Cal. Code Regs. tit. 10 § 2699.6107

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

Section 2699.6107 - Participation Requirements for Sole Employers

(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.

Cal. Code Regs. Tit. 10, § 2699.6107

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.