Section 1357.615 Of Article 3.17. Grandfathered Small Employer Plans From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 3.17.
1357.615
. (a) At least 20 business days prior to renewing or
amending a small employer health care service plan contract subject
to 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 (i) of
Section 1357.600 and Section 1357.612. 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) 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), the plan shall file as an
amendment a statement setting forth the changes and certifying that
the plan is in compliance with subdivision (i) of Section 1357.600
and Section 1357.612. A plan may commence 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 utilizing the changed
standard employee risk rate upon filing the certified statement
unless the director disapproves the amendment by written notice.
(c) 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) or (b).
(d) 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.
(e) Each plan shall make available to the director, on request,
the risk adjustment factor used in determining the rate for any
particular small employer.
(f) Nothing in this section shall be construed to limit the
director's authority to enforce the rating practices set forth in
this article.