This law allows the board to use different methods, like a purchasing pool model, giving purchasing credits, or offering extra coverage, to achieve the goals of this part of the insurance regulations.

This law requires the establishment of a purchasing pool to help applicants without affordable employer-sponsored benefits provide their children with health, dental, and vision coverage. The board can negotiate contracts with health, dental, and vision plans or other entities to offer these benefits, and is not limited by usual bidding requirements.

The board can work with entities outside of traditional health plans to ensure compliance with federal laws and provide ample access to benefits for subscribers. Interagency agreements are exempt from competitive bidding and some standard review procedures, streamlining the process for implementing these benefits.

This section describes a system for helping families with employer-sponsored health plans enroll their children using a purchasing credit. If a company offers affordable and comprehensive health coverage for dependents, the government can help enroll the children in the employer's plan through this credit.

For the credit, employers must contribute significantly to the cost of the dependent coverage without focusing on employee wage or job type. Employers and health plans must use all the funds strictly for coverage. If the dependent leaves the plan, there are mechanisms to reclaim funds. Also, employees won't pay more than they would if the kids were in a separate purchasing pool program, even for additional coverage. Participation may be limited to employers in certain cooperative health arrangements.

This law ensures that the program is managed fairly and equally without discrimination based on gender, race, sexual orientation, health status, disability, or job type.

This law requires the board to inform families about the availability of health coverage for children. They need to use effective methods like brochures and outreach campaigns. The State Department of Health Services will help with community outreach and education to spread the word about this coverage.

This law ensures that the health insurance program makes its enrollment information available in all major languages spoken in the area, based on a specified government list. Additionally, the program must provide phone services in these languages for subscribers and applicants.

The law also requires that interpreter services be available to help subscribers communicate with their health plan providers, and that network directories list providers who speak multiple languages.

Lastly, health, dental, and vision plans participating in the program must show how they offer services and marketing materials that are culturally and linguistically appropriate for diverse subscribers.

This law makes sure that health, dental, or vision plans cannot give out any marketing materials about the program's benefits or pricing unless those materials have been checked and approved by the board overseeing the program. This applies to materials shared by anyone working directly or indirectly for the plan in areas the program serves.

This law allows the board to pay individuals or organizations for helping applicants fill out program applications if the applicant is successfully enrolled. The board decides who is eligible to receive these payments and sets up rules for payment integrity. As part of outreach efforts, community-based initiatives may inform people about the program, but they cannot choose a health plan or provider for applicants. Plans cannot solicit applicants directly except through certain employers. All assistance must be free, except for the board's application payments. Asking for money for application help without board approval is fined at $500 per violation. The Attorney General or other officials can take legal action against those breaking these rules, with actions needing to be filed within three years of the violation discovery.

This law mandates the creation of a combined application form for Medi-Cal and another program aimed at enrolling children, designed by the State Department of Health Services and another board. They aim to streamline the process as much as possible while following federal laws and securing any necessary federal approvals.

This law allows the board in charge to set specific regions where health, dental, and vision plans can be offered to subscribers. It also ensures that county health systems or local health initiatives can still serve subscribers within their approved areas.

This law outlines the requirements for health, dental, and vision plans that want to participate in the program. Firstly, they need to be financially strong and able to cover the costs of services, possibly using risk-sharing methods like reinsurance. Secondly, they must have good administrative skills. Thirdly, they require a process for handling complaints. Additionally, plans involving healthcare providers must review care quality, ensure care is appropriate, and make sure services are accessible to members. Before contracts start, plans must have a clear system to identify that services are provided under the program, and they must continue to use this system during the contract. Lastly, plans licensed by the Department of Managed Health Care automatically meet certain requirements.

This law states that the board managing health-related plans is not required to be licensed or regulated by the California Department of Insurance or the Department of Managed Health Care. However, any health, dental, or vision plans that want to participate in the program must be properly licensed and in good standing with their respective regulatory bodies. These plans need to prove their compliance when applying to join the program.

This law requires the board to contract with a variety of health plans, giving subscribers a choice among competing options. Health plans must be selected based on objective criteria, and the board must ensure that plans include traditional and safety net providers. Each year, participating plans need to submit a report detailing their provider networks, covering aspects like geographic access, linguistic services, ethnic diversity of providers, and subscriber choices for traditional providers.

The board will assess provider networks beyond the Department of Managed Health Care's findings, focusing on areas with significant uninsured children in low-income families. Health plans with more providers in these targeted areas will receive priority. Additionally, the board will designate a plan in each area with the most traditional providers, offering discounts to subscribers. Limits on plan administrative costs will also be established.

This law section requires a board to contract with enough dental and vision plans to ensure all subscribers have access to these benefits. The board must create clear criteria for choosing these plans and allow all providers a fair chance to apply. Participating plans must comply with state and federal regulations if possible. Selection will be based on the board's criteria.

Dental plans must annually report on their provider network, including geographic access, language services, and the ethnic diversity of providers. Additionally, the board must set reasonable limits on the administrative costs of dental plans.

This law requires the board to create a system to decide which employer-sponsored health plans can get a purchasing credit from a special program. The chosen plans must offer benefits, copayments, coinsurance, and deductibles that are at least 95% as valuable as the ones given to people enrolled in the program's purchasing pool.

This law states that when an applicant or their spouse has an employer-sponsored health plan that doesn't offer benefits roughly equal to 95% of those given to subscribers, the board must arrange for supplemental coverage. If this extra coverage is provided, the plan can qualify for purchasing credits, even if it normally wouldn't under another section noted in the law.

This law requires that the board works with the State Department of Health Services to set up a preenrollment process for the Healthy Families Program and Medi-Cal, which is a California Medicaid program. When someone fills out a follow-up application, it serves as an application for these health programs. The preenrollment is handled by the Department of Health Services and is provided at no cost to the applicant.

The board can use the state's Medicaid fiscal intermediary to manage eligibility checks and payments. It doesn't have to follow some typical state procurement rules when using these services.

The board is also allowed to create emergency regulations to help with preenrollment into these health programs. These rules can change aspects like who can join and how they join or leave the programs. Emergency regulations are quickly put into effect and are temporarily exempt from a detailed review process, but they need to be filed for public record.

The section went into effect on April 1, 2003.

This law section limits how much money the board or its contractor can spend on purchasing credits for health insurance. The total cost for these credits cannot exceed what it would cost to enroll someone in the cheapest insurance plan available. This includes not only the insurance itself but also any administrative expenses and extra products, which should all be factored into the final amount of the purchasing credit.

This law outlines the rules for family contributions in applying to a health insurance purchasing pool. Applicants need to pay a set fee unless a sponsor covers it. There are two parts to the contribution: a flat fee and any additional costs from plan choices exceeding the highest cost Family Value Package in their area.

Contribution amounts vary based on family income relative to the federal poverty level, with specific dollar amounts defined for different income brackets and time periods. There are discounts for selecting certain plans and paying contributions through electronic means.

If applicants pay three months’ worth of contributions upfront, they get a fourth month free. The law intends to comply with federal premium cost-sharing limits and allows for adjustments if federal approval is required. Some regulations under this law are seen as emergencies and bypass certain standard requirements for urgent implementation.

This law states that families who are purchasing credit members should pay the same amount as regular subscribers in a health insurance pool. These purchasing credit members can't be charged more than they would if they were in the pool. When figuring out how much it costs, certain discounts can't be included. They also get dental and vision insurance for free. Additionally, payments for these plans can be made directly through payroll deductions or other methods.

If an applicant doesn't pay their family contributions for two months in a row, they can be removed from the plan after a 30-day notice. The board can also take steps to collect the unpaid fees.

Removals from the plan are effective at the end of the second month of missed payments, following any federal law requirements.

If someone enrolls in a health insurance pool and then decides to drop out, the board can prevent them from rejoining the program for up to six months.

If you receive benefits through a specific insurance policy, the program that provides these benefits can claim a right (called a lien) on any compensation you receive from a third party who is responsible for your injury or loss. This means they can get reimbursed before you fully receive your compensation.

This law allows the board to change the amount of money paid to health plans if it's found they have an unusually high or low number of high-risk members compared to others. Before making any changes, the board will gather verified information from the health plans. The reporting requirements should align with how the health plans work. Any payment adjustments will consider factors that are related to the risk levels of the members, like age and other demographics.

If you're unhappy with your health, dental, or vision plan through a purchasing pool, you should first try to settle the issue directly with the plan using their procedures. Each plan must inform you about any regulatory help you can get from state or licensing authorities. Additionally, these plans need to report yearly to the board about the number and types of complaints they receive, and this info must be available to you if you ask for it.

This law ensures that the board works with the State Department of Health Services to put into effect the Medi-Cal to Healthy Families Accelerated Enrollment program. The state must get federal approval for any necessary changes to its plans to implement this program. Once approved, the board can issue temporary emergency rules to quickly provide these eligibility benefits, focusing on eligibility, enrollment, and disenrollment. These emergency rules are considered crucial for public health and will initially bypass detailed reviews but are only effective for a limited time.

This law allows people to switch from one health plan to another under certain conditions. Subscribers can change plans according to rules set by the board. If a subscriber's current health plan contract is canceled, or if they move to a new area where their plan isn't available, the board must help them transfer to a different plan. Additionally, subscribers can request to switch plans at least once a year.

This law allows the board to organize stop-loss insurance or set up agreements with health plans to manage financial risks for program subscribers. The goal is to cap the total costs or share the expenses for health services provided.

The board is tasked with finding ways to keep costs low to offer as much coverage as possible under the program. They might do this by sticking to the cheapest plan available for state funding and setting rules to prevent employers or applicants from dropping their current insurance just to get children eligible for the program.

This law means that when contracts are made under this specific part, they don't have to go through the usual process of competitive bidding or get approval from the Department of General Services. In other words, these contracts can be made more quickly and without some of the usual red tape. The board in charge can decide how much money each contract gets, based on how many people are expected to sign up for the program, without having to specify exact amounts for each contract. However, the total funding must stay within the program's budget, which includes any contributions from families.

Health care providers who receive proof of a person's enrollment in this health program cannot ask for payment directly from the patient for services covered under the program. Instead, they must seek payment from the patient's health plan or other contracted entities. However, this rule doesn't affect any copayments that the patient might need to pay for these services. The term 'health care provider' includes any licensed individual or organization that delivers health care services.

This law acknowledges that California is experiencing a financial crisis and needs to cut spending. As a result, starting in the fifth month after the 2008–09 Budget Act is enacted, the rates for health, dental, and vision plans will be reduced by 5% from the rates in place on July 1, 2007. Additionally, these rates will be further decreased if there are any reductions in the value of benefits provided, especially related to dental benefit limits. The board can also make further cuts as needed during their yearly rate discussions.

This law outlines how health, dental, or vision plans can assist applicants in applying for health coverage. These plans can help applicants when contacted directly by them at specific places or referred by a government agency, school, or school district. However, the plan must follow certain rules, such as not soliciting referrals, offering compensation for referrals, changing the applicants' current plan, or using forbidden marketing practices like door-to-door selling.

Furthermore, if a child’s eligibility for Medi-Cal changes, the plan must explain the differences in benefits between programs. Representatives providing help must be trained and disclose their relationship with the plan. Plans cannot give gifts or pay costs for applicants as inducements to enroll. They must also submit their methods for application assistance for approval and inform applicants of their choices and report these activities to a regulatory board biennially.

If you're a new member of a health insurance program, you can change your plan once for any reason during the first three months of being covered.

Starting July 1, 2004, if you choose or are automatically assigned to a federally qualified health center, rural health clinic, or primary care clinic, it means your coverage is with that facility, not a specific individual working there. This applies whether you are seeing a doctor, dentist, or optometrist who is employed by the clinic. Importantly, you still have the right to choose a primary care physician within your health plan's service area.