California Code of Regulations
Title 10 - Investment
Chapter 12 - California Health Benefit Exchange
Article 12 - Medi-Cal Managed Care Plan Enrollment Assistance
Section 6907 - Conflict of Interest
Universal Citation: 10 CA Code of Regs 6907
Current through Register 2024 Notice Reg. No. 12, March 22, 2024
(a) Certified Medi-Cal Managed Care Plans and Certified Medi-Cal Managed Care Plan Enrollers shall:
(1) Comply with applicable
State law related to the sale, solicitation, and negotiation of insurance
products, including applicable State law related to agent, broker, and producer
licensure;
(2) Create a written
plan to remain free of conflicts of interest while carrying out functions under
this Article;
(3) Provide
information to consumers about the full range of QHP options and insurance
affordability programs for which they are eligible;
(4) Disclose to each consumer who receives
application assistance from the entity or individual:
(A) Any lines of insurance business which the
entity or individual intents to sell while carrying out the Consumer Assistance
functions;
(B) Any existing
employment relationships, or any former employment relationships within the
last five years, with any health insurance issuers or issuers of stop loss
insurance, or subsidiaries of health insurance issuers or issuers of stop loss
insurance, including any existing employment relationships between a spouse or
domestic partner and any health insurance issuers or issuers of stop loss
insurance, or subsidiaries of health insurance issuers or issuers of stop loss
insurance; and
(C) Any existing or
anticipated financial, business, or contractual relationship with one or more
health insurance issuers or issuers of stop loss insurance, or subsidiaries of
health insurance issuers or issuers of stop loss
insurance.
(b) Medi-Cal Managed Care Plan Enrollers who are licensed insurance agents with the California Department of Insurance shall:
(1)
Comply with 45 C.F.R.
section 155.220, (December 22, 2016), hereby
incorporate by reference;
(2)
Execute an agreement with the Exchange that complies with
45 C.F.R. section
155.220;
(3) While a Certified Medi-Cal Managed Care
Plan Enroller, not receive any direct or indirect consideration from any health
insurance issuer or stop loss insurance issuer, other than compensation on a
salary or contractual basis from the Certified Medi-Cal Managed Care Plan, in
connection with the enrollment of any individuals in a QHP or
non-QHP;
(4) Not be concurrently
certified as a certified insurance agent by the Exchange.
1. New section filed 3-12-2020; operative 3-12-2020 pursuant to Government Code section 11343.4(b)(3) (Register 2020, No. 11).
Note: Authority cited: Sections 100502 and 100504, Government Code. Reference: Sections 100502 and 100503, Government Code; and 45 C.F.R. § 155.220.
Disclaimer: These regulations may not be the most recent version. California may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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