Healthy FamiliesDefinitions
Section § 12693.01
This section states that the specific definitions explained within this chapter will be used to interpret this part of the law, unless there's a specific context that needs a different understanding.
Section § 12693.02
This law defines who can be considered an 'applicant' for a child’s health coverage program. Generally, it describes an applicant as someone over 18, like a parent or guardian, applying on a child's behalf. It also extends the definition to include certain minors, like those who are emancipated, living independently, or applying for their own or their child's health coverage.
Section § 12693.03
This section defines the term "Board" as referring to the Managed Risk Medical Insurance Board.
Section § 12693.04
This section defines a 'child' as someone under 19 who qualifies for a specific program detailed in Chapter 9, starting with Section 12693.70.
Section § 12693.05
This section defines a "county organized health system" as a health care organization that makes contracts with the State Department of Health Services. Its purpose is to provide full healthcare services to all eligible people who reside in the county and receive Medi-Cal benefits. Such an organization must be directly operated by a public entity set up by the county government following specific sections of the Welfare and Institutions Code or the Health and Safety Code.
Section § 12693.06
The 'family contribution' is the amount a person pays for themselves or their eligible children to join and take part in a specific program. This does not cover copayments for services that are insured. Additionally, someone else, called a family contribution sponsor, can pay this amount under certain conditions.
Section § 12693.07
This section defines the term "Fund" as referring specifically to the Healthy Families Fund.
Section § 12693.08
This law defines a "local initiative" as a prepaid health plan set up or recognized by county governments, or formed by key players in a given area, to provide thorough medical care to those who qualify for Medi-Cal, California's Medicaid program. The law specifically mentions several sections of the Welfare and Institutions Code that establish these local initiatives.
Section § 12693.09
A "participating dental plan" is a dental service plan that legally offers services and covers costs like insurance or membership plans in exchange for payments. These plans must work with a board to provide dental coverage to subscribers.
There are two main types of participating dental plans: (a) dental insurers that have a valid certificate from the commissioner, or (b) specialized health care service plans defined by a specific section of the Health and Safety Code.
Section § 12693.10
A 'participating health plan' is defined as any plan that provides or arranges for healthcare services and that has an agreement with the state to offer coverage to subscribers of a specific program. This can include private health insurers with state approval, health care service plans, county-organized health systems, or local initiatives.
Section § 12693.11
A "participating vision care plan" is basically a type of vision insurance that covers personal vision services. There are two main types that qualify: one is a vision insurer that has a valid certificate from the insurance commissioner, and the other is a specialized healthcare service plan as defined in another part of the Health and Safety Code. To participate, these plans must work with a governing board to offer coverage to people subscribed to the program.
Section § 12693.12
This law section defines the 'Program' as the Healthy Families Program. It includes two main parts: a purchasing pool that helps give health coverage to children in families who don't have affordable employer-based dependent coverage, and a purchasing credit system that helps families with employer-based coverage by offering financial help for their children's coverage costs.
Section § 12693.13
This law section defines a 'purchasing credit member' as either an adult applicant or a child who is eligible for and takes part in the purchasing credit aspect of the program.
Section § 12693.14
The term “Subscriber” refers to either an adult who applies for or a child who can join and is part of the health care program's purchasing pool.
Section § 12693.15
This law explains what "supplemental coverage" means within a specific insurance program. It refers to extra health insurance that can be bought either from a private insurer approved by the Insurance Commissioner or a health care service plan. The goal is to make sure that the supplemental coverage is at least 95% as good, from a value standpoint, as the main coverage offered to members in the program's purchasing pool. It also ensures that the costs members pay, such as deductibles or co-pays, should be adjusted to match those paid by members in the main purchasing pool, ensuring fairness.
Section § 12693.16
This section defines a "Geographic managed care plan" as a company that works under a special contract set by specific California welfare laws aimed at managing healthcare services in a certain area.
Section § 12693.17
In simple terms, a "family contribution sponsor" is a person or organization that covers the payment necessary for a family's health coverage application for a year. If this sponsor is covering the first year, the payment must be made when the application is first submitted.
Section § 12693.045
A "community provider plan" is a health plan recognized by the board in each area for having the most traditional and safety net healthcare providers within its network.
Section § 12693.065
A "family value package" refers to a set of health, dental, and vision insurance plans offered to subscribers that provide the lowest prices in a specific geographic area. The board can also consider packages that are slightly above the lowest price, either by a fixed percentage or dollar amount, as part of this value package option.
Section § 12693.105
This law states that a health care service plan must be designed to function as a geographic managed care plan. Essentially, the plan should be organized to manage the delivery of health care services within a specific geographical area.