Terms Used In California Codes > Health and Safety Code > Division 26 > Part 4 > Chapter 4 - Enforcement

• Adjourn: A motion to adjourn a legislative chamber or a committee, if passed, ends that day's session.
• Adjournment sine die: The end of a legislative session "without day." These adjournments are used to indicate the final adjournment of an annual or the two-year session of legislature.
• Agency official: as used in this chapter means any official of a state agency whose administrative actions the lobbyist, lobbying firm, lobbyist employer, or person described in subdivision (b) of Section 86115 has attempted or is attempting to influence. See California Government Code 86111
• Agent or broker: means a person or entity licensed under Chapter 5 (commencing with Section 1621) of Part 2 of Division 1. See California Insurance Code 10755
• Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
• Ancillary benefit plan: means a policy or contract written or administered by a participating carrier that covers dental or vision benefits for the covered eligible employees of an employer or small employer and their dependents. See California Insurance Code 10810
• Apparent owner: means the person who appears from the records of the holder to be entitled to property held by the holder. See California Code of Civil Procedure 1501
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Appellate: About appeals; an appellate court has the power to review the judgement of another lower court or tribunal.
• Appropriate Regulatory Authority: means the Department of Insurance except for health care service plans, in which case it means the Department of Managed Health Care. See California Insurance Code 10810
• Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
• Arraignment: A proceeding in which an individual who is accused of committing a crime is brought into court, told of the charges, and asked to plead guilty or not guilty.
• Arrest: Taking physical custody of a person by lawful authority.
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
• Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Benefit plan design: means a specific health coverage product issued by a carrier to employers or small employers, to trustees of associations, or to individuals if the coverage is offered through employment or sponsored by an employer or small employer. See California Insurance Code 10810
• Benefit plan design: means a specific health coverage product issued by a carrier to small employers, to trustees of associations that include small employers, or to individuals if the coverage is offered through employment or sponsored by an employer. See California Insurance Code 10755
• Bequest: Property gifted by will.
• Board: means the governing body of the purchasing alliance. See California Insurance Code 10810
• Business association: means any private corporation, joint stock company, business trust, partnership, or any association for business purposes of two or more individuals, whether or not for profit, including, but not by way of limitation, a banking organization, financial organization, life insurance corporation, and utility. See California Code of Civil Procedure 1501
• Carrier: means any licensed disability insurance company or licensed health care service plan or any other entity that writes, issues, or administers any health benefit plan or ancillary benefit plan to employers or small employers in this state. See California Insurance Code 10810
• Carrier: means any disability insurance company or any other entity that writes, issues, or administers health benefit plans that cover the employees of small employers, regardless of the situs of the contract or master policyholder. See California Insurance Code 10755
• City: includes "city and county" and "incorporated town" but does not include "unincorporated town" or "village. See California Government Code 20
• City: includes incorporated city, city and county, municipal corporation, municipality, town and incorporated town. See California Financial Code 13
• Commissioner: means the Insurance Commissioner, who shall have regulatory jurisdiction over purchasing alliances. See California Insurance Code 10810
• Commissioner: means the Insurance Commissioner of this State. See California Insurance Code 20
• Committee: means the California Debt Limit Allocation Committee established pursuant to Section 8869. See California Government Code 8869.82
• compensation: means workers' compensation insurance. See California Insurance Code 11551
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Contract: A legal written agreement that becomes binding when signed.
• Conviction: A judgement of guilt against a criminal defendant.
• 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.
• County: includes city and county. See California Government Code 19
• County: includes city and county. See California Health and Safety Code 14
• County: includes "city and county. See California Insurance Code 14
• County: includes city and county. See California Financial Code 14
• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
• Dependent: A person dependent for support upon another.
• Dependent: means the spouse or registered domestic partner, or child, of an eligible employee, subject to applicable terms of the health benefit plan 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 (t). See California Insurance Code 10755
• Devise: To gift property by will.
• Dismissal: The dropping of a case by the judge without further consideration or hearing. ^Source:
• Domestic: means organized under the laws of this State, whether or not admitted. See California Insurance Code 26
• Donor: The person who makes a gift.
• Eligible employee: means any permanent employee who is actively engaged on a full-time basis in the conduct of business of the employer or small employer and, who has satisfied any employer or small employer waiting period requirements. See California Insurance Code 10810
• Eligible employee: means either of the following:

  California Insurance Code 10755

• Employee benefit plan distribution: means any money, life insurance, endowment or annuity policy or proceeds thereof, securities or other intangible property, or any tangible property, distributable to a participant, former participant, or the beneficiary or estate or heirs of a participant or former participant or beneficiary, from a trust or custodial fund established under a plan to provide health and welfare, pension, vacation, severance, retirement benefit, death benefit, stock purchase, profit sharing, employee savings, supplemental unemployment insurance benefits or similar benefits, or which is established under a plan by a business association functioning as or in conjunction with a labor union which receives for distribution residuals on behalf of employees working under collective-bargaining agreements. See California Code of Civil Procedure 1501
• Employer: means any corporation, partnership, sole proprietorship, or other business entity doing business in this state that may be eligible to participate in a purchasing alliance. See California Insurance Code 10810
• Enrollee: means an eligible employee or a dependent of an eligible employee who is enrolled in a health benefit plan or ancillary benefit plan offered through the purchasing alliance by a participating carrier. See California Insurance Code 10810
• Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
• Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. ^{Source: U.S. Courts}
• Escheat: Reversion of real or personal property to the state when 1) a person dies without leaving a will and has no heirs, or 2) when the property (such as a bank account) has been inactive for a certain period of time. ^{Source: OCC}
• 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.
• Ex officio: Literally, by virtue of one's office.
• Executor: A male person named in a will to carry out the decedent
• Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
• Fiduciary: A trustee, executor, or administrator.
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• Fraud: Intentional deception resulting in injury to another.
• Fund: means the California Debt Limit Allocation Committee Fund created pursuant to Section 8869. See California Government Code 8869.82
• Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
• Gift: as used in this article means a gift made directly or indirectly to any state candidate, elected state officer, or legislative official, or to an agency official of any agency required to be listed on the registration statement of the lobbying firm or the lobbyist employer of the lobbyist. See California Government Code 86201
• Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. ^{Source: Federal Reserve}
• Grandfathered health benefit plan: means a health benefit plan that constitutes a grandfathered health plan. See California Insurance Code 10755
• 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 which (1) includes one or more small employers as defined in subparagraph (A) of paragraph (1) of subdivision (q), (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 by 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 been offering health insurance to its members 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 benefit plan design that is purchased to all individual members and employer members in this state, (9) includes any member choosing to enroll in the benefit plan design 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 carrier with which it contracts. See California Insurance Code 10755
• Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
• Health benefit plan: means a policy or contract written or administered by a carrier that arranges or provides health care benefits for the covered eligible employees of a small employer and their dependents. See California Insurance Code 10755
• Health benefit plan: means a policy or contract written or administered by a participating carrier that arranges or provides health care benefits for the covered eligible employees of an employer or small employer and their dependents. See California Insurance Code 10810
• Holder: means any person in possession of property subject to this chapter belonging to another, or who is trustee in case of a trust, or is indebted to another on an obligation subject to this chapter. See California Code of Civil Procedure 1501
• In force business: means an existing health benefit plan issued by the carrier to a small employer. See California Insurance Code 10755
• Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
• Insurance agent: means a person authorized, by and on behalf of an insurer, to transact all classes of insurance other than life, disability, or health insurance, on behalf of an admitted insurance company. See California Insurance Code 31
• Interest rate: The amount paid by a borrower to a lender in exchange for the use of the lender's money for a certain period of time. Interest is paid on loans or on debt instruments, such as notes or bonds, either at regular intervals or as part of a lump sum payment when the issue matures. ^{Source: OCC}
• Internal Revenue Code: means the Internal Revenue Code of 1986 (26 U. See California Government Code 8869.82
• Issuer: means any local agency or state agency authorized by the Constitution or laws of the state to issue private activity bonds. See California Government Code 8869.82
• Joint committee: Committees including membership from both houses of teh legislature. Joint committees are usually established with narrow jurisdictions and normally lack authority to report legislation.
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• 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}
• Legislative session: That part of a chamber's daily session in which it considers legislative business (bills, resolutions, and actions related thereto).
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• liability: means liability and common carrier liability insurance. See California Insurance Code 11550
• licensee: means an insurer, agent, broker, or any other person who is required to be licensed by the department. See California Insurance Code 38.6
• Lien: A claim against real or personal property in satisfaction of a debt.
• Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
• Local agency: means any political subdivision of the state within the meaning of Section 103 of the Internal Revenue Code (26 U. See California Government Code 8869.82
• Management company: means the company under contract to the purchasing alliance to provide managerial services for the operation of the purchasing alliance. See California Insurance Code 10810
• MBTCAC: means the California Tax Credit Allocation Committee created by §. See California Government Code 8869.82
• Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
• Mortgagee: The person to whom property is mortgaged and who has loaned the money.
• Nongrandfathered health benefit plan: means a health benefit plan that is not a grandfathered health plan. See California Insurance Code 10755
• 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.
• Oversight: Committee review of the activities of a Federal agency or program.
• Owner: means a depositor in case of a deposit, a beneficiary in case of a trust, or creditor, claimant, or payee in case of other choses in action, or any person having a legal or equitable interest in property subject to this chapter, or his or her legal representative. See California Code of Civil Procedure 1501
• Participating carrier: means a carrier that contracts with a purchasing alliance to provide coverage to enrollees under a health benefit plan or ancillary benefit plan. See California Insurance Code 10810
• Participating employer: means an employer or small employer who contracts with a purchasing alliance to provide coverage to the employer's or small employer's employees. See California Insurance Code 10810
• 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: includes any person, firm, association, organization, partnership, limited liability company, business trust, corporation, or company. See California Government Code 17
• Person: means any person, firm, association, organization, partnership, business trust, corporation, limited liability company, or company. See California Health and Safety Code 19
• Person: means any person, association, organization, partnership, business trust, limited liability company, or corporation. See California Insurance Code 19
• Person: means any individual, business association, government or governmental subdivision or agency, two or more persons having a joint or common interest, or any other legal or commercial entity, whether that person is acting in his or her own right or in a representative or fiduciary capacity. See California Code of Civil Procedure 1501
• Person: includes any person, firm, partnership, association, corporation, company, limited liability company, syndicate, estate, trust, business trust, or organization of any kind. See California Financial Code 18
• Personal property: All property that is not real property.
• Personal property: includes money, goods, chattels, things in action, and evidences of debt. See California Code of Civil Procedure 17
• Plaintiff: The person who files the complaint in a civil lawsuit.
• 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 Insurance Code 10755
• Precedent: A court decision in an earlier case with facts and law similar to a dispute currently before a court. Precedent will ordinarily govern the decision of a later similar case, unless a party can show that it was wrongly decided or that it differed in some significant way.
• Preexisting condition provision: means a policy provision that excludes coverage for charges or expenses incurred during a specified period following the insured'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 Insurance Code 10755
• Private activity bond: means a part or all of any bond, or other instrument, required to obtain a portion of the state's volume cap pursuant to Sections 142(k) and 146 of the Internal Revenue Code (26 U. See California Government Code 8869.82
• Private activity bond limit: means any portion of the state ceiling allocated or transferred to a state agency or local agency pursuant to this chapter. See California Government Code 8869.82
• Probation: A sentencing alternative to imprisonment in which the court releases convicted defendants under supervision as long as certain conditions are observed.
• Process: includes a writ or summons issued in the course of judicial proceedings of either a civil or criminal nature. See California Government Code 22
• Property: includes both personal and real property. See California Code of Civil Procedure 17
• Purchasing alliance: means a non-risk-bearing entity issued a certificate of registration pursuant to this chapter to provide health benefits through multiple unaffiliated participating carriers to multiple participating employers, small employers and their employees within this state as authorized by the commissioner. See California Insurance Code 10810
• Quorum: The number of legislators that must be present to do business.
• Rating period: means the period for which premium rates established by a carrier are in effect and shall be no less than 12 months from the date of issuance or renewal of the health benefit plan. See California Insurance Code 10755
• Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
• Recess: A temporary interruption of the legislative business.
• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• Residuals: means payments pursuant to a collective bargaining agreement of additional compensation for domestic and foreign uses of recorded materials. See California Code of Civil Procedure 1501
• Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
• Risk adjusted employee risk rate: means the rate determined for an eligible employee of a small employer in a particular risk category after applying the risk adjustment factor. See California Insurance Code 10755
• Risk adjustment factor: means the percent adjustment to be applied equally to each standard employee risk rate for a particular small employer, based upon any expected deviations from standard claims. See California Insurance Code 10755
• Risk category: means the following characteristics of an eligible employee: age, geographic region, and family size of the employee, plus the benefit plan design selected by the small employer. See California Insurance Code 10755
• Service of process: The service of writs or summonses to the appropriate party.
• Service region: means that portion of the state, designated by the commissioner pursuant to regulations as described in this chapter in which each purchasing alliance must fairly and affirmatively offer, market, and sell all of the health benefit plan designs offered through the purchasing alliance that are sold or offered to a small employer to all small employers. See California Insurance Code 10810
• Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
• Small employer: means either of the following:

  California Insurance Code 10755

• Spouse: includes "registered domestic partner" as required by §. See California Government Code 12.2
• Standard employee risk rate: means the rate applicable to an eligible employee in a particular risk category in a small employer group. See California Insurance Code 10755
• State: means the State of California, unless applied to the different parts of the United States. See California Government Code 18
• State: means the State of California. See California Government Code 8869.82
• State: means the State of California, unless applied to the different parts of the United States. See California Insurance Code 28
• State: includes the District of Columbia and the territories when applied to the different parts of the United States, and the words "United States" may include the district and territories. See California Code of Civil Procedure 17
• State agency: means the state and all state entities, including joint powers authorities of which the state or agency or instrumentality thereof is a member, empowered to issue private activity bonds, the interest on which is exempt from income tax under Section 103(a) of the Internal Revenue Code (26 U. See California Government Code 8869.82
• State ceiling: includes all of the following:

  California Government Code 8869.82

• Statute: A law passed by a legislature.
• Statute of limitations: A law that sets the time within which parties must take action to enforce their rights.
• Subdivision: means a subdivision of the section in which the term occurs unless some other section is expressly mentioned. See California Government Code 10
• Summons: Another word for subpoena used by the criminal justice system.
• Temporary restraining order: Prohibits a person from an action that is likely to cause irreparable harm. This differs from an injunction in that it may be granted immediately, without notice to the opposing party, and without a hearing. It is intended to last only until a hearing can be held.
• Testimony: Evidence presented orally by witnesses during trials or before grand juries.
• Third-party administrator: means the company contracted by the purchasing alliance to provide administrative services for the purchasing alliance and that is licensed to provide those services by the department pursuant to Section 1759. See California Insurance Code 10810
• Trust account: A general term that covers all types of accounts in a trust department, such as estates, guardianships, and agencies. ^{Source: OCC}
• Trustee: A person or institution holding and administering property in trust.
• Trustor: The person who makes or creates a trust. Also known as the grantor or settlor.
• Veto: The procedure established under the Constitution by which the President/Governor refuses to approve a bill or joint resolution and thus prevents its enactment into law. A regular veto occurs when the President/Governor returns the legislation to the house in which it originated. The President/Governor usually returns a vetoed bill with a message indicating his reasons for rejecting the measure. In Congress, the veto can be overridden only by a two-thirds vote in both the Senate and the House.
• Will: includes codicil. See California Code of Civil Procedure 17
• Writ: A formal written command, issued from the court, requiring the performance of a specific act.
• Writing: includes printing and typewriting. See California Code of Civil Procedure 17