For the purposes of this part, the following terms have the following meanings:
(a) “Applicant” means an individual who applies for high risk medical coverage through the program.
(b) “Board” means the Managed Risk Medical Insurance Board.
(c) “Federal temporary high risk pool” is the temporary high risk health insurance pool program established pursuant to Section 1101 of the federal Patient Protection and Affordable Care Act (Public Law 111-148).
(d) “Fund” means the Federal Temporary High Risk Health Insurance Fund, established in Section 12739.71, from which the board may authorize expenditures to pay for all of the following:
(1) Covered, medically necessary services that exceed subscribers’ contributions.
(2) Administration of the program.
(3) Marketing and outreach.
(e) “High risk medical coverage” or “coverage” means payment for medically necessary services provided by institutional and professional providers through the program.
(f) “Participating health plan” means a private insurer holding a valid outstanding certificate of authority from the Insurance Commissioner or a health care service plan, as defined under subdivision (f) of Section 1345 of the Health and Safety Code, that contracts with the program to provide or administer high risk medical coverage to program subscribers.
(g) “Plan rates” means the total monthly amount charged by a participating health plan to provide or administer high risk medical coverage.
(h) “Program” means the Federal Temporary High Risk Pool through which the board operates the federal temporary high risk pool in California.
(i) “Subscriber” means an eligible individual, as defined in subsection (d) of Section 1101 of the federal Patient Protection and Affordable Care Act (Public Law 111-148), who is enrolled in the program, and includes a member of a federally recognized California Indian tribe.
(j) “Subscriber contribution” means the premium for high risk medical coverage paid by the subscriber or, if authorized by the federal government, paid on behalf of the subscriber by a federally recognized California Indian tribal government. If a federally recognized California Indian tribal government makes a contribution on behalf of a member of the tribe, the tribal government shall ensure that the subscriber is made aware of all the health coverage options, including participating health plans, available in the county where the member resides.
(Added by Stats. 2010, Ch. 31, Sec. 5. (SB 227) Effective June 29, 2010. Repealed as of January 1, 2020, pursuant to Section 12739.62.)
Last modified: October 25, 2018