The program may be implemented in Santa Clara County at the option of the local initiative, but if so implemented shall be as a pilot program. A maximum of 5,000 employees may be covered in the county, provided, however, that the number of enrollees may be increased pursuant to the prior approval of the Department of Managed Health Care. The local initiative shall administer the program.
Chapter 2Administration
Section § 131510
This law allows a health program to be implemented as a pilot initiative in Santa Clara County, California. The program can cover up to 5,000 employees. The number of participants can only be increased if the Department of Managed Health Care approves it first. The local initiative is responsible for running the program.
Santa Clara County pilot program health program local initiative employee coverage limit Department of Managed Health Care number of enrollees program administration health care initiative enrollee limit managed health care
Section § 131511
This law section outlines the rules for a health care pilot program in Santa Clara County. It says that the program doesn't have to follow one specific requirement but must follow others related to health care regulations, including approval by the Department of Managed Health Care. The program can't exclude eligible employees from coverage based on their health condition or past illnesses, except for certain preexisting condition rules. Small businesses that participate can renew the health coverage they offer to their employees, ensuring ongoing availability as long as the business opts in.
(a)CA Health and Safety Code § 131511(a) In implementing the pilot program established pursuant to this division, the local initiative in Santa Clara County shall not be subject to the requirements of subdivision (a) of Section 1357.03. The program shall be otherwise subject to the requirements of Chapter 2.2 (commencing with Section 1340) of Division 2, including Article 3.1 (commencing with Section 1357) thereof, except as otherwise provided in this division, and shall be subject to approval as to regulatory filings with the Department of Managed Health Care as prescribed in
Chapter 2.2 (commencing with Section 1340) of Division 2 and in implementing regulations promulgated by the department.
(b)CA Health and Safety Code § 131511(b) Except in the case of a late enrollee or for satisfaction of a preexisting condition clause in the case of initial coverage for an eligible employee, the local initiative may not exclude any eligible employee who would otherwise be eligible for health care coverage under this division on the basis of an actual or expected health care condition. The local initiative may not limit or exclude coverage for any eligible employee by type of illness, treatment, medical condition, or accident, except for preexisting conditions as permitted under Section 1357.06.
(c)CA Health and Safety Code § 131511(c) Coverage provided through the program to an eligible small business shall be renewable with respect to all eligible employees at the option of the participating small business.
health care pilot program Santa Clara County local initiative Department of Managed Health Care eligible employee health condition exclusion preexisting condition clause renewable coverage small business health coverage health care regulations regulatory filings small business participation employee health care coverage illness exclusion limits health care program requirements
