Section 1399.864 Of Article 11.8. Individual Access To Health Care Coverage From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 11.8.
1399.864
. (a) For purposes of this article, a bridge plan product
shall mean an individual health benefit plan, as defined in
subdivision (f) of Section 1399.845, that is offered by a health care
service plan licensed under this chapter that contracts with the
Exchange pursuant to Title 22 (commencing with Section 100500) of the
Government Code.
(b) Until December 31, 2014, a health care service plan that
contracts with the California Health Benefit Exchange to offer a
qualified bridge plan product pursuant to Section 100504 of the
Government Code shall do all of the following:
(1) As of the effective date of this section, if the health care
service plan has not been approved by the director to offer
individual health benefit plans pursuant to this chapter, the plan
shall file a material modification pursuant to Section 1352 to expand
its license to include individual health benefit plans.
(2) As of the effective date of this section, if the health care
service plan has been approved by the director to offer individual
health benefit plans pursuant to this chapter, the plan shall,
pursuant to Section 1352, file an amendment to expand its license to
include a bridge plan product as an individual health benefit plan.
(c) During the time the health care service plan's material
modification or amendment is pending approval by the director, the
health care service plan shall be deemed to comply with subdivision
(b) of Section 100507 of the Government Code.
(d) A health care service plan shall maintain a medical loss
ratio of 85 percent for the bridge plan product. A health care
service plan shall utilize, to the extent possible, the same
methodology for calculating the medical loss ratio for the bridge
plan product that is used for calculating the health care service
plan medical loss ratio pursuant to Section 1367.003 and shall report
its medical loss ratio for the bridge plan product to the department
as provided in Section 1367.003.
(e) Notwithstanding subdivision (a) of Section 1399.849, a health
care service plan selling a bridge plan product shall not be required
to fairly and affirmatively offer, market, and sell the health care
service plan's bridge plan product except to individuals eligible for
the bridge plan product pursuant to the State Department of Health
Care Services and the Medi-Cal managed care plan's contract entered
into pursuant to Section 14005.70 of the Welfare and Institutions
Code, provided the health care service plan meets the requirements of
subdivision (b) of Section 14005.70 of the Welfare and Institutions
Code.
(f) Notwithstanding subdivision (c) of Section 1399.849, a health
care service plan selling a bridge plan product shall provide an
initial open enrollment period of six months, and an annual
enrollment period and a special enrollment period consistent with the
annual enrollment and special enrollment periods of the Exchange.
(g) This section shall become inoperative on the October 1 that is
five years after the date that federal approval of the bridge plan
option occurs, and, as of the second January 1 thereafter, is
repealed, unless a later enacted statute that is enacted before that
date deletes or extends the dates on which it becomes inoperative and
is repealed.