Terms Used In California Codes > Insurance Code > Division 2 > Part 2 > Chapter 8 - Small Employer Health Insurance

• Affiliation period: means a period that, under the terms of the health benefit plan, shall elapse before health care services under the plan become effective. See California Insurance Code 10700
• 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 10700
• Agreement: includes , but is not limited to, agreements providing for valuations, appraisals, and similar proceedings and agreements between employers and employees or between their respective representatives. See California Code of Civil Procedure 1280
• 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.
• 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
• 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.
• Attachment point: means the amount of health claims incurred by a small employer in a policy year for its employees and their dependents, and covered by a stop-loss insurance policy, above which the stop-loss insurer incurs a liability for payment. See California Insurance Code 10752
• axle: is a structure or portion of a structure consisting of one or more shafts, spindles, or bearings in the same vertical transverse plane by means of which, in conjunction with wheels mounted on said shafts, spindles, or bearings, a portion of the weight of a vehicle and its load, if any, is continuously transmitted to the roadway when the vehicle is in motion. See California Vehicle Code 230
• 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 10700
• Board: means the Major Risk Medical Insurance Board. See California Insurance Code 10700
• camp trailer: is a vehicle designed to be used on a highway, capable of human habitation for camping or recreational purposes, that does not exceed 16 feet in overall length from the foremost point of the trailer hitch to the rear extremity of the trailer body and does not exceed 96 inches in width and includes any tent trailer. See California Vehicle Code 242
• camper: is a structure designed to be mounted upon a motor vehicle and to provide facilities for human habitation or camping purposes. See California Vehicle Code 243
• 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 10700
• Commission: means the Public Utilities Commission created by §. See California Public Utilities Code 20
• Commissioner: means the Insurance Commissioner of this State. See California Insurance Code 20
• Controversy: means any question arising between parties to an agreement whether the question is one of law or of fact or both. See California Code of Civil Procedure 1280
• Conviction: A judgement of guilt against a criminal defendant.
• County: includes "city and county. See California Insurance Code 14
• County: includes "city and county. See California Code of Civil Procedure 17
• County: includes city and county. See California Public Utilities Code 18
• Creditable coverage: means :

  California Insurance Code 10700

• Dealer: is a person not otherwise expressly excluded by Section 286 who:

  California Vehicle Code 285

• Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
• Department: means the Department of Motor Vehicles except, when used in Chapter 2 (commencing with Section 2100) of Division 2 and in Divisions 11 (commencing with Section 21000), 12 (commencing with Section 24000), 13 (commencing with Section 29000), 14 (commencing with Section 31600), 14. See California Vehicle Code 290
• Department: means Department of Industrial Relations. See California Labor Code 19
• Dependent: A person dependent for support upon another.
• Dependent: means the spouse, registered domestic partner as described in §. See California Insurance Code 10752
• Dependent: means the spouse 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 (z). See California Insurance Code 10700
• Direct coverage: means that an insurance company assumes a direct obligation to an employee under an insurance policy to pay or indemnify the employee for health claims incurred by the employee or the employee's dependents. See California Insurance Code 10752
• Domestic: means organized under the laws of this State, whether or not admitted. See California Insurance Code 26
• Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) ^{Source: OCC}
• Eligible employee: means either of the following:

  California Insurance Code 10700

• Energy Commission: means the State Energy Resources Conservation and Development Commission. See California Public Utilities Code 20
• Enrollee: means an eligible employee or dependent who receives health coverage through the program from a participating carrier. See California Insurance Code 10700
• 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.
• Expected claims: means , for the purposes of aggregate stop-loss coverage, the total amount of health claims that is projected to be incurred by a small employer for its employees and their dependents in a policy year. See California Insurance Code 10752
• 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.
• Financially impaired: means , for the purposes of this chapter, a carrier that, on or after the effective date of this chapter, is not insolvent and is either:

  California Insurance Code 10700

• 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.
• Fund: means the California Small Group Reinsurance Fund. See California Insurance Code 10700
• Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
• 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 paragraph (1) of subdivision (w), (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 10700
• 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 10700
• Highway: is a way or place of whatever nature, publicly maintained and open to the use of the public for purposes of vehicular travel. See California Vehicle Code 360
• In force business: means an existing health benefit plan issued by the carrier to a small employer. See California Insurance Code 10700
• Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. ^{Source: FDIC}
• Insurance broker: means a person who, for compensation and on behalf of another person, transacts insurance other than life, disability, or health with, but not on behalf of, an insurer. See California Insurance Code 33
• 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.
• Labor Commissioner: means Chief of the Division of Labor Standards Enforcement. See California Labor Code 21
• Late enrollee: means an eligible employee or dependent who has declined health coverage under 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 Insurance Code 10700
• Lawful possession of an explosive: as used in this chapter , means possessing explosives in accordance with the stated purpose and conditions of a valid permit obtained pursuant to the provisions of this part, unless such person is specifically excepted from the permit requirements by the provisions of this part. See California Health and Safety Code 12303
• Lawsuit: A legal action started by a plaintiff against a defendant based on a complaint that the defendant failed to perform a legal duty, resulting in harm to the plaintiff.
• 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}
• Lessor: includes "bailor" and "lease" includes "bailment. See California Vehicle Code 372
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
• motor vehicle: includes a recreational vehicle as that term is defined in subdivision (a) of §. See California Vehicle Code 415
• New business: means a health benefit plan issued to a small employer that is not the carrier's in force business. See California Insurance Code 10700
• nonrepairable vehicle: is a vehicle of a type otherwise subject to registration that meets the criteria specified in subdivision (a), (b), or (c). See California Vehicle Code 431
• nonrepairable vehicle certificate: is a vehicle ownership document issued to the owner of a nonrepairable vehicle. See California Vehicle Code 432
• 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: is a person having all the incidents of ownership, including the legal title of a vehicle whether or not such person lends, rents, or creates a security interest in the vehicle. See California Vehicle Code 460
• Participating carrier: means a carrier that has entered into a contract with the program to provide health benefits coverage under this part. See California Insurance Code 10700
• 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 person, association, organization, partnership, business trust, limited liability company, or corporation. See California Labor Code 18
• Person: includes a natural person, firm, copartnership, association, limited liability company, or corporation. See California Vehicle Code 470
• Plaintiff: The person who files the complaint in a civil lawsuit.
• Plan of operation: means the plan of operation of the fund, including articles, bylaws, and operating rules adopted by the fund pursuant to Article 3 (commencing with Section 10719). See California Insurance Code 10700
• Policy year: means the 12-month period that is designated as the policy year or policy period for the stop-loss insurance policy. See California Insurance Code 10752
• 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 10700
• Preschool facility: means a residence or building or part thereof in which preschool services are provided. See California Education Code 8205
• Program: means the Health Insurance Plan of California. See California Insurance Code 10700
• promise: includes promise, undertaking, contract, or agreement, whether written or oral, express or implied. See California Labor Code 920
• Property: includes both personal and real property. See California Code of Civil Procedure 17
• 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 carrier are in effect and shall be no less than six months. See California Insurance Code 10700
• 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.
• required action: means any removal or other remedial action with regard to hazardous materials that is necessary to comply with any requirement of federal, state, or local law. See California Code of Civil Procedure 1263.710
• Resident: means any person who manifests an intent to live or be located in this state on more than a temporary or transient basis. See California Vehicle Code 516
• retail sale: is a sale of goods to a person for the purpose of consumption and use, and not for resale to others, including, but not limited to, an arrangement where a motor vehicle is consigned to a dealer for sale. See California Vehicle Code 520
• 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 10700
• 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 10700
• 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 10700
• Small employer: means either of the following:

  California Insurance Code 10700

• 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 10700
• 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: means the State of California, unless applied to the different parts of the United States. See California Public Utilities Code 17
• Statute: A law passed by a legislature.
• Stop-loss insurance policy: means a policy, contract, certificate, or statement of coverage between a stop-loss insurer and small employer providing individual or aggregate stop-loss insurance coverage, or both, or any other assumption of risk, to a small employer for the liability the small employer incurs related to the covered health claims of its employees and their dependents. See California Insurance Code 10752
• Stop-loss insurer: means an insurance company providing individual or aggregate stop-loss insurance coverage, or both, or any other assumption of risk, to a small employer for the health claims it incurs for its employees and their dependents. See California Insurance Code 10752
• subscription: includes mark when the signer or subscriber cannot write, such signer's or subscriber's name being written near the mark by a witness who writes his own name near the signer's or subscriber's name. See California Public Utilities Code 16
• Summons: Another word for subpoena used by the criminal justice system.
• Teacher: means a person with the appropriate permit issued by the Commission on Teacher Credentialing who provides program supervision and instruction that includes supervision of a number of aides, volunteers, and groups of children. See California Education Code 8205
• trailer: includes a semitrailer when used in conjunction with an auxiliary dolly, if the auxiliary dolly is of a type constructed to replace the function of the drawbar and the front axle or axles of a trailer. See California Vehicle Code 630
• trailer coach: is a vehicle, other than a motor vehicle, designed for human habitation or human occupancy for industrial, professional, or commercial purposes, for carrying property on its own structure, and for being drawn by a motor vehicle. See California Vehicle Code 635
• Trustee: A person or institution holding and administering property in trust.
• used vehicle: is a vehicle that has been sold, or has been registered with the department, or has been sold and operated upon the highways, or has been registered with the appropriate agency of authority, of any other state, District of Columbia, territory or possession of the United States or foreign state, province or country, or unregistered vehicles regularly used or operated as demonstrators in the sales work of a dealer or unregistered vehicles regularly used or operated by a manufacturer in the sales or distribution work of such manufacturer. See California Vehicle Code 665
• vehicle: is a device by which any person or property may be propelled, moved, or drawn upon a highway, excepting a device moved exclusively by human power or used exclusively upon stationary rails or tracks. See California Vehicle Code 670
• Venue: The geographical location in which a case is tried.
• Will: includes codicil. See California Code of Civil Procedure 17
• Writing: includes printing and typewriting. See California Code of Civil Procedure 17