Current through Register 2024 Notice Reg. No. 38, September 20, 2024
(a) Qualified sole employers shall be eligible to
participate in the program to provide health benefits coverage for sole employees
and their dependents.
(b) To be a
qualified sole employer, a sole employer shall be a sole employer as defined as of
the effective date of coverage and shall meet the following requirements:
(1) Inform all potential sole employees of the
employer's intention to purchase coverage through the program and provide them the
opportunity to apply for coverage.
(2)
Provide all potential sole employees with at least thirty (30) calendar days to
decide whether to apply for coverage and choose their health benefit plan; this
shall be done for all potential sole employees in a consistent time and
manner.
(3) Inform all potential sole
employees of the amount the employer will contribute toward the purchase of
coverage.
(4) For each potential sole
employee who declines to apply for coverage or who fails to request coverage for all
of his or her dependents, the employer shall do one of the following:
(A) For an employee waiving because the employee
and/or the employee's dependents have health coverage under the terms of another
employer benefit plan or coverage under the federal Medicare program pursuant to
Title XVIII, the employer shall obtain from the employee a certification that the
employee is waiving because the employee and/or his or her dependents have coverage
under another health benefit plan.
(B)
For any employee declining coverage who fails to make the certification in (A)
above, require the employee to sign a written statement, the content of which will
be provided by the program, which informs the employee that failure to enroll for
coverage during the enrollment period will result in the employee being unable to
enroll himself or herself or dependents with the program until the program's next
open enrollment period. The form is contained in the HIPC application
booklet.
(5) Maintain at the
sole employer's principal place of business copies of the certifications and written
statements required by (4) above for a period of one (1) year.
(6)
(A) For sole
employers who have an effective date of coverage prior to September 1, 1998, who
have not made an election pursuant to Section
2699.6116, for every employee who
enrolls in the program, the sole employer shall contribute an amount equal to at
least 50% of the monthly "employee only" rate of the lowest "employee only" rate
available to the eligible employee.
(B)
For sole employers who have an effective date of coverage on or after September 1,
1998, and sole employers who made an election pursuant to Section
2699.6116, for every employee who
enrolls in the program, the sole employer shall contribute an amount equal to at
least 50% of the lowest available monthly employee only comprehensive individual
medical premium.
(7) For sole
employers of four (4) or more eligible employees, at least 70% of the eligible
employees shall be enrolled in the program unless the sole employer contributes 100%
of the "employee only" rate in which case 100% of the eligible employees shall be
enrolled in the program. For sole employers of two (2) or three (3) eligible
employees, all of the eligible employees shall be enrolled in the program. At the
time of the initial application, this determination shall be made as of the
effective day of coverage for the group.
(8) One hundred percent of the eligible employees
enrolling in the program shall be covered by workers' compensation insurance except
those eligible employees who are not legally required to be covered by workers'
compensation insurance.
(9) Inform the
program when an eligible sole employee or dependent ceases to be eligible by the end
of the month in which the event occurs.
1. Renumbering and
amendment of former section
2699.621 to section 2699.6107 filed
5-27-94; operative 5-27-94 (Register 94, No. 21).
2. Amendment of
subsections (b), (b)(4)(A), (b)(4)(B), (b)(7), and (b)(8) filed 12-29-94 as an
emergency; operative 12-29-94 (Register 94, No. 52). A Certificate of Compliance
must be transmitted to OAL 4-28-95 or emergency language will be repealed by
operation of law on the following day.
3. Certificate of Compliance as to
12-29-94 order transmitted to OAL 4-12-95 and filed 5-22-95 (Register 95, No.
21).
4. Amendment of subsections (b), (b)(7) and (b)(9) filed 6-16-95 as
an emergency; operative 6-16-95 (Register 95, No. 24). A Certificate of Compliance
must be transmitted to OAL by 10-16-95 or emergency language will be repealed by
operation of law on the following day.
5. Certificate of Compliance as to
6-16-95 order transmitted to OAL 9-26-95 and filed 10-18-95 (Register 95, No.
42).
6. Amendment of subsection (b)(7) filed 5-5-97; operative 7-1-97
(Register 97, No. 19).
7. Redesignation and amendment of former
subsection (b)(6) to new subsection (b)(6)(A) and new subsection (b)(6)(B) filed
7-3-98 as an emergency; operative 7-3-98 (Register 98, No. 27). A Certificate of
Compliance must be transmitted to OAL by 11-2-98 or emergency language will be
repealed by operation of law on the following day.
8. Certificate of
Compliance as to 7-3-98 order transmitted to OAL 10-2-98 and filed 11-16-98
(Register 98, No. 47).
Note: Authority cited: Section
10731, Insurance
Code. Reference: Sections
10731 and
10741, Insurance
Code.
