California Health and Safety Code 1399.825
- 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
- Solicitor: means any person who engages in the acts defined in subdivision ( l). See 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
(1) Encourage or direct a child or responsible party for a child to refrain from filing an application for coverage with a plan because of the health status, claims experience, industry, occupation, or geographic location, provided that the location is within the plan’s approved service area, of the child.
(2) Encourage or direct a child or responsible party for a child to seek coverage from another plan because of the health status, claims experience, industry, occupation, or geographic location, provided that the location is within the plan’s approved service area, of the child.
(c) A health care service plan shall not, directly or indirectly, enter into any contract, agreement, or arrangement with a solicitor that provides for or results in the compensation paid to a solicitor for the sale of a health care service plan contract to be varied because of the health status, claims experience, industry, occupation, or geographic location of the child. This subdivision does not apply to a compensation arrangement that provides compensation to a solicitor on the basis of percentage of premium, provided that the percentage shall not vary because of the health status, claims experience, industry, occupation, or geographic area of the child.
(Added by Stats. 2010, Ch. 656, Sec. 3. (AB 2244) Effective January 1, 2011. Inoperative, pursuant to Section 1399.836, on January 1, 2014, subject to condition for resuming operation.)