Terms Used In California Codes > Health and Safety Code > Division 2 > Chapter 2.2 > Article 3.17 - Grandfathered Small Employer Plans

• Affiliation period: means a period that, under the terms of the health care service plan contract, must expire before health care services under the contract become effective. See California Health and Safety Code 1357.600
• 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.
• Awarding department: means any state agency, department, governmental entity, or other officer or entity empowered by law to enter into contracts on behalf of the State of California. See California Public Contract Code 10115.1
• 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.
• Contract: includes any agreement or joint development agreement to provide labor, services, material, supplies, or equipment in the performance of a contract, franchise, concession, or lease granted, let, or awarded for and on behalf of the State of California. See California Public Contract Code 10115.1
• Contractor: means any person or persons, regardless of race, color, sex, ethnic origin or ancestry, or any firm, partnership, corporation, or combination thereof, whether or not a minority or women business enterprise, who submits a bid and enters into a contract with a representative of a state agency, department, governmental entity, or other officer empowered by law to enter into contracts on behalf of the State of California. See California Public Contract Code 10115.1
• Conviction: A judgement of guilt against a criminal defendant.
• Creditable coverage: means :

  California Health and Safety Code 1357.600

• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• department: means State Department of Health Services. See California Health and Safety Code 20
• 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

• 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
• 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}
• 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.
• 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
• Fraud: Intentional deception resulting in injury to another.
• Grandfathered health plan: has the meaning set forth in Section 1251 of PPACA. See California Health and Safety Code 1357.600
• Grandfathered small employer health care service plan contract: means a small employer health care service plan contract that constitutes a grandfathered health plan. See California Health and Safety Code 1357.600
• 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 subparagraph (A) of paragraph (1) of subdivision (k), (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 1357.600
• In force business: means an existing health benefit plan contract issued by the plan to a small employer. See California Health and Safety Code 1357.600
• 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 1357.600
• 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
• person: as used in this article , means any individual, partnership, joint venture, or association or any other organization or any combination thereof. See California Public Contract Code 10285
• 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
• 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 Health and Safety Code 1357.600
• Preexisting condition provision: means a contract provision that excludes coverage for charges or expenses incurred during a specified period following the enrollee'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 1357.600
• 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
• 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 12 months from the date of issuance or renewal of the health care service plan contract. See California Health and Safety Code 1357.600
• Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
• Registered domestic partner: means a person who has established a domestic partnership as described in §. See California Health and Safety Code 1357.600
• 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 Health and Safety Code 1357.600
• 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 1357.600
• 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 1357.600
• 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
• 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
• specialized health care service plan: means either of the following:

  California Health and Safety Code 1345

• 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 1357.600
• State: means the State of California, unless applied to the different parts of the United States. See California Health and Safety Code 23
• Waiting period: means a period that is required to pass with respect to an employee before the employee is eligible to be covered for benefits under the terms of the contract. See California Health and Safety Code 1357.600