Title INS — California Ins. Code
0 chapters · 3,633 sections in this title.
Ins. Code § 10800 Section 10800
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This chapter shall be known as the Private Health Care Voluntary Purchasing Alliance Act.
Ins. Code § 10801 Section 10801
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The purpose of this chapter is to improve the competition in the pricing and delivering of health care coverage for employers and small employers. It does so by allowing for the establishment of private competing purchasing alliances through which eligible employers or small empl…
Ins. Code § 10802 Section 10802
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This chapter is also intended to provide a meaningful choice of high quality, fairly priced health care providers, and health care coverage for participating employers and employees of a purchasing alliance through a system that is fair, efficient, and accountable to its members …
Ins. Code § 10803 Section 10803
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It is envisioned that a purchasing alliance will contract with qualified group carriers to provide a meaningful choice of carriers providing health benefit plans or ancillary benefit plans to purchasing alliance participants.
Ins. Code § 10810 Section 10810
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As used in this chapter: (a) “Ancillary benefit plan” means a policy or contract written or administered by a participating carrier that covers dental or vision benefits for the covered eligible employees of an employer or small employer and their dependents. (b) “Appropriate Reg…
Ins. Code § 10820 Section 10820
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(a) The commissioner shall regulate the establishment and conduct of purchasing alliances as set forth in this chapter. (b) No person or entity may market, sell, offer, or contract for a package of one or more health benefit plans underwritten by two or more carriers to two or mo…
Ins. Code § 10821 Section 10821
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(a) An entity seeking to obtain a certificate of registration to act as a purchasing alliance shall complete and file with the commissioner an application designated by the commissioner. An application will not be deemed filed until all information necessary to properly process t…
Ins. Code § 10821.5 Section 10821.5
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(a) The purchasing alliance shall furnish an annual financial audit to the commissioner on the forms provided by the commissioner. The annual financial audit may be filed either on a calendar year basis on or before March 31, or, if approved in writing by the commissioner in resp…
Ins. Code § 10822 Section 10822
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After the issuance or reissuance of a certificate of registration to act as a purchasing alliance, the holder shall continue to comply with the requirements as to its business set forth in this chapter and in the other applicable sections of this code, and in the other laws of th…
Ins. Code § 10823 Section 10823
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In addition to any other grounds specified in this chapter, the following constitute grounds for denial, nonrenewal, suspension, or revocation of an application or existing certificate of registration, following notice and an opportunity for hearing: (a) Failure to comply with th…
Ins. Code § 10824 Section 10824
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(a) The commissioner may take disciplinary action against a purchasing alliance if the commissioner determines that the purchasing alliance has committed any of the acts set forth in Section 10823. The disciplinary action may include censuring the purchasing alliance, or prohibit…
Ins. Code § 10825 Section 10825
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(a) A purchasing alliance whose certificate has been revoked or suspended for more than one year may petition the commissioner to reinstate the certificate as provided by Section 11522 of the Government Code. No petition may be considered if the petitioner is under criminal sente…
Ins. Code § 10826 Section 10826
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(a) Any person who violates any provision of this chapter, or who violates any rule or order adopted or issued pursuant to this chapter, shall be liable for a civil penalty not to exceed two thousand five hundred dollars ($2,500) for each violation, which shall be assessed and re…
Ins. Code § 10830 Section 10830
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No owner, officer, partner, or board members or members of their household nor any management personnel of the alliance may be employed by, be a consultant for, be a member of the board of directors of, be affiliated with an agent of, or otherwise be a representative of any carri…
Ins. Code § 10840 Section 10840
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A purchasing alliance shall do all of the following: (a) Set reasonable fees, which may vary by employer or small employer size, in the purchasing alliance that will finance reasonable and necessary costs incurred in marketing, selling, servicing, and administering the purchasing…
Ins. Code § 10841 Section 10841
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(a) A purchasing alliance shall comply with all requirements pertaining to the underwriting, rating and renewal practices for small employers, pursuant to subdivisions (a) and (b) of Section 1357.12 of , and subdivision (f) of Section 1357.03 of, the Health and Safety Code, and s…
Ins. Code § 10842 Section 10842
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A purchasing alliance may do any of the following: (a) Contract with qualified independent third parties for any services necessary to carry out the powers and duties authorized or required by this chapter. (b) Employ necessary staff. (c) Sue or be sued, including taking any lega…
Ins. Code § 10843 Section 10843
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A purchasing alliance shall not do any of the following: (a) Purchase health care services, assume risk for the cost or provision of health services, or otherwise contract with health care providers for the provision of health care services directly to enrollees. (b) Exclude a sm…
Ins. Code § 10844 Section 10844
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A purchasing alliance may offer coverage pursuant to Chapter 9.5 (commencing with Section 10900).
Ins. Code § 10845 Section 10845
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(a) The commissioner shall require every purchasing alliance, as a condition precedent to receiving and holding a certificate of registration, to file and maintain in the commissioner’s office a writing designating an agent for service of process. The writing shall state the name…
Ins. Code § 10850 Section 10850
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(a) In order to be eligible to be a participating carrier, a carrier shall demonstrate the following operating characteristics satisfactory to the board: (1) Be licensed and approved as a carrier and in good standing with the appropriate regulatory authority. (2) The ability to p…
Ins. Code § 10851 Section 10851
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Every participating carrier shall: (a) Meet the standards established by the board pursuant to this chapter. (b) Provide any data required by the board. (c) Comply with, all applicable laws and regulations that regulate health care coverage or medical benefits provided to employe…
Ins. Code § 10853 Section 10853
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In contracts with participating carriers, the purchasing alliance may establish performance standards for specific contractual elements and penalties for failure to fulfill specific contractual obligations.
Ins. Code § 10854 Section 10854
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Nothing in this chapter shall prohibit a participating carrier from contracting with particular health care providers or types, classes, or categories of health care providers or setting reimbursement methodology.
Ins. Code § 10855 Section 10855
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In the event the participating carrier elects to terminate its participating agreement with a purchasing alliance, the participating carrier shall do both of the following: (a) Provide advance notice of its decision to the board. (b) Provide notice of the decision at least 180 da…
Ins. Code § 10856 Section 10856
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Nothing in this article shall be construed to limit the existing regulatory authority of the Department of Managed Health Care to regulate health care service plans or of the Department of Insurance to regulate disability or life insurers or hospital service plans. None of the re…
Ins. Code § 10860 Section 10860
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Contracts between the purchasing alliance and participating carriers shall specify how all premiums will be transmitted, and penalties and grace periods for payments.
Ins. Code § 10861 Section 10861
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Contracts between purchasing alliances and participating employers shall provide all of the following: (a) For administrative purposes, the purchasing alliance shall be the policyholder or contractholder of the health benefit plan or ancillary benefit plan on behalf of participat…
Ins. Code § 10870 Section 10870
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The board shall establish marketing standards to be used by participating carriers.
Ins. Code § 10871 Section 10871
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Any marketing, advertisement, or educational material for health benefit plans or ancillary benefit plans sold through the purchasing alliance shall be approved by the board prior to its use.
Ins. Code § 10872 Section 10872
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This article shall not be construed to prohibit or to compel the purchasing alliance or a participating carrier from using the services of an agent or broker.
Ins. Code § 10873 Section 10873
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(a) A participating carrier, agent, broker, contractor, or producer of a participating carrier, or independent insurance agent, broker, contractor, or producer may not engage, directly or indirectly, in an activity or marketing practice that would encourage small employers or eli…
Ins. Code § 10880 Section 10880
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In the event a purchasing alliance becomes insolvent, the commissioner shall maintain jurisdiction of the alliance for purposes of protection of the interests of the alliance enrollees. In that event, the commissioner may do any of the following: (a) Arrange for transfer of cover…
Ins. Code § 10885 Section 10885
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Purchasing alliances shall be exempt from requirements of licensure as a health care service plan or solicitor under Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code.
Ins. Code § 10886 Section 10886
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For purposes of carrier product disclosure, a purchasing alliance shall be considered an entity that provides administrative services, as is described in paragraph (1) of subdivision (d) of Section 10705. As such, a purchasing alliance shall not be required to provide a summary o…
Ins. Code § 10887 Section 10887
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Except as provided in subdivision (c) of Section 10820, nothing in this chapter shall apply to a health care service plan licensed under the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 (commencing with Section 1340) of the Health and Safety Code) when operating w…
Ins. Code § 1850.4 Section 1850.4
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In this chapter “casualty insurance” means all classes of insurance to which the provisions of this chapter are applicable and which are included within Sections 105, 107, 108, 110, 112, 113, 115, and, when written by insurers not admitted to transact fire or marine insurance, Se…
Ins. Code § 1850.5 Section 1850.5
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In this chapter “wilful” or “wilfully” in relation to an act or omission which constitutes a violation of this chapter means with actual knowledge or belief that such act or omission constitutes such violation and with specific intent to commit such violation.
Ins. Code § 1851 Section 1851
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The provisions of this chapter shall apply to all insurance on risks or on operations in this state, except: (a) Reinsurance, other than joint reinsurance to the extent stated in Article 5 (commencing with Section 1856). (b) Life insurance. (c) Insurance of vessels or craft, thei…
Ins. Code § 1851.1 Section 1851.1
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Notwithstanding subdivision (f) of Section 1851 or any other provision of law and except as and to the extent otherwise provided in Section 1854.5 and 11753.3, any classification of risks and premium rates or system of rating for insurance covering employers against their liabili…
Ins. Code § 1853.5 Section 1853.5
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With respect to any matters pertaining to the making of rates or rating systems, the preparation or making of insurance policy or bond forms, underwriting rules, surveys, inspections and investigations, the furnishing of loss or expense statistics or other information and data, o…
Ins. Code § 1853.8 Section 1853.8
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Agreements may be made among admitted insurers with respect to the equitable apportionment among them of casualty insurance which may be afforded applicants who are in good faith entitled to but who are unable to procure such insurance through ordinary methods, and with respect t…
Ins. Code § 1853.9 Section 1853.9
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Upon compliance with the provisions of this chapter applicable thereto any rating organization, advisory organization, and any group, association or other organization of admitted insurers which engages in joint underwriting or joint reinsurance through such organization or by st…
Ins. Code § 1853.95 Section 1853.95
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Admitted insurers are hereby expressly authorized to enter into agreements with the Department of Veterans Affairs with respect to the furnishing of insurance covering property being purchased from such department pursuant to Chapter 3, Division 4 of the Military and Veterans Cod…
Ins. Code § 1853.96 Section 1853.96
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The use of such rates and forms by insurers pursuant to such agreements is hereby expressly permitted, and the provisions of Section 1852 are not applicable thereto.
Ins. Code § 1853.97 Section 1853.97
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Automobile liability insurance and automobile physical damage insurance may, at the option of the insurer, be considered a single line for rate filing purposes.
Ins. Code § 1855 Section 1855
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No advisory organization shall conduct its operations in this State unless and until it has filed with the commissioner (a) a copy of its constitution, articles of incorporation, agreement or association, and of its by-laws, or rules and regulations governing its activities, all …
Ins. Code § 1855.1 Section 1855.1
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It is the intent of the Legislature in enacting this article to promote competition in the insurance business and provide a means whereby insurance consumers can more easily comparison shop for insurance coverage by allowing insurance advisory organizations to develop and draft f…
Ins. Code § 1855.2 Section 1855.2
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As used in this article, “advisory organization” means every group, association, or other organization of insurers, whether located within or outside of this state, that develops and prepares policy or bond forms, or manuals, for use by admitted insurers, carries on research rela…
Ins. Code § 1855.3 Section 1855.3
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Two or more insurers may cooperate with and act in concert with others as members of an advisory organization with respect to any matters pertaining to the preparation or making of insurance policy or bond forms, or manuals, or carrying on of research relative to the preparation …