§ 10851
327 words·~1 min read·
/ca/insurance-code/10851A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Every participating carrier shall:
(a)Meet the standards established by the board pursuant to this chapter.
(b)Provide any data required by the board.
(c)Comply with, all applicable laws and regulations that regulate health care coverage or medical benefits provided to employers, including, with respect to coverage that is provided to small employers, Chapter 8 (commencing with Section 10700) for insurers and Article 3.1 (commencing with Section 1357) of Chapter 2.2 of Division 2 of the Health and Safety Code for health care service plans. However, a carrier contracting to participate in a purchasing alliance shall be deemed to be in compliance with the requirements for small employers of subdivision
(a)of Section 1357.03 of the Health and Safety Code and of subdivisions
(b)and
(c)of Section 10705 for a benefit plan design offered through the purchasing alliance in those service regions in which the carrier participates in the purchasing alliance and the benefit plan design is offered exclusively through the purchasing alliance.
(d)Comply with all rules and regulations regarding the application of risk adjustment factors to standard risk rates for small employers as specified in subdivisions
(a)and
(b)of Section 1357.12 of the Health and Safety Code and subdivisions
(a)and
(b)of Section 10714 of this code. A participating carrier shall also comply with the requirements that coverage be issued to small employers on a guaranteed issue basis as is specified in subdivision
(a)of Section 1357.03 of the Health and Safety Code and subdivision
(b)of Section 10705 of this code for small employers.
(e)All participating medical carriers shall, in determining small employer rates for health benefit plans offered through a purchasing alliance, use the six service regions established by this chapter in determining risk categories for standard employee risk rates.
(f)Enroll and disenroll individuals as directed by the purchasing alliance or its designee.
(g)Comply with any other requirement established by the board pursuant to this chapter.