California Code of Regulations
Title 10 - Investment
Chapter 5.8 - Managed Risk Medical Insurance Board Healthy Families Program
Article 4 - Risk Categories and Family Contributions
Section 2699.6809 - Determination of Family Contribution for the Program

Universal Citation: 10 CA Code of Regs 2699.6809

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

(a) Family child contributions for the program shall consist of one of the following:

(1) A flat fee in each county for a family value package:
(A) Seven dollars ($7) per subscriber child with a maximum required contribution of fourteen dollars ($14) per month for subscriber children with annual household incomes after income deductions of up to and including 150 percent of the federal poverty level.

(B) Through January 31, 2009, nine dollars ($9) per subscriber child with a maximum required contribution of twenty-seven dollars ($27) per month for subscriber children with annual household incomes after income deductions if greater than 150 percent and up to and including 200 percent of the federal poverty level; these rates are also applicable for subscribers who entered the program as AIM infants. On and after February 1, 2009, and through October 31, 2009, twelve dollars ($12) per subscriber child with a maximum required contribution of thirty-six dollars ($36) per month. On and after November 1, 2009, sixteen dollars ($16) per subscriber child with a maximum required contribution of forty-eight dollars ($48) per month.

(C) Through January 31, 2009, fifteen dollars ($15) per subscriber child with a maximum required contribution of forty-five dollars ($45) per month for subscriber children with annual household incomes after income deductions greater than 200 percent and up to and including 250 percent of the federal poverty level; these rates are also applicable, through the first year of eligibility, for subscribers who entered the program as AIM infants and for those AIM infants whose annual household income after deductions remains above 200 percent of the federal poverty level after each Annual Eligibility Review. On and after February 1, 2009, and through October 31, 2009, seventeen dollars ($17) per subscriber child with a maximum required contribution of fifty-one dollars ($51) per month. On and after November 1, 2009, twenty-four dollars ($24) per subscriber child with a maximum required contribution of seventy-two dollars ($72) per month.

(2) A flat fee in each county for a family value package that includes a community provider plan:
(A) Four dollars ($4) per subscriber child with a maximum required contribution of eight dollars ($8) per month for subscriber children with annual household incomes after income deductions of up to and including 150 percent of the federal poverty level,

(B) Through January 31, 2009, six dollars ($6) per subscriber child with a maximum required contribution of eighteen dollars ($18) per month for subscriber children with annual household incomes after income deductions of greater than 150 percent and up to and including 200 percent of the federal poverty level; these rates are also applicable for subscribers who entered the program as AIM infants. On and after February 1, 2009, and through October 31, 2009, nine dollars ($9) per subscriber child with a maximum required contribution of twenty-seven dollars ($27) per month. On and after November 1, 2009, thirteen dollars ($13) per subscriber child with a maximum required contribution of thirty-nine dollars ($39) per month.

(C) Through January 31, 2009, twelve dollars ($12) per subscriber child with a maximum required contribution of thirty-six ($36) per month for subscriber children with annual household incomes after income deductions of greater than 200 percent and up to and including 250 percent of the federal poverty level; these rates are also applicable, through the first year of eligibility, for subscribers who entered the program as AIM infants and for those AIM infants whose annual household income after income deductions remains above 200 percent of the federal poverty level after each Annual Eligibility Review. On and after February 1, 2009, and through October 31, 2009, fourteen dollars ($14) per subscriber child with a maximum required contribution of forty-two dollars ($42) per month. On and after November 1, 2009, twenty-one dollars ($21) per subscriber child with a maximum required contribution of sixty-three dollars ($63) per month.

(b) Family parent contributions for the program shall consist of one of the following:

(1) A flat fee in each county for a family value package:
(A) Ten dollars ($10) per month per subscriber parent with an annual household income after income deductions of up to and including 150 percent of the federal poverty level.

(B) Twenty dollars ($20) per month per subscriber parent with an annual household income after income deductions greater than 150 percent and up to and including 200 percent of the federal poverty level.

(2) A flat fee in each county for a family value package that includes a community provider plan:
(A) Seven dollars ($7) per month per subscriber parent with an annual household income after income deductions of 150 percent of the federal poverty level.

(B) Seventeen dollars ($17) per subscriber parent with an annual household income after income deductions of greater than 150 percent and up to and including 200 percent of the federal poverty level.

(c) Applicants who pay in advance the amount of three (3) months of family child contributions shall receive the fourth consecutive month of coverage for a subscriber child with no family child contributions required.

(d) Applicants who pay in advance the amount of three (3) months of family parent contributions shall receive the fourth consecutive month of coverage for a subscriber parent with no family parent contributions required if the subscriber child contributions (if applicable) are also paid in advance, at the same time for the same three month period.

(e) Applicants who pay the family child contributions (if applicable) and the family parent contributions (if applicable) by electronic fund transfer or scheduled credit card payment shall receive a twenty-five (25) percent discount off the monthly combined total of the family child contributions and family parent contributions.

(f) If the applicant is applying for children in more than one household, the income of the household with the lowest annual income after income deductions will be used to determine the family contributions.

(g) If an applicant has a family contribution sponsor, family child contributions and/or family parent contributions that are to be paid by the family contribution sponsor for any twelve (12) consecutive months in the program shall be established based on subsections (a) and (b) above.

(h) If an AIM infant is enrolled in a different health plan from his or her siblings until the Open Enrollment period after the AIM infant's first birthday, the family child contribution will be the family child contribution for the siblings, plus the contribution rate for one more child at the same rate, up to the maximum required contribution.

1. New section filed 2-20-98 as an emergency; operative 2-20-98 (Register 98, No. 8). A Certificate of Compliance must be transmitted to OAL by 6-22-98 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 2-20-98 order transmitted to OAL 6-5-98 and filed 7-15-98 (Register 98, No. 29).
3. Amendment filed 12-14-98 as an emergency; operative 12-14-98 (Register 98, No. 51). A Certificate of Compliance must be transmitted to OAL by 4-13-99 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 12-14-98 order transmitted to OAL 3-25-99 and filed 5-6-99 (Register 99, No. 19).
5. Repealer of subsections (a)(3)-(a)(3)(B) filed 8-5-99 as an emergency; operative 8-5-99 (Register 99, No. 32). A Certificate of Compliance must be transmitted to OAL by 12-3-99 or emergency language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 5-26-99 order, including further amendment of subsection (c), transmitted to OAL 9-17-99 and filed 10-28-99 (Register 99, No. 44).
7. Certificate of Compliance as to 8-5-99 order transmitted to OAL 11-2-99 and filed 12-1-99 (Register 99, No. 49).
8. Amendment of subsections (a)(1)B. and (a)(2)B. filed 6-20-2000 as an emergency; operative 6-20-2000 (Register 2000, No. 25). A Certificate of Compliance must be transmitted to OAL by 10-18-2000 or emergency language will be repealed by operation of law on the following day.
9. New subsection (d) filed 9-5-2000; operative 9-5-2000 pursuant to Government Code 11343.4(d) (Register 2000, No. 36).
10. Certificate of Compliance as to 6-20-2000 order transmitted to OAL 10-12-2000; disapproval and reinstatement of text as it existed prior to emergency amendment pursuant to Government Code section 11349.6(d) filed 11-27-2000 (Register 2000, No. 48).
11. Amendment of subsections (a)(1)B. and (a)(2)B. filed 11-28-2000 as an emergency; operative 11-28-2000 (Register 2000, No. 48). A Certificate of Compliance must be transmitted to OAL by 3-28-2001 or emergency language will be repealed by operation of law on the following day.
12. Certificate of Compliance as to 11-28-2000 order transmitted to OAL 1-31-2001 and filed 2-20-2001 (Register 2001, No. 8).
13. Amendment of section and NOTE filed 4-29-2002 as an emergency; operative 4-29-2002 (Register 2002, No. 18). Pursuant to Chapter 946, Statutes of 2000, section 2, a Certificate of Compliance must be transmitted to OAL by 10-28-2002 or emergency language will be repealed by operation of law on the following day.
14. Certificate of Compliance as to 4-29-2002 order transmitted to OAL 10-28-2002 and filed 12-12-2002 (Register 2002, No. 50).
15. Amendment of subsections (a)(1)(B) and (a)(2)(B) and new subsection (h) filed 7-1-2004 as an emergency; operative 7-1-2004 (Register 2004, No. 27). Pursuant to Section 80, A.B. 1762 (Chapter 230, Stats. 2003) a Certificate of Compliance must be transmitted to OAL by 12-28-2004 or emergency language will be repealed by operation of law on the following day.
16. Certificate of Compliance as to 7-1-2004 order transmitted to OAL 11-24-2004 and filed 1-7-2005 (Register 2005, No. 1).
17. Amendment of subsection (e) filed 6-30-2005 as an emergency; operative 6-30-2005 (Register 2005, No. 26). A Certificate of Compliance must be transmitted to OAL by 10-28-2005 or emergency language will be repealed by operation of law on the following day.
18. Amendment of subsection (a)(1)(B), new subsection (a)(1)(C), amendment of subsection (a)(2)(B) and new subsection (a)(2)(C) filed 6-30-2005 as an emergency; operative 6-30-2005 (Register 2005, No. 26). Pursuant to Insurance Code section 12693.43(h), a Certificate of Compliance must be transmitted to OAL by 12-27-2005 or emergency language will be repealed by operation of law on the following day.
19. Certificate of Compliance as to 6-30-2005 order transmitted to OAL 10-5-2005 and filed 11-16-2005 (Register 2005, No. 46).
20. Amendment of subsections (a)(1)(B)-(C) and (a)(2)(B)-(C) filed 1-15-2009, deemed an emergency pursuant to Chapter 758, Statutes of 2008; operative 1-15-2009 (Register 2009, No. 3). A Certificate of Compliance must be transmitted to OAL by 7-14-2009 or emergency language will be repealed by operation of law on the following day.
21. Certificate of Compliance as to 1-15-2009 order transmitted to OAL 7-13-2009 and filed 8-19-2009 (Register 2009, No. 34).
22. Amendment of subsections (a)(1)(B)-(C) and (a)(2)(B)-(C) and amendment of NOTE filed 10-29-2009; operative 11-1-2009 pursuant to Government Code section 11346.1(d) (Register 2009, No. 44). A Certificate of Compliance must be transmitted to OAL by 4-30-2010 or emergency action will be repealed by operation of law on the following day. This regulatory action is deemed to meet the emergency standard and is exempt from OAL review pursuant to Insurance Code section 12693.22.
23. Certificate of Compliance as to 10-29-2009 order transmitted to OAL 4-27-2010 and filed 5-26-2010 (Register 2010, No. 22).

Note: Authority cited: Sections 12693.21, 12693.22 and 12693.755, Insurance Code. Reference: Sections 12693.21, 12693.22, 12693.43, 12693.53 and 12693.755, Insurance Code.

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