Section 100503.5.
100503.5. (a) The Exchange shall provide payments equaling the cost of providing coverage of services described in Section 18023(b)(1)(B)(i) of Title 42 of the United States Code to individuals enrolled in a qualified health plan through the Exchange in the individual market. The payments shall not be less than one dollar ($1) per enrollee per month. […]
Section 100503.7.
100503.7. (a) (1) If the board requires, or has previously required in its contracts with qualified health plans, a qualified health plan to report on cost reduction efforts, quality improvements, or disparity reductions, the board shall make public on the internet website of the Exchange plan-specific data on cost reduction efforts, quality improvements, and disparity reductions. (2) Data […]
Section 100503.8.
100503.8. The board shall engage in health oversight activities relating to Exchange operations, including, but not limited to, audits, investigations, inspections, evaluations, analyses, data collection through routine reporting, and any other activities for oversight of the Exchange, including qualified health plan contracts with health care service plans and health insurers. In performing those duties, the […]
Section 100503.9.
100503.9. (a) (1) Beginning no later than September 1, 2023, and at least monthly thereafter, the Exchange shall request from the Employment Development Department the following information of each new applicant for unemployment compensation, state disability, and paid family leave: (A) Last name. (B) First name. (C) Middle initial. (D) Social security number. (E) Date of birth. (F) Race or ethnicity, to the […]
Section 100504.
100504. (a) The board may do the following: (1) With respect to individual coverage made available in the Exchange, collect premiums and assist in the administration of subsidies. (2) Enter into contracts. (3) Sue and be sued. (4) Receive and accept gifts, grants, or donations of moneys from an agency of the United States, an agency of the state, and […]
Section 100504.5.
100504.5. (a) To the extent approved by the appropriate federal agency, for the purpose of implementing the option in paragraph (7) of subdivision (a) of Section 100504, the Exchange shall make available bridge plan products to individuals specified in Section 14005.70 of the Welfare and Institutions Code. In implementing this requirement, the Exchange, using the selective […]
Section 100504.6.
100504.6. (a) The Exchange shall have the authority to adopt regulations to implement the provisions of Section 100504.5. Prior to the adoption of regulations, the board and its staff shall meet the requirement of subdivision (t) of Section 100503 in implementing the bridge plan option. Until January 1, 2016, the adoption, amendment, or repeal of a […]
Section 100505.
100505. (a) The board shall establish and use a competitive process to select participating carriers and any other contractors under this title. Any contract entered into pursuant to this title shall be exempt from Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and shall be exempt from the review or […]
Section 100506.
100506. (a) The board shall establish an appeals process for prospective and current enrollees of the Exchange that complies with all requirements of the federal act concerning the role of a state Exchange in facilitating federal appeals of Exchange-related determinations. Once the federal regulations concerning appeals have been issued in final form by the United States […]
Section 100506.1.
100506.1. An applicant or enrollee has the right to appeal any of the following: (a) Any action or inaction related to the individual’s eligibility for or enrollment in an insurance affordability program, or for advance payment of premium tax credits and cost-sharing reductions, or the amount of the advance payment of the premium tax credit and […]