(a)CA 保险 Code § 10753(a) “代理人或经纪人”指根据第1部第2章第5章（自第1621条起）获得许可的个人或实体。
(b)CA 保险 Code § 10753(b) “福利计划设计”指承运人向小型雇主、包含小型雇主的协会受托人或个人（如果保险通过就业提供或由雇主赞助）发行的特定健康保险产品。它包括所涵盖的服务以及共同支付和免赔额的水平，并且可能包括提供这些服务的专业提供者以及提供这些服务的地点。福利计划设计也可以是质量医疗服务融资和交付的综合系统，该系统对受保个人使用该系统具有显著激励。
(c)CA 保险 Code § 10753(c) “承运人”指健康保险公司或任何其他编写、发行或管理涵盖小型雇主员工的健康福利计划的实体，无论合同或主保单持有人的所在地如何。
(d)CA 保险 Code § 10753(d) “子女”指《政府法典》第22775条以及《加州法规》第2篇第599.500条的(n)至(p)款（含）所述的子女。
(e)CA 保险 Code § 10753(e) “受抚养人”指合格雇员的配偶、注册同居伴侣或子女，受涵盖该雇员的健康福利计划的适用条款约束，并包括担保协会成员的受抚养人，如果该协会在根据(s)款确定其成员构成时选择将其受抚养人纳入其健康保险范围。
(f)CA 保险 Code § 10753(f) “合格雇员”指以下任一情况：
(1)CA 保险 Code § 10753(f)(1) 任何永久雇员，其在小型雇主的常规营业地点全职积极参与小型雇主业务，每月平均每周工作30小时的正常工作周，并已满足任何法定授权的适用等待期要求。该术语不包括独资经营者或其配偶、合伙企业的合伙人或其配偶，或兼职、临时或替代工作的雇员。它包括通过担保协会获得保险的本款所定义的任何合格雇员。通过担保协会购买保险的雇主的雇员，如果他们除了雇主雇佣的人数外符合定义，则为合格雇员。永久雇员每周工作至少20小时但不超过29小时，如果以下所有四项条件均适用，则为合格雇员：
(A)CA 保险 Code § 10753(f)(1)(A) 除工作小时数外，该雇员在其他方面符合合格雇员的定义。
(B)CA 保险 Code § 10753(f)(1)(B) 雇主根据健康福利计划向雇员提供健康保险。
(C)CA 保险 Code § 10753(f)(1)(C) 所有情况相似的个人均根据健康福利计划获得保险。
(D)CA 保险 Code § 10753(f)(1)(D) 雇员在上一季度至少50%的周内，每周正常工作至少20小时。保险公司可以要求任何必要的信息来证明所涉小时数和时间段，包括但不限于工资记录以及雇员的工资和税务申报。
(2)Copy CA 保险 Code § 10753(f)(2)
(s)Copy CA 保险 Code § 10753(f)(2)(s)款所定义的担保协会的任何成员。
(g)CA 保险 Code § 10753(g) “参保人”指通过该计划从参与承运人处获得健康保险的合格雇员或受抚养人。
(h)CA 保险 Code § 10753(h) “交易平台”指根据《政府法典》第100500条设立的加州健康福利交易平台。
(i)CA 保险 Code § 10753(i) “财务受损”就本章而言，指在本章生效之日或之后，未破产且属于以下任一情况的承运人：
(1)CA 保险 Code § 10753(i)(1) 被专员认定可能无法履行其合同义务。
(2)CA 保险 Code § 10753(i)(2) 被有管辖权的法院置于重组或保全令之下。
(j)CA 保险 Code § 10753(j) “健康福利计划”指第106条所定义的健康保险保单，适用于小型雇主的受保合格雇员及其受抚养人。该术语不包括根据与美国政府签订的合同提供的医疗保险服务，或根据《联邦公共卫生服务法》第2722条和第2791条所述的、受第10701条约束的提供例外福利的保险。
(k)CA 保险 Code § 10753(k) “现行业务”指承运人向小型雇主发行的现有健康福利计划。
(l)CA 保险 Code § 10753(l) “延迟参保人”指在小型雇主提供的健康福利计划的初次参保期内（该期限符合根据第10753.05条规定的期限）拒绝参保，但随后又请求参保该小型雇主健康福利计划的合格雇员或受抚养人，除非该雇员或受抚养人符合根据第10753.05条规定的特殊参保期的资格。它也指保证协会的任何成员以及任何其他有资格通过保证协会购买保险的人，当该人在保证协会健康福利计划的初次参保期内（该期限符合根据第10753.05条规定的期限）未能购买保险，但随后又请求参保该计划，除非该雇员或受抚养人符合根据第10753.05条规定的特殊参保期的资格。
(m)CA 保险 Code § 10753(m) “新业务”指签发给小型雇主的健康福利计划，且该计划并非承运人现行有效的业务。
(n)CA 保险 Code § 10753(n) “既往病症条款”指一项保单条款，该条款排除对被保险人承保生效日期之后特定期间内发生的费用或开支的承保，涉及在承保生效日期紧接之前的特定期间内曾被建议或接受过医疗咨询、诊断、护理或治疗的病症。
(o)CA 保险 Code § 10753(o) “可信承保”指：
(1)CA 保险 Code § 10753(o)(1) 任何由健康保险公司、医疗服务计划、兄弟互助福利社、自保雇主计划或本州或其他地方的任何其他实体签发或管理的个人或团体保单、合同或计划，且该计划安排或提供不旨在补充其他私人或政府计划的医疗、住院和外科承保。该术语包括延续或转换承保，但不包括仅限意外、信用、现场医疗诊所承保、残疾收入、医疗保险补充、长期护理、牙科、视力、作为责任保险补充签发的承保、因工人赔偿或类似法律产生的保险、汽车医疗支付保险，或无论过错与否均可支付福利且法律规定必须包含在任何责任保险单或等效自保中的保险。
(2)CA 保险 Code § 10753(o)(2) 根据联邦社会保障法第XVIII篇（42 U.S.C. Sec. 1395 et seq.）的联邦医疗保险计划。
(3)CA 保险 Code § 10753(o)(3) 根据联邦社会保障法第XIX篇（42 U.S.C. Sec. 1396 et seq.）的医疗补助计划。
(4)CA 保险 Code § 10753(o)(4) 本州或其他地方提供的任何其他公共资助的医疗、住院和外科护理计划。
(5)CA 保险 Code § 10753(o)(5) 美国法典第10篇第55章（自第1071条起）（军人医疗保健计划（CHAMPUS））。
(6)CA 保险 Code § 10753(o)(6) 印第安人健康服务或部落组织的医疗护理计划。
(7)CA 保险 Code § 10753(o)(7) 根据美国法典第5篇第89章（自第8901条起）提供的健康计划（联邦雇员健康福利计划（FEHBP））。
(8)CA 保险 Code § 10753(o)(8) 根据联邦公共卫生服务法第2701(c)(1)(I)条授权的联邦法规所定义的公共健康计划，该法案经第104-191号公法，即1996年联邦健康保险可携性与责任法案修订。
(9)CA 保险 Code § 10753(o)(9) 根据联邦和平队法第5(e)条（22 U.S.C. Sec. 2504(e)）的健康福利计划。
(10)CA 保险 Code § 10753(o)(10) 根据联邦公共卫生服务法第XXVII篇第2704条(c)款（42 U.S.C. Sec. 300gg-3(c)）所定义的任何其他可信承保。
(p)CA 保险 Code § 10753(p) “费率期”指承运人设定的保费费率有效的期间，且自健康福利计划签发或续保之日起不得少于12个月。
(q)Copy CA 保险 Code § 10753(q)
(1)Copy CA 保险 Code § 10753(q)(1) “小型雇主”指以下任一情况：
(r)CA 保险 Code § 10753(r) “Guaranteed association” means a nonprofit organization comprised of a group of individuals or employers who associate based solely on participation in a specified profession or industry, accepting for membership any individual or employer meeting its membership criteria which (1) includes one or more small employers as defined in subparagraph (A) of paragraph (1) of subdivision (q), (2) does not condition membership directly or indirectly on the health or claims history of any person, (3) uses membership dues solely for and in consideration of the membership and membership benefits, except that the amount of the dues
shall not depend on whether the member applies for or purchases insurance offered by the association, (4) is organized and maintained in good faith for purposes unrelated to insurance, (5) has been in active existence on January 1, 1992, and for at least five years prior to that date, (6) has been offering health insurance to its members for at least five years prior to January 1, 1992, (7) has a constitution and bylaws, or other analogous governing documents that provide for election of the governing board of the association by its members, (8) offers any benefit plan design that is purchased to all individual members and employer members in this state, (9) includes any member choosing to enroll in the benefit plan design offered to the association provided that the member has agreed to make the required premium payments, and (10) covers at least 1,000 persons with the carrier with which it contracts. The requirement of 1,000 persons may be met if component chapters of a statewide association contracting
separately with the same carrier cover at least 1,000 persons in the aggregate.
This subdivision applies regardless of whether a master policy by an admitted insurer is delivered directly to the association or a trust formed for or sponsored by an association to administer benefits for association members.
For purposes of this subdivision, an association formed by a merger of two or more associations after January 1, 1992, and otherwise meeting the criteria of this subdivision shall be deemed to have been in active existence on January 1, 1992, if its predecessor organizations had been in active existence on January 1, 1992, and for at least five years prior to that date and otherwise met the criteria of this subdivision.
(s)CA 保险 Code § 10753(s) “Members of a guaranteed association” means any individual or employer meeting the association’s membership criteria if that person is a
member of the association and chooses to purchase health coverage through the association. At the association’s discretion, it may also include employees of association members, association staff, retired members, retired employees of members, and surviving spouses and dependents of deceased members. However, if an association chooses to include those persons as members of the guaranteed association, the association must so elect in advance of purchasing coverage from a plan. Health plans may require an association to adhere to the membership composition it selects for up to 12 months.
(t)CA 保险 Code § 10753(t) “Grandfathered health plan” has the meaning set forth in Section 1251 of PPACA.
(u)CA 保险 Code § 10753(u) “Nongrandfathered health benefit plan” means a health benefit plan that is not a grandfathered health plan.
(v)CA 保险 Code § 10753(v) “Plan year” has the meaning set
forth in Section 144.103 of Title 45 of the Code of Federal Regulations.
(w)CA 保险 Code § 10753(w) “PPACA” means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder.
(x)CA 保险 Code § 10753(x) “Waiting period” means a period that is required to pass with respect to the employee before the employee is eligible to be covered for benefits under the terms of the contract.
(y)CA 保险 Code § 10753(y) “Registered domestic partner” means a person who has established a domestic partnership as described in Section 297 of the Family Code.
(z)CA 保险 Code § 10753(z) “Family” means the policyholder and his or her dependents.
