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Section 1399.804 Of Article 11.5. Individual Access To Contracts For Health Care Services From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 11.5.
1399.804
. (a) Commencing January 1, 2001, a plan shall fairly and
affirmatively offer, market, and sell the health care service plan
contracts described in subdivision (d) of Section 1366.35 that are
sold to individuals or to associations that include individuals to
all federally eligible defined individuals in each service area in
which the plan provides or arranges for the provision of health care
services. Each plan shall make available to each federally eligible
defined individual the identified health care service plan contracts
which the plan offers and sells to individuals or to associations
that include individuals.
(b) The plan may not reject an application from a federally eligible defined individual for a health care service plan contract under the following circumstances:
(1) The federally eligible defined individual as defined by subdivision (c) of Section 1399.801 agrees to make the required premium payments.
(2) The federally eligible defined individual, and his or her dependents who are to be covered by the plan contract, work or reside in the service area in which the plan provides or otherwise arranges for the provision of health care services.
(c) No plan or solicitor shall, directly or indirectly, encourage or direct federally eligible defined individuals to refrain from filing an application for coverage with a plan because of health status, claims experience, industry, occupation, receipt of health care, genetic information, evidence of insurability, including conditions arising out of acts of domestic violence, disability, or geographic location provided that it is within the plan's approved service area.
(d) No plan shall, 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 health status, claims experience, industry, occupation, receipt of health care, genetic information, evidence of insurability, including conditions arising out of acts of domestic violence, disability, or geographic location of the individual.
(e) Each plan shall comply with the requirements of Section 1374.3.
(b) The plan may not reject an application from a federally eligible defined individual for a health care service plan contract under the following circumstances:
(1) The federally eligible defined individual as defined by subdivision (c) of Section 1399.801 agrees to make the required premium payments.
(2) The federally eligible defined individual, and his or her dependents who are to be covered by the plan contract, work or reside in the service area in which the plan provides or otherwise arranges for the provision of health care services.
(c) No plan or solicitor shall, directly or indirectly, encourage or direct federally eligible defined individuals to refrain from filing an application for coverage with a plan because of health status, claims experience, industry, occupation, receipt of health care, genetic information, evidence of insurability, including conditions arising out of acts of domestic violence, disability, or geographic location provided that it is within the plan's approved service area.
(d) No plan shall, 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 health status, claims experience, industry, occupation, receipt of health care, genetic information, evidence of insurability, including conditions arising out of acts of domestic violence, disability, or geographic location of the individual.
(e) Each plan shall comply with the requirements of Section 1374.3.
