Cal. Code Regs. tit. 10 § 6712

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

Section 6712 - Conflict of Interest Standards

(a) All PBEEs and PBEs shall:

(1) Only receive consideration pursuant to the exclusive agreement between the PBEE and the PBE in connection with the enrollment of any individuals in the PBEE's QHPs pursuant to this Article.

(2) Only make representations that are accurate and not misleading. Additionally, the PBE may only make representations regarding QHPs offered by the PBEE affiliated with the PBE.

(3) Disclose conflicts of interest to Consumers:

(A) A PBEE and its PBEs shall disclose to the consumer when contact is first initiated that the PBE is employed or contracted by a QHP Issuer and is only able to provide plan details and enrollment assistance for QHPs offered by the PBEE affiliated with the PBE.

(B) After a consumer is determined eligible for coverage through the Exchange, the PBE shall:

(i) Disclose to the consumer that the Individual Exchange offers other QHPs sold by other QHP Issuers, and stand-alone dental plans as defined in Section 6410 of Article 2 of this chapter, that may meet the consumer's needs;

(ii) Provide information to consumers about the availability of the full range of QHP options and Insurance Affordability Programs for which they are eligible. It must be apparent to consumers that if determined eligible they would be free to choose among all QHPs offered in the Individual Exchange through the Service Center of the Exchange;

(iii) Provide information required in Section 6710(a)(9); and

(iv) Inform the consumer that there may be an insurance agent of record in connection with any existing health insurance policy the consumer may currently have, and if the consumer acknowledges having an agent of record, offer to attach the agent to the consumer's enrollment in a QHP, unless:

1. The consumer is determined eligible for coverage through the Exchange, and the insurance agent of record is not authorized to sell QHPs in the Individual Exchange; or

2. The consumer would prefer not to seek further assistance from the consumer's insurance agent of record.

(4) At the consumer's request following the PBE's disclosures in either subdivision (a)(3)(A) or (a)(3)(B) of this Section, the PBE shall transfer the consumer to the Service Center of the Exchange for further enrollment assistance.

(5) Document that the PBE has provided the required disclosures in subdivision (a)(3)(A) or (a)(3)(B) of this Section and the consumer has acknowledged that the consumer:

(A) Understands the disclosures;

(B) Does not want to be referred to the Service Center of the Exchange; and

(C) Wants to receive information and enrollment assistance solely from the PBE.

(b) A record of the documentation required under subdivision (a)(5) of this Section shall be:

(1) Retained by the PBEE for at least 10 years;

(2) Subject to the Exchange's review of program conduct at the discretion of the Exchange; and

(3) Provided to the Exchange at its request.

(c) Where enrollment services pursuant to this Article are provided to consumers over the phone, the PBEE shall keep copies of such conversations and shall make those records available for review by the Exchange on a quarterly basis.

(d) With regards to any QHP or other products offered in the Individual Exchange by QHP Issuers other than the PBEE with which the PBE has an exclusive appointment, a PBE:

(1) May not provide enrollment services related to QHPs or other products not offered by the entity affiliated with the PBE; and

(2) Shall at any time transfer any requests for information or enrollment services related to QHPs or stand-alone dental plans in the Individual Exchange not offered by the PBEE affiliated with the PBE to the Service Center of the Exchange and provide information on how to access the Exchange Web Site.

(e) With regards to any other products offered by the PBEE outside the Individual Exchange with which the PBE has an exclusive appointment, a PBE shall cease to provide enrollment services in a manner deemed to be through the Exchange in order to provide any information or services related to other products offered by the entity.

Cal. Code Regs. Tit. 10, § 6712

1. New 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 section, including amendment of subsections (a)(4)(B)(iii) and (b)(3), 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 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 section refiled with amendments to section and NOTE 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: Section 100503, Government Code; and 45 Code of Federal Regulations, Sections 155.415, 155.1210 and 156.1230.