Individual Access to Health Care Coverage
Cal. HSC § 1399.845
California Statutes
For purposes of this article, the following
definitions shall apply: (a) “Child” means a child described in
Section of the Government Code and subdivisions (
n) to (p), inclusive, of
Section 599.500 of Title of the California Code of Regulations. (b) “Dependent” means the spouse or registered domestic partner, child, or parent or stepparent pursuant to
Section 1374.1, of an individual, subject to applicable terms of the health benefit plan. (c) “Exchange” means the California Health Benefit Exchange created by
Section of the Government Code. (d) “Family” means the subscriber and their dependent or dependents. (e) “Grandfathered health plan” has the same meaning as defined in
Section of PPACA. (f) “Health benefit plan” means an individual or group health care service plan contract that provides medical, hospital, and surgical benefits. The term does not include a specialized health care service plan contract, a health care service plan contract provided in the Medi-Cal program (Chapter 7 (commencing with
Section 14000) of Part of Division of the Welfare and Institutions Code), the Healthy Families Program (Part 6.2 (commencing with
Section 12693) of Division of the Insurance Code), the Access for Infants and Mothers Program (Part 6.3 (commencing with
Section 12695) of Division of the Insurance Code), or the program under
Part 6.4 (commencing with
Section 12699.50) of Division of the Insurance Code, or Medicare supplement coverage, to the extent consistent with PPACA. (g) “Policy year” means the period from January to December 31, inclusive. (h) “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 pursuant to that law. (i) “Preexisting condition provision” means a contract provision that excludes coverage for charges or expenses incurred during a specified period following the enrollee’s effective date of coverage, as to a condition for which medical advice, diagnosis, care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage. (j) “Rating period” means the calendar year for which premium rates are in effect pursuant to subdivision (
d) of