California Code of Regulations
Title 10 - Investment
Chapter 5.6 - Access for Infants and Mothers Program
Article 1 - Definitions
Section 2699.100 - Definitions

(a) "Appellant" means an applicant or subscriber who has filed an appeal with the program.

(b) "Applicant" means a pregnant woman 18 years of age or older who is applying on her own behalf, or a legal guardian or a natural parent, foster parent, or stepparent with whom the child resides, who applies for coverage under the program on behalf of a child. "Applicant" also means a pregnant woman who is applying for coverage on her own behalf who is under 18 years of age, or who is an emancipated minor, or who is a minor not living in the home of a natural or adoptive parent, a legal guardian, foster parent or stepparent.

(c) "Application Date" means the date an application is sent to the program as evidenced by the U.S. postmark date on the application envelope, or documentation from other delivery services including fax delivery.

(d) "Board" means the Managed Risk Medical Insurance Board.

(e) "Coverage" means the payment for benefits provided through the program.

(f) "Disenroll" means to terminate coverage by the program.

(g) "Eligible" means the applicant is qualified to be enrolled in a participating health plan.

(h) "Enroll" means to accept an applicant as a subscriber by notifying a participating health plan to accept the applicant.

(i) "Executive Director" means the executive director for the Board.

(j) "Family member" means the following persons living in the individual's home:

(k) "Federal poverty level" means the level determined by the "Poverty Guidelines for the 48 Contiguous States and the District of Columbia" as contained in the Annual Update of HHS Poverty Guidelines as published in the Federal Register by the U.S. Department of Health and Human Services.

(l) "First trimester" means the first 13 weeks of a 40-week, full-term pregnancy.

(m) "Gross household income" means the total annual gross income of all family members except dependent children. Income includes before tax earnings from a job, including cash, wages, salary, commissions and tips, self-employment net profits, Social Security, State Disability Insurance (SDI), Retirement Survivor Disability Insurance (RSDI), veterans benefits, Railroad Retirement, disability worker's compensation, unemployment benefits, alimony, spousal support, pensions and retirement benefits, grants that cover living expenses, settlement benefits, rental income, gifts, lottery/bingo winnings and interest income. Income excludes child support, public assistance program benefits such as SSI/SSP and CalWORKS payments, foster care payments, general relief, loans, grants or scholarships applied toward college expenses, or earned income of a child aged 13 or under, or a child attending school. Income does not include income exclusions applicable to all federal means tested programs such as, disaster relief payments, per capita payments to Native Americans from proceeds held in trust and/or arising from use of restricted lands, Agent Orange payments, Title IV student assistance, energy assistance payments to low income families, relocation assistance payments, victims of crime assistance program, Spina Bifida payments, earned income tax credit and Japanese reparation payments.

(n) "Healthy Families Program" (HFP) means the Federal/State funded program that is operated pursuant to Title XXI of the Social Security Act and Part 6.2 (commencing with Section 12693) of Division 2 of the California Insurance Code, and that provides low cost health, dental and vision insurance coverage to eligible children.

(o) "Income deduction" means any of the following:

(p) "Infant" means a subscriber's child born to a subscriber while the subscriber is enrolled in the program.

(q) "Living in the home" means using the home as the primary place of residence.

(r) "Medi-Cal" means the California health care services program under Title XIX of the Social Security Act.

(s) "Medicare" means the Health Insurance for the aged and permanently disabled provided under Title XVIII of the Social Security Act; "Part A" means Hospital Insurance as defined in Title XVIII of the Social Security Act; and "Part B" means Medical Insurance as defined in Title XVIII of the Social Security Act.

(t) "Participating health plan" means any of the following plans which are lawfully engaged in providing, arranging, paying for, or reimbursing the cost of personal health care services under insurance policies or contracts, medical and hospital service arrangements, or membership contracts, in consideration of premiums or other periodic charges payable to it, and that contracts with the program to provide coverage to program subscribers:

(u) "Program" means the Access for Infants and Mothers Program.

(v) "Resident" means a person who is present in California with intent to remain present except when absent for transitory or temporary purposes.

(w) "State supported services" mean abortion services provided to the subscribers through the program.

(x) "Subscriber" means an individual who is eligible for and enrolled in the program.

(y) "Subscriber contribution" means the cost to the subscriber to participate in the program.

(z) "Tenses and Number". The present tense includes the past and future, and the future the present; the singular includes the plural and the plural the singular.

(aa) "Time." Whenever in this chapter a time is stated in which an act is to be done, the time is computed by excluding the first day and including the last day. If the last day is a holiday it is also excluded.