Section 1357.15 Of Article 3.1. Small Employer Group Access To Contracts For Health Care Services From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 3.1.
1357.15
. (a) At least 20 business days prior to renewing or
amending a plan contract subject to this article which will be in
force on the operative date of this article, a plan shall file a
notice of material modification with the director in accordance with
the provisions of Section 1352. The notice of material modification
shall include a statement certifying that the plan is in compliance
with subdivision (j) of Section 1357 and Section 1357.12. The
certified statement shall set forth the standard employee risk rate
for each risk category and the highest and lowest risk adjustment
factors that will be used in setting the rates at which the contract
will be renewed or amended. 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 that
the plan contract does not comply with the requirements of this
chapter.
(b) At least 20 business days prior to offering a plan contract
subject to this article, all plans shall file a notice of material
modification with the director in accordance with the provisions of
Section 1352. The notice of material modification shall include a
statement certifying that the plan is in compliance with subdivision
(j) of Section 1357 and Section 1357.12. The certified statement
shall set forth the standard employee risk rate for each risk
category and the highest and lowest risk adjustment factors that will
be used in setting the rates at which the contract will be offered.
Plans that will be offering to a small employer plan contracts
approved by the director prior to the effective date of this article
shall file a notice of material modification in accordance with this
subdivision. 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 that the plan
contract does not comply with the requirements of this chapter.
(c) Prior to making any changes in the risk categories, risk
adjustment factors or standard employee risk rates filed with the
director pursuant to subdivision (a) or (b), the plan shall file as
an amendment a statement setting forth the changes and certifying
that the plan is in compliance with subdivision (j) of Section 1357
and Section 1357.12. A plan may commence offering plan contracts
utilizing the changed risk categories set forth in the certified
statement on the 31st day from the date of the filing, or at an
earlier time determined by the director, unless the director
disapproves the amendment by written notice, stating the reasons
therefor. If only the standard employee risk rate is being changed,
and not the risk categories or risk adjustment factors, a plan may
commence offering plan contracts utilizing the changed standard
employee risk rate upon filing the certified statement unless the
director disapproves the amendment by written notice.
(d) Periodic changes to the standard employee risk rate that a
plan proposes to implement over the course of up to 12 consecutive
months may be filed in conjunction with the certified statement filed
under subdivision (a), (b), or (c).
(e) Each plan shall maintain at its principal place of business
all of the information required to be filed with the director
pursuant to this section.
(f) Each plan shall make available to the director, on request,
the risk adjustment factor used in determining the rate for any
particular small employer.
(g) Nothing in this section shall be construed to limit the
director's authority to enforce the rating practices set forth in
this article.