Individual Access to Contracts for Health Care Services
Cal. HSC § 1399.815
California Statutes
(
a) At least business days prior to renewing or amending a plan contract subject to this article, or at least business days prior to the initial offering of a plan contract subject to this article, a plan shall file a notice of an amendment with the director in accordance with the provisions of
Section 1352. The notice of an amendment shall include a statement certifying that the plan is in compliance with subdivision (
a) of
Section 1399.805 and with
Section 1399.811. Any action by the director, as permitted under
Section 1352, to disapprove, suspend, or postpone the plan’s use of a plan contract shall be in writing, specifying the reasons the plan contract does not comply with the requirements of this chapter. (
b) Prior to making any changes in the premium, the plan shall file an amendment in accordance with the provisions of
Section 1352, and shall include a statement certifying the plan is in compliance with subdivision (
a) of
Section 1399.805 and with
Section 1399.811. All other changes to a plan contract previously filed with the director pursuant to subdivision (
a) shall be filed as an amendment in accordance with the provisions of
Section 1352, unless the change otherwise would require the filing of a material modification. (c)
(1) On and after January 1, 2014, and except as provided in paragraph (2), this
section shall apply only to individual grandfathered health plan contracts previously issued pursuant to this
section to federally eligible defined individuals.
(2) If
Section 5000A of the Internal Revenue Code, as added by
Section of PPACA, is repealed or amended to no longer apply to the individual market, as defined in
Section of the federal Public Health Service Act (42 U.S.C.
Section 300gg-91), paragraph (1) shall become inoperative on the date of that repeal or amendment and this
section shall apply to plan contracts issued, amended, or renewed on or after that date.
(3) For purposes of this subdivision, the following
definitions apply: (A) “Grandfathered health plan” has the same meaning as that term is defined in
Section of PPACA. (B) “PPACA” means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care Education and Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued pursuant to that law.