Section 2699.6300 - Risk CategoriesHealth benefits plan rates shall be based exclusively on the following risk categories:
(a) Geographic region of sole employee's or guaranteed association member's residence. (1) The six geographic regions for sole employee's or guaranteed association members residing within the State of California shall be as follows:(A) Area 1 shall include the counties of Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Inyo, Kings, Lake, Lassen, Mendocino, Modoc, Mono, Monterey, Nevada, Placer, Plumas, San Benito, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tulare, Tuolumne, Yuba, and Yolo.(B) Area 2 shall include the counties of Fresno, Imperial, Kern, Madera, Mariposa, Merced, Napa, Sacramento, San Joaquin, San Luis Obispo, Santa Cruz, Solano, Sonoma, and Stanislaus.(C) Area 3 shall include the counties of Alameda, Contra Costa, Marin, San Francisco, San Mateo, and Santa Clara.(D) Area 4 shall include the counties of Orange, Santa Barbara, and Ventura.(E) Area 5 shall include the county of Los Angeles.(F) Area 6 shall include the counties of Riverside, San Bernardino, and San Diego.(2) The eight geographic regions for sole employees or member employees residing in areas of the United States except the State of California shall be as follows:(A) Area A shall consist of the States of Maine, New Hampshire, Vermont, the State of New York except Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, Westchester and Suffolk Counties and the Territory of Guam.(B) Area B shall consist of the States of Arkansas, Iowa, Kentucky, Montana, North Carolina, Oregon, South Carolina, and the Commonwealth of Puerto Rico.(C) Area C shall consist of the States of Delaware, Hawaii, Idaho, Mississippi, Nebraska, North Dakota, Ohio, South Dakota, Tennessee, Washington, West Virginia, Wisconsin, and the State of Illinois except the counties of Cook, Dupage, Kane, Lake and McHenry.(D) Area D shall consist of the States of Colorado, Georgia, Indiana, Kansas, Maryland, Massachusetts, Michigan, Missouri, Oklahoma, Pennsylvania, Rhode Island, Utah, Wyoming, and the State of Florida except Dade and Broward counties.(E) Area E shall consist of the States of Alabama, Connecticut, Minnesota, New Jersey, New Mexico, Virginia, and counties of Cook, Dupage, Kane, Lake, and McHenry in the State of Illinois.(F) Area F shall consist of the States of Alaska, Arizona, Louisiana, and the District of Columbia, and the State of Texas except Galveston and Harris counties.(G) Area G shall consist of the State of Nevada and the counties of Bronx, Kings, Manhattan, Nassau, Queens, Richmond, Rockland, Westchester and Suffolk in the State of New York, and the counties of Galveston and Harris in the State of Texas.(H) Area H shall consist of the counties of Dade and Broward in the State of Florida.(b) Age of enrolled sole employee or guaranteed association member. The seven (7) age groups shall be as follows: (6) 60-64 years of age; and(7) 65 years of age and over.(c) Family size category of enrolled sole employee or guaranteed association member. The four (4) family size categories shall be as follows: (1) Sole employee or guaranteed association member only.(2) Sole employee or guaranteed association member and spouse.(3) Sole employee and dependent child or dependent children, or guaranteed association member and dependent child or dependent children.(4) Sole employee and spouse, and dependent child or dependent children, or guaranteed association member and spouse and dependent child or dependent children.Cal. Code Regs. Tit. 10, § 2699.6300
1. Relocation of article heading and renumbering and amendment of former section 2699.640 to section 2699.6300 filed 5-27-94; operative 5-27-94 (Register 94, No. 21). Note: Authority cited: Section 10731, Insurance Code. Reference: Sections 10731 and 10746, Insurance Code.
1. Relocation of article heading and renumbering and amendment of former section 2699.640 to section 2699.6300 filed 5-27-94; operative 5-27-94 (Register 94, No. 21).