Cal. Code Regs. tit. 10 § 6700

Current through Register 2024 Notice Reg. No. 45, November 8, 2024

Section 6700 - Definitions

In addition to the definitions in Section 6410 of Article 2 of this chapter, for purposes of this Article, the following terms shall mean:

(a) Authorized Contact: The contact designated by the carrier to serve as the individual responsible for all Plan-Based Enrollment Program communications with the Exchange and who is also responsible for management of the program. Pursuant to this Article, the Authorized Contact may delegate a designee where allowed by the Exchange.

(b) Cold-Calling: The unsolicited outgoing phone calls of a Certified Plan-Based Enrollment Entity (PBEE) or Certified Plan-Based Enroller (PBE) as defined in Section 6410 of Article 2 of this chapter, that were not prompted by a permissible lead, to an individual that has not expressed an interest in the PBEE's Qualified Health Plans (QHPs) in the Individual Exchange. Permissible leads are lists that are consumer opt-in and outreach to a PBEE's current or former members.

(c) Consumer: For the purposes of this article, Consumer shall mean the following targeted populations:

(1) Issuer's non-group members that meet the requirements of a Qualified Individual in Section 6410 of Article 2 of this chapter;

(2) Issuer's members receiving coverage required by the Consolidated Omnibus Budget and Reconciliation Act of 1985 ("COBRA") and the California Continuation Benefits Replacement Act, or Health and Safety Code Section 1366.20 et seq. ("Cal-COBRA") that meet the requirements of a Qualified Individual;

(3) Issuer's current members meeting the requirements of a Qualified Individual, or those current members terminating their individual or group coverage including 25 year old dependents;

(4) Qualified Individuals interested in obtaining health care coverage through the Exchange; and

(5) Individuals eligible for other Insurance Affordability Programs, as defined in Section 6410 of Article 2 of this chapter (e.g. Medi-Cal).

(d) Enrollment Assistance: For the purposes of this Article, Enrollment Assistance shall mean the following direct enrollment assistance to Consumers in the Individual Exchange by a PBE:

(1) Applying for an eligibility determination or redetermination for coverage through the Exchange;

(2) Applying for Insurance Affordability Programs;

(3) Facilitating the enrollment in a QHP offered by the Issuer; and

(4) If the consumer is determined eligible for Medi-Cal following the process in Section 6710(a)(11).

Cal. Code Regs. Tit. 10, § 6700

1. New article 9 (sections 6700-6718) and section filed 9-30-2013 as an emergency; operative 9-30-2013 (Register 2013, No. 40). A Certificate of Compliance must be transmitted to OAL by 4-1-2014 or emergency language will be repealed by operation of law on the following day.
2. New article 9 (sections 6700-6718) and section refiled 4-1-2014 as an emergency; operative 4-1-2014 (Register 2014, No. 14). A Certificate of Compliance must be transmitted to OAL by 6-30-2014 or emergency language will be repealed by operation of law on the following day.
3. New article 9 (sections 6700-6718) and section refiled 6-26-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 7-1-2014 (Register 2014, No. 26). A Certificate of Compliance must be transmitted to OAL by 9-30-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
4. New article 9 (sections 6700-6718) and section refiled with amendment of subsections (a), (c) and (c)(4) 10-2-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats. 2014, c. 31); operative 10-2-2014 (Register 2014, No. 40). A Certificate of Compliance must be transmitted to OAL by 9-30-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
5. Editorial correction of HISTORY 3 (Register 2014, No. 51).
6. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government Code section 100504(a)(6) to change the date upon which a Certificate of Compliance must be transmitted to OAL. Pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of Compliance must be transmitted to OAL by 9-30-2016 or the language in the emergency order of 10-2-2014 will be repealed by operation of law on the following day (Register 2015, No. 38).
7. Certificate of Compliance as to 10-2-2014 order, including further amendment of section, transmitted to OAL 4-12-2016 and filed 5-23-2016; amendments effective 5-23-2016 pursuant to Government Code section 11343.4(b)(3) (Register 2016, No. 22).

Note: Authority cited: Sections 100503 and 100504, Government Code. Reference: 45 Code of Federal Regulations, Sections 155.20, 155.415, 156.265 and 156.1230.