Section 1357.604 Of Article 3.17. Grandfathered Small Employer Plans From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 3.17.
1357.604
. (a) (1) A plan shall fairly and affirmatively renew a
grandfathered health plan contract with a small employer.
(2) Each plan shall make available to each small employer all
nongrandfathered small employer health care service plan contracts
that the plan offers and sells to small employers or to associations
that include small employers in this state consistent with Article
3.1 (commencing with Section 1357).
(3) No plan or solicitor shall induce or otherwise encourage a
small employer to separate or otherwise exclude an eligible employee
from a health care service plan contract that is provided in
connection with the employee's employment or membership in a
guaranteed association.
(b) Every plan shall file with the director the reasonable
employee participation requirements and employer contribution
requirements that will be applied in renewing its grandfathered
health care service plan contracts. Participation requirements shall
be applied uniformly among all small employer groups, except that a
plan may vary application of minimum employee participation
requirements by the size of the small employer group and whether the
employer contributes 100 percent of the eligible employee's premium.
Employer contribution requirements shall not vary by employer size. A
health care service plan shall not establish a participation
requirement that (1) requires a person who meets the definition of a
dependent in subdivision (a) of Section 1357.600 to enroll as a
dependent if he or she is otherwise eligible for coverage and wishes
to enroll as an eligible employee and (2) allows a plan to reject an
otherwise eligible small employer because of the number of persons
that waive coverage due to coverage through another employer. Members
of an association eligible for health coverage under subdivision (n)
of Section 1357.600, but not electing any health coverage through
the association, shall not be counted as eligible employees for
purposes of determining whether the guaranteed association meets a
plan's reasonable participation standards.
(c) No plan or solicitor shall, directly or indirectly, engage in
the following activities:
(1) Encourage or direct small employers to refrain from filing an
application for coverage or renewal of coverage with a plan because
of the health status, claims experience, industry, occupation of the
small employer, or geographic location provided that it is within the
plan's approved service area.
(2) Encourage or direct small employers to seek coverage from
another plan, or coverage offered through the California Health
Benefit Exchange, because of the health status, claims experience,
industry, occupation of the small employer, or geographic location
provided that it is within the plan's approved service area.
(d) A plan shall not, directly or indirectly, enter into any
contract, agreement, or arrangement with a solicitor that provides
for or results in the compensation paid to a solicitor for the sale
of a health care service plan contract to be varied because of the
health status, claims experience, industry, occupation, or geographic
location of the small employer. This subdivision does not apply to a
compensation arrangement that provides compensation to a solicitor
on the basis of percentage of premium, provided that the percentage
shall not vary because of the health status, claims experience,
industry, occupation, or geographic area of the small employer or
small employer's employees.
(e) A policy or contract that covers a small employer, as defined
in Section 1304(b) of PPACA and in subdivision (k) of Section
1357.600 shall not establish rules for eligibility, including
continued eligibility, of an individual, or dependent of an
individual, to enroll under the terms of the plan based on any of the
following health status-related factors:
(1) Health status.
(2) Medical condition, including physical and mental illnesses.
(3) Claims experience.
(4) Receipt of health care.
(5) Medical history.
(6) Genetic information.
(7) Evidence of insurability, including conditions arising out of
acts of domestic violence.
(8) Disability.
(9) Any other health status-related factor as determined by any
federal regulations, rules, or guidance issued pursuant to Section
2705 of the federal Public Health Service Act.
(f) A plan shall comply with the requirements of Section 1374.3.