Terms Used In California Codes > Health and Safety Code > Division 2 > Chapter 2.2 > Article 3.1 - Small Employer Group Access to Contracts for Health Care Services

• Affiliation period: means a period that, under the terms of the health care service plan contract, is required to elapse before health care services under the contract become effective. See California Health and Safety Code 1357
• 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.
• Basic health care services: includes ambulance and ambulance transport services provided through the "911" emergency response system. See California Health and Safety Code 1345
• 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
• 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

• department: means State Department of Health Services. See California Health and Safety Code 20
• Department: means the Department of Water Resources. See California Public Contract Code 10112.1
• Dependent: means the spouse or child of an eligible employee, subject to applicable terms of the health care 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 (o). See California Health and Safety Code 1357
• Dependent: A person dependent for support upon another.
• Eligible employee: means either of the following:

  California Health and Safety Code 1357

• 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 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
• 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.
• 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 paragraph (1) of subdivision (l), (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
• 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
• 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.
• Late enrollee: means an eligible employee or dependent who has declined enrollment in a health benefit plan offered by a small employer at the time of the initial enrollment period provided under the terms of the health benefit plan and who subsequently requests enrollment in a health benefit plan of that small employer, provided that the initial enrollment period shall be a period of at least 30 days. See California Health and Safety Code 1357
• licensed: refers to , a license as a plan pursuant to Section 1353. See California Health and Safety Code 1345
• New business: means a health care service plan contract issued to a small employer that is not the plan's in force business. See California Health and Safety Code 1357
• 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
• Preexisting condition provision: means a contract provision that excludes coverage for charges or expenses incurred during a specified period following the employee'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
• 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
• 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 six months. See California Health and Safety Code 1357
• 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.
• 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 Health and Safety Code 1357
• Risk adjustment factor: means the percentage adjustment to be applied equally to each standard employee risk rate for a particular small employer, based upon any expected deviations from standard cost of services. See California Health and Safety Code 1357
• Risk category: means the following characteristics of an eligible employee: age, geographic region, and family composition of the employee, plus the health benefit plan selected by the small employer. See California Health and Safety Code 1357
• 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 either of the following:

  California Health and Safety Code 1357

• 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
• Spouse: includes "registered domestic partner" as required by §. See California Health and Safety 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 Health and Safety Code 1357
• 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