Section 1399.825 Of Article 11.7. Child Access To Health Care Coverage From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 11.7.
1399.825
. As used in this article:
(a) "Child" means any individual under 19 years of age.
(b) "Individual grandfathered plan coverage" means health care
coverage in which an individual was enrolled on March 23, 2010,
consistent with Section 1251 of PPACA and any rules or regulations
adopted pursuant to that law.
(c) "Initial open enrollment period" means the open enrollment
period beginning on January 1, 2011, and ending 60 days thereafter.
(d) "Late enrollee" means a child without coverage who did not
enroll in a health care service plan contract during an open
enrollment period because of any of the following:
(1) The child lost dependent coverage due to termination or change
in employment status of the child or the person through whom the
child was covered; cessation of an employer's contribution toward an
employee or dependent's coverage; death of the person through whom
the child was covered as a dependent; legal separation; divorce; loss
of coverage under the Healthy Families Program, the Access for
Infants and Mothers Program, or the Medi-Cal program; or adoption of
the child.
(2) The child became a resident of California during a month that
was not the child's birth month.
(3) The child is born as a resident of California and did not
enroll in the month of birth.
(4) The child is mandated to be covered pursuant to a valid state
or federal court order.
(e) "Open enrollment period" means the annual open enrollment
period, subsequent to the initial open enrollment period, applicable
to each individual child that is the month of the child's birth date.
(f) "PPACA" means the federal Patient Protection and Affordable
Care Act (Public Law 111-148), as amended by the Health Care and
Education Reconciliation Act of 2010 (Public Law 111-152), and any
subsequent rules or regulations issued pursuant to that law.
(g) "Preexisting condition exclusion" means, with respect to
coverage, a limitation or exclusion of benefits relating to a
condition based on the fact that the condition was present before the
date of enrollment of the coverage, whether or not any medical
advice, diagnosis, care, or treatment was recommended or received
before that date.
(h) "Responsible party for a child" means an adult having custody
of the child or with responsibility for the financial needs of the
child, including the responsibility to provide health care coverage.
(i) "Standard risk rate" means the lowest rate that can be offered
for a child with the same benefit plan, effective date, age,
geographic region, and family status.