1068. (a) As used in this section, the following definitions shall
apply:
(1) "Health care service plan" means any plan as defined in
Section 1345 of the Health and Safety Code, but this section does not
apply to specialized health care service contracts.
(2) "Carrier" means a health care service plan, an insurer issuing
group disability coverage which covers hospital, medical, or
surgical expenses, a nonprofit hospital service plan, or any other
entity responsible for either the payment of benefits for or the
provision of hospital, medical, and surgical benefits under a group
contract.
(3) "Insolvency" means that the Director of the Department of
Managed Health Care has determined that the health care service plan
is not financially able to provide health care services to its
enrollees and (A) the Director of the Department of Managed Health
Care has taken an action pursuant to Section 1386, 1391, or 1399 of
the Health and Safety Code, or (B) an order requested by the Director
of the Department of Managed Health Care or the Attorney General has
been issued by the superior court under Section 1392, 1393, or
1394.1 of the Health and Safety Code.
(b) In the event of the insolvency of a health care service plan,
upon order of the commissioner which shall be issued following his or
her receipt of a notice issued by the Director of the Department of
Managed Health Care pursuant to Section 1394.7 of the Health and
Safety Code, any insurer, nonprofit hospital service plan, and any
other entity, other than a health care service plan, responsible for
either the payment of benefits for or the provision of hospital,
medical, and surgical benefits under a group contract, that
participated in the enrollment process with the insolvent health care
service plan at the last regular open enrollment period of a group,
shall offer enrollees of the group in the insolvent health care
service plan a 30-day enrollment period commencing upon the date of
insolvency. Each such carrier shall offer enrollees of the group in
the insolvent health care service plan the same coverages and rates
that it offered to enrollees of the group at the last regular open
enrollment period of the group.
1068.1. (a) As used in this section:
(1) "Carrier" means a specialized health care service plan, and
any of the following entities which offer coverage comparable to the
coverages offered by a specialized health care service plan: an
insurer issuing group disability coverage; a nonprofit hospital
service plan; or other entity responsible for either the payment of
benefits for or the provision of services under a group contract.
(2) "Insolvency" means that the Director of the Department of
Managed Health Care has determined that the specialized health care
service plan is not financially able to provide specialized health
care services to its enrollees and (A) the Director of the Department
of Managed Health Care has taken an action pursuant to Section 1386,
1391, or 1399 of the Health and Safety Code, or (B) an order
requested by the commissioner or the Attorney General has been issued
by the superior court under Section 1392, 1393, or 1394.1 of the
Health and Safety Code.
(3) "Specialized health care service plan" means any plan
authorized to issue only specialized health care service plan
contracts as defined in Section 1345 of the Health and Safety Code.
(b) In the event of the insolvency of a specialized health care
service plan, upon order of the commissioner which shall be issued
following his or her receipt of a notice issued by the Director of
the Department of Managed Health Care pursuant to Section 1394.8 of
the Health and Safety Code, all carriers that participated in the
enrollment process with the insolvent specialized health care service
plan at a group's last regular open enrollment period for the same
type of specialized health care service benefits shall offer the
group's enrollees in the insolvent specialized health care service
plan a 30-day enrollment period commencing upon the date of
insolvency. Each such carrier shall offer enrollees of the insolvent
specialized health care service plan the same specialized coverage
and rates that it had offered to the enrollees of the group at its
last regular open enrollment period.
1068.2. (a) The commissioner shall have the administrative
authority to assess penalties against any person, including a natural
person or other entity, for violations of this article.
(b) Upon a showing of a violation of this article in any civil
action, a court may also assess the penalties prescribed in this
section.
(c) Whenever the commissioner has reasonable cause to believe or
determines after a public hearing that any person has violated this
article he or she shall make and serve upon the person an notice of
hearing. The notice shall state the commissioner's intent to assess
the administrative penalties, the time and place of the hearing, and
the conduct, condition or grounds upon which the commissioner is
holding the hearing and assessing the penalties. The hearings shall
occur within 30 days after the notice is served. Within 30 days after
the hearing the commissioner shall issue an order specifying the
penalty. The penalties resulting from the hearing shall be paid to
the Insurance Fund, but may be spent only when appropriated by the
Legislature.
(d) Any person who violates this article is liable for
administrative penalties of no less than twenty-five thousand dollars
($25,000).
1068. (a) As used in this section, the following definitions shall
apply:
(1) "Health care service plan" means any plan as defined in
Section 1345 of the Health and Safety Code, but this section does not
apply to specialized health care service contracts.
(2) "Carrier" means a health care service plan, an insurer issuing
group disability coverage which covers hospital, medical, or
surgical expenses, a nonprofit hospital service plan, or any other
entity responsible for either the payment of benefits for or the
provision of hospital, medical, and surgical benefits under a group
contract.
(3) "Insolvency" means that the Director of the Department of
Managed Health Care has determined that the health care service plan
is not financially able to provide health care services to its
enrollees and (A) the Director of the Department of Managed Health
Care has taken an action pursuant to Section 1386, 1391, or 1399 of
the Health and Safety Code, or (B) an order requested by the Director
of the Department of Managed Health Care or the Attorney General has
been issued by the superior court under Section 1392, 1393, or
1394.1 of the Health and Safety Code.
(b) In the event of the insolvency of a health care service plan,
upon order of the commissioner which shall be issued following his or
her receipt of a notice issued by the Director of the Department of
Managed Health Care pursuant to Section 1394.7 of the Health and
Safety Code, any insurer, nonprofit hospital service plan, and any
other entity, other than a health care service plan, responsible for
either the payment of benefits for or the provision of hospital,
medical, and surgical benefits under a group contract, that
participated in the enrollment process with the insolvent health care
service plan at the last regular open enrollment period of a group,
shall offer enrollees of the group in the insolvent health care
service plan a 30-day enrollment period commencing upon the date of
insolvency. Each such carrier shall offer enrollees of the group in
the insolvent health care service plan the same coverages and rates
that it offered to enrollees of the group at the last regular open
enrollment period of the group.
1068.1. (a) As used in this section:
(1) "Carrier" means a specialized health care service plan, and
any of the following entities which offer coverage comparable to the
coverages offered by a specialized health care service plan: an
insurer issuing group disability coverage; a nonprofit hospital
service plan; or other entity responsible for either the payment of
benefits for or the provision of services under a group contract.
(2) "Insolvency" means that the Director of the Department of
Managed Health Care has determined that the specialized health care
service plan is not financially able to provide specialized health
care services to its enrollees and (A) the Director of the Department
of Managed Health Care has taken an action pursuant to Section 1386,
1391, or 1399 of the Health and Safety Code, or (B) an order
requested by the commissioner or the Attorney General has been issued
by the superior court under Section 1392, 1393, or 1394.1 of the
Health and Safety Code.
(3) "Specialized health care service plan" means any plan
authorized to issue only specialized health care service plan
contracts as defined in Section 1345 of the Health and Safety Code.
(b) In the event of the insolvency of a specialized health care
service plan, upon order of the commissioner which shall be issued
following his or her receipt of a notice issued by the Director of
the Department of Managed Health Care pursuant to Section 1394.8 of
the Health and Safety Code, all carriers that participated in the
enrollment process with the insolvent specialized health care service
plan at a group's last regular open enrollment period for the same
type of specialized health care service benefits shall offer the
group's enrollees in the insolvent specialized health care service
plan a 30-day enrollment period commencing upon the date of
insolvency. Each such carrier shall offer enrollees of the insolvent
specialized health care service plan the same specialized coverage
and rates that it had offered to the enrollees of the group at its
last regular open enrollment period.
1068.2. (a) The commissioner shall have the administrative
authority to assess penalties against any person, including a natural
person or other entity, for violations of this article.
(b) Upon a showing of a violation of this article in any civil
action, a court may also assess the penalties prescribed in this
section.
(c) Whenever the commissioner has reasonable cause to believe or
determines after a public hearing that any person has violated this
article he or she shall make and serve upon the person an notice of
hearing. The notice shall state the commissioner's intent to assess
the administrative penalties, the time and place of the hearing, and
the conduct, condition or grounds upon which the commissioner is
holding the hearing and assessing the penalties. The hearings shall
occur within 30 days after the notice is served. Within 30 days after
the hearing the commissioner shall issue an order specifying the
penalty. The penalties resulting from the hearing shall be paid to
the Insurance Fund, but may be spent only when appropriated by the
Legislature.
(d) Any person who violates this article is liable for
administrative penalties of no less than twenty-five thousand dollars
($25,000).
1068. (a) As used in this section, the following definitions shall
apply:
(1) "Health care service plan" means any plan as defined in
Section 1345 of the Health and Safety Code, but this section does not
apply to specialized health care service contracts.
(2) "Carrier" means a health care service plan, an insurer issuing
group disability coverage which covers hospital, medical, or
surgical expenses, a nonprofit hospital service plan, or any other
entity responsible for either the payment of benefits for or the
provision of hospital, medical, and surgical benefits under a group
contract.
(3) "Insolvency" means that the Director of the Department of
Managed Health Care has determined that the health care service plan
is not financially able to provide health care services to its
enrollees and (A) the Director of the Department of Managed Health
Care has taken an action pursuant to Section 1386, 1391, or 1399 of
the Health and Safety Code, or (B) an order requested by the Director
of the Department of Managed Health Care or the Attorney General has
been issued by the superior court under Section 1392, 1393, or
1394.1 of the Health and Safety Code.
(b) In the event of the insolvency of a health care service plan,
upon order of the commissioner which shall be issued following his or
her receipt of a notice issued by the Director of the Department of
Managed Health Care pursuant to Section 1394.7 of the Health and
Safety Code, any insurer, nonprofit hospital service plan, and any
other entity, other than a health care service plan, responsible for
either the payment of benefits for or the provision of hospital,
medical, and surgical benefits under a group contract, that
participated in the enrollment process with the insolvent health care
service plan at the last regular open enrollment period of a group,
shall offer enrollees of the group in the insolvent health care
service plan a 30-day enrollment period commencing upon the date of
insolvency. Each such carrier shall offer enrollees of the group in
the insolvent health care service plan the same coverages and rates
that it offered to enrollees of the group at the last regular open
enrollment period of the group.
1068.1. (a) As used in this section:
(1) "Carrier" means a specialized health care service plan, and
any of the following entities which offer coverage comparable to the
coverages offered by a specialized health care service plan: an
insurer issuing group disability coverage; a nonprofit hospital
service plan; or other entity responsible for either the payment of
benefits for or the provision of services under a group contract.
(2) "Insolvency" means that the Director of the Department of
Managed Health Care has determined that the specialized health care
service plan is not financially able to provide specialized health
care services to its enrollees and (A) the Director of the Department
of Managed Health Care has taken an action pursuant to Section 1386,
1391, or 1399 of the Health and Safety Code, or (B) an order
requested by the commissioner or the Attorney General has been issued
by the superior court under Section 1392, 1393, or 1394.1 of the
Health and Safety Code.
(3) "Specialized health care service plan" means any plan
authorized to issue only specialized health care service plan
contracts as defined in Section 1345 of the Health and Safety Code.
(b) In the event of the insolvency of a specialized health care
service plan, upon order of the commissioner which shall be issued
following his or her receipt of a notice issued by the Director of
the Department of Managed Health Care pursuant to Section 1394.8 of
the Health and Safety Code, all carriers that participated in the
enrollment process with the insolvent specialized health care service
plan at a group's last regular open enrollment period for the same
type of specialized health care service benefits shall offer the
group's enrollees in the insolvent specialized health care service
plan a 30-day enrollment period commencing upon the date of
insolvency. Each such carrier shall offer enrollees of the insolvent
specialized health care service plan the same specialized coverage
and rates that it had offered to the enrollees of the group at its
last regular open enrollment period.
1068.2. (a) The commissioner shall have the administrative
authority to assess penalties against any person, including a natural
person or other entity, for violations of this article.
(b) Upon a showing of a violation of this article in any civil
action, a court may also assess the penalties prescribed in this
section.
(c) Whenever the commissioner has reasonable cause to believe or
determines after a public hearing that any person has violated this
article he or she shall make and serve upon the person an notice of
hearing. The notice shall state the commissioner's intent to assess
the administrative penalties, the time and place of the hearing, and
the conduct, condition or grounds upon which the commissioner is
holding the hearing and assessing the penalties. The hearings shall
occur within 30 days after the notice is served. Within 30 days after
the hearing the commissioner shall issue an order specifying the
penalty. The penalties resulting from the hearing shall be paid to
the Insurance Fund, but may be spent only when appropriated by the
Legislature.
(d) Any person who violates this article is liable for
administrative penalties of no less than twenty-five thousand dollars
($25,000).
