California Insurance Code CHAPTER 4 - Administration

Section 12693.25.
The board may use a purchasing pool model, issuance of purchasing credits, supplemental coverage, or other means as appropriate to meet the purposes of this...
Section 12693.26.
(a) The board shall establish a purchasing pool for coverage of program subscribers to enable applicants without access to affordable and comprehensive employer-sponsored dependent coverage to...
Section 12693.27.
(a) The board shall develop a purchasing credit mechanism to enable applicants with access to affordable and comprehensive employer-sponsored dependent coverage to have an eligible child...
Section 12693.271.
(a) The Legislature finds and declares that the state faces a fiscal crisis that requires unprecedented measures to reduce General Fund expenditures.(b) Notwithstanding any other provision of...
Section 12693.28.
The program shall be administered without regard to gender, gender identity, gender expression, race, creed, color, sexual orientation, health status, disability, or occupation.(Amended by Stats....
Section 12693.29.
(a) The board shall use appropriate and efficient means to notify families of the availability of health coverage from the program.(b) The State Department of Health Services...
Section 12693.30.
(a) The board shall assure that written enrollment information issued or provided by the program is available to program subscribers and applicants in each of the...
Section 12693.31.
No participating health, dental, or vision plan shall, in an area served by the program, directly, or through an employee, agent, or contractor, provide an...
Section 12693.32.
(a) The board may pay designated individuals or organizations an application assistance fee, if the individual or organization assists an applicant to complete the program application,...
Section 12693.325.
(a) (1) Notwithstanding any provision of this chapter, a participating health, dental, or vision plan that is licensed and in good standing as required by subdivision (b)...
Section 12693.326.
Notwithstanding any other provision of this part, a new subscriber in the program shall be allowed to switch his or her choice of plans once...
Section 12693.33.
To the extent feasible and permissible under federal law and with receipt of necessary federal approvals, the State Department of Health Services and the board...
Section 12693.34.
(a) The board may establish geographic areas within which participating health, dental, and vision plans may offer coverage to subscribers.(b) Nothing in this section shall restrict a...
Section 12693.35.
Participating health, dental, and vision plans shall have, but need not be limited to, all of the following operating characteristics satisfactory to the board in...
Section 12693.36.
(a) Notwithstanding any other provision of law, the board shall not be subject to licensure or regulation by the Department of Insurance or the Department of...
Section 12693.37.
(a) The board shall contract with a broad range of health plans in an area, if available, to ensure that subscribers have a choice from among...
Section 12693.38.
(a) The board shall contract with a sufficient number of dental and vision plans to assure that dental and vision benefits are available to all subscribers....
Section 12693.39.
The board shall establish a process for determining which employer-sponsored health plans are eligible to receive a purchasing credit issued by the program. The process...
Section 12693.40.
The board shall contract with health plans to provide coverage supplemental to that provided by an applicant’s or applicant’s spouse’s employer-sponsored health plan for the...
Section 12693.41.
(a) The board shall consult and coordinate with the State Department of Health Services in implementing a preenrollment program into the Healthy Families Program or the...
Section 12693.42.
Any purchasing credit issued by the board, or a contractor acting on behalf of the board, pursuant to this part shall have an overall cost...
Section 12693.43.
(a) Applicants applying to the purchasing pool shall agree to pay family contributions, unless the applicant has a family contribution sponsor. Family contribution amounts consist of...
Section 12693.44.
(a) The board shall establish family contribution amounts for purchasing credit members that are equivalent to the amounts charged to subscribers participating in the purchasing pool...
Section 12693.45.
(a) After two consecutive months of nonpayment of family contributions by an applicant, and a reasonable written notice period of no less than 30 days is...
Section 12693.46.
The board may prohibit applicants who drop coverage after enrolling in the pool from reenrollment in the program for up to six months.(Added by Stats....
Section 12693.47.
The program may place a lien on compensation or benefits, recovered or recoverable by a subscriber or applicant from any party or parties responsible for...
Section 12693.48.
The board may adjust payments made to a participating health plan if the board finds that the plan has a significantly disproportionate share of high-...
Section 12693.49.
(a) When an applicant is dissatisfied with any action or inaction of a participating plan in which a subscriber is enrolled through the purchasing pool, the...
Section 12693.50.
(a) The board shall consult and coordinate with the State Department of Health Services to implement the Medi-Cal to Healthy Families Accelerated Enrollment program pursuant to...
Section 12693.51.
(a) A transfer of enrollment from one participating health plan to another may be made by a subscriber at times and under conditions as may be...
Section 12693.515.
(a) Effective July 1, 2004, any subscriber who affirmatively selects, or is assigned by default to, a federally qualified health center, as defined by Section 1396(d)(l)(2)...
Section 12693.52.
The board may negotiate or arrange for stop-loss insurance coverage that limits the program’s fiscal responsibility for the total costs of health services provided to...
Section 12693.53.
The board shall develop and utilize appropriate cost containment measures to maximize the coverage offered under the program. Those measures may include limiting the expenditure...
Section 12693.54.
A contract entered pursuant to this part shall be exempt from any provision of law relating to competitive bidding, and shall be exempt from the...
Section 12693.55.
(a) A health care provider who is furnished documentation of a person’s enrollment in the program shall not seek reimbursement nor attempt to obtain payment for...

Last modified: October 22, 2018