Terms Used In California Codes > Insurance Code > Division 2 > Part 2 > Chapter 8.02 > Article 1 - Definitions

• 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
• 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
• Commissioner: means the Insurance Commissioner of this State. See California Insurance Code 20
• Contract: A legal written agreement that becomes binding when signed.
• 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 Insurance Code 14
• Creditable coverage: means :

  California Insurance Code 10755

• 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
• Domestic: means organized under the laws of this State, whether or not admitted. See California Insurance Code 26
• Eligible employee: means either of the following:

  California Insurance Code 10755

• Enrollee: means an eligible employee or dependent who receives health coverage through the program from a participating carrier. See California Insurance Code 10755
• Grandfathered health plan: has the meaning set forth in Section 1251 of PPACA. 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
• 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
• 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 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 10755
• 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, association, organization, partnership, business trust, limited liability company, or corporation. See California Insurance Code 19
• 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
• Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
• Registered domestic partner: means a person who has established a domestic partnership as described in §. 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
• Small employer: means either of the following:

  California Insurance Code 10755

• 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 Health and Safety Code 23
• State: means the State of California, unless applied to the different parts of the United States. See California Insurance Code 28
• Waiting period: means a period that is required to pass with respect to the employee before the employee is eligible to be covered for benefits under the terms of the contract. See California Insurance Code 10755