California Code
DIVISION 2 - CLASSES OF INSURANCE
PART 6.2 - HEALTHY FAMILIES

CHAPTER 1 - Purpose

Section 12693. - 12693. The Legislature declares all of the following: (a) Approximately...

CHAPTER 2 - Definitions

Section 12693.01. - 12693.01. For purposes of this part, the definitions contained in...

Section 12693.02. - 12693.02. (a) “Applicant” means a person over the age of...

Section 12693.03. - 12693.03. “Board” means the Managed Risk Medical Insurance Board. (Added...

Section 12693.04. - 12693.04. “Child” means a person who is under 19 years...

Section 12693.045. - 12693.045. “Community provider plan” means that participating health plan in...

Section 12693.05. - 12693.05. “County organized health system” means a health care organization...

Section 12693.06. - 12693.06. “Family contribution” means the cost to an applicant to...

Section 12693.065. - 12693.065. “Family value package” means the combination of participating health,...

Section 12693.07. - 12693.07. “Fund” means the Healthy Families Fund. (Added by Stats....

Section 12693.08. - 12693.08. “Local initiative” means a prepaid health plan that is...

Section 12693.09. - 12693.09. “Participating dental plan” means any of the following plans...

Section 12693.10. - 12693.10. “Participating health plan” means any of the following plans...

Section 12693.105. - 12693.105. A health care service plan, as defined in subdivision...

Section 12693.11. - 12693.11. “Participating vision care plan” means any of the following...

Section 12693.12. - 12693.12. “Program” means the Healthy Families Program, which includes a...

Section 12693.13. - 12693.13. “Purchasing credit member” means an applicant 18 years of...

Section 12693.14. - 12693.14. “Subscriber” means an applicant 18 years of age or...

Section 12693.15. - 12693.15. “Supplemental coverage” means coverage purchased by the program from...

Section 12693.16. - 12693.16. “Geographic managed care plan” means an entity that is...

Section 12693.17. - 12693.17. “Family contribution sponsor” means a person or entity that...

CHAPTER 3 - Creation of Program and Powers of the Board

Section 12693.20. - 12693.20. The Healthy Families Program is hereby created and shall...

Section 12693.21. - 12693.21. The board may do all of the following consistent...

Section 12693.22. - 12693.22. During the 2009–10 and 2010–11 fiscal years, the adoption...

Section 12693.23. - 12693.23. Until July 1, 2012, the adoption and readoption of...

CHAPTER 4 - Administration

Section 12693.25. - 12693.25. The board may use a purchasing pool model, issuance...

Section 12693.26. - 12693.26. (a) The board shall establish a purchasing pool for...

Section 12693.27. - 12693.27. (a) The board shall develop a purchasing credit mechanism...

Section 12693.271. - 12693.271. (a) The Legislature finds and declares that the state...

Section 12693.28. - 12693.28. The program shall be administered without regard to gender,...

Section 12693.29. - 12693.29. (a) The board shall use appropriate and efficient means...

Section 12693.30. - 12693.30. (a) The board shall assure that written enrollment information...

Section 12693.31. - 12693.31. No participating health, dental, or vision plan shall, in...

Section 12693.32. - 12693.32. (a) The board may pay designated individuals or organizations...

Section 12693.325. - 12693.325. (a) (1) Notwithstanding any provision of this chapter, a...

Section 12693.326. - 12693.326. Notwithstanding any other provision of this part, a new...

Section 12693.33. - 12693.33. To the extent feasible and permissible under federal law...

Section 12693.34. - 12693.34. (a) The board may establish geographic areas within which...

Section 12693.35. - 12693.35. Participating health, dental, and vision plans shall have, but...

Section 12693.36. - 12693.36. (a) Notwithstanding any other provision of law, the board...

Section 12693.37. - 12693.37. (a) The board shall contract with a broad range...

Section 12693.38. - 12693.38. (a) The board shall contract with a sufficient number...

Section 12693.39. - 12693.39. The board shall establish a process for determining which...

Section 12693.40. - 12693.40. The board shall contract with health plans to provide...

Section 12693.41. - 12693.41. (a) The board shall consult and coordinate with the...

Section 12693.42. - 12693.42. Any purchasing credit issued by the board, or a...

Section 12693.43. - 12693.43. (a) Applicants applying to the purchasing pool shall agree...

Section 12693.44. - 12693.44. (a) The board shall establish family contribution amounts for...

Section 12693.45. - 12693.45. (a) After two consecutive months of nonpayment of family...

Section 12693.46. - 12693.46. The board may prohibit applicants who drop coverage after...

Section 12693.47. - 12693.47. The program may place a lien on compensation or...

Section 12693.48. - 12693.48. The board may adjust payments made to a participating...

Section 12693.49. - 12693.49. (a) When an applicant is dissatisfied with any action...

Section 12693.50. - 12693.50. (a) The board shall consult and coordinate with the...

Section 12693.51. - 12693.51. (a) A transfer of enrollment from one participating health...

Section 12693.515. - 12693.515. (a) Effective July 1, 2004, any subscriber who affirmatively...

Section 12693.52. - 12693.52. The board may negotiate or arrange for stop-loss insurance...

Section 12693.53. - 12693.53. The board shall develop and utilize appropriate cost containment...

Section 12693.54. - 12693.54. A contract entered pursuant to this part shall be...

Section 12693.55. - 12693.55. (a) A health care provider who is furnished documentation...

CHAPTER 5 - Health Benefits and Copayments

Section 12693.60. - 12693.60. (a) Coverage provided to subscribers shall meet the federal...

Section 12693.61. - 12693.61. The following provisions apply for subscribers who have been...

Section 12693.615. - 12693.615. (a) The board shall establish the required subscriber copayment...

Section 12693.62. - 12693.62. Notwithstanding any other provision of law, for a subscriber...

CHAPTER 6 - Dental Benefits and Copayments

Section 12693.63. - 12693.63. (a) The board shall determine the dental benefits to...

Section 12693.64. - 12693.64. Notwithstanding any other provision of law, for a subscriber...

CHAPTER 7 - Vision Benefits and Copayments

Section 12693.65. - 12693.65. (a) Vision benefits shall be provided to subscribers and...

Section 12693.66. - 12693.66. Notwithstanding any other provision of law, for a subscriber...

CHAPTER 8 - Linkages with Public Programs

Section 12693.68. - 12693.68. The board shall encourage all plans, including those receiving...

Section 12693.69. - 12693.69. A child enrolled in the Healthy Families Program who...

CHAPTER 9 - Eligibility

Section 12693.70. - 12693.70. To be eligible to participate in the program, an...

Section 12693.71. - 12693.71. (a) The board shall monitor applications to determine whether...

Section 12693.72. - 12693.72. (a) The board may disapprove an application if it...

Section 12693.73. - 12693.73. Notwithstanding any other provision of law, children excluded from...

Section 12693.74. - 12693.74. (a) Subscribers shall continue to be eligible for the...

Section 12693.74. - 12693.74. (a) To the extent federal financial participation is available,...

Section 12693.75. - 12693.75. (a) The program shall make use of a simple...

Section 12693.755. - 12693.755. (a) Subject to subdivision (b), commencing four months after...

Section 12693.76. - 12693.76. (a) Notwithstanding any other provision of law, a child...

Section 12693.765. - 12693.765. (a) Notwithstanding any other provision of law and subject...

CHAPTER 10 - Fiscal Integrity

Section 12693.77. - 12693.77. (a) The board shall develop safeguards to assure the...

CHAPTER 11 - Protection Against Substitution of Benefits

Section 12693.80. - 12693.80. The board shall use due diligence in the creation...

Section 12693.81. - 12693.81. (a) It shall constitute unfair competition for purposes of...

Section 12693.82. - 12693.82. It shall constitute an unfair labor practice contrary to...

Section 12693.83. - 12693.83. (a) It shall constitute an unfair labor practice contrary...

Section 12693.84. - 12693.84. For purposes of Sections 12693.82 and 12693.83, group health...

CHAPTER 12 - Appeals

Section 12693.85. - 12693.85. Program decisions described in this section may be appealed...

Section 12693.86. - 12693.86. (a) An appeal shall be filed in writing with...

Section 12693.87. - 12693.87. (a) Any appellant who files an appeal pursuant to...

Section 12693.88. - 12693.88. In addition to the appeal process established above, the...

Section 12693.89. - 12693.89. (a) Administrative hearings of appeals shall be conducted according...

CHAPTER 14 - Rural Demonstration Project

Section 12693.91. - 12693.91. (a) The State Department of Health Services, in conjunction...

Section 12693.915. - 12693.915. (a) It is the intent of the Legislature to...

CHAPTER 15 - Reports

Section 12693.92. - 12693.92. (a) The program shall prepare an annual report in...

Section 12693.925. - 12693.925. (a) The Managed Risk Medical Insurance Board shall report...

Section 12693.93. - 12693.93. The board shall prepare an evaluation of the program...

Section 12693.95. - 12693.95. (a) The board in consultation with the Department of...

CHAPTER 16 - Funds

Section 12693.96. - 12693.96. (a) There is hereby created in the State Treasury...

Section 12693.97. - 12693.97. The State Department of Health Services and the board...

CHAPTER 16.1 - Healthy Families Bridge Benefits Program

Section 12693.98. - 12693.98. (a) (1) The Medi-Cal-to-Healthy Families Bridge Benefits Program is...

Section 12693.98a. - 12693.98a. (a) (1) The Healthy Families Presumptive Eligibility Program is...

Section 12693.981. - 12693.981. (a) (1) The Healthy Families-to-Medi-Cal Bridge Benefits Program is...

Section 12693.982. - 12693.982. For purposes of this chapter, “Medi-Cal” means the state...

Section 12694. - 12694. (a) The board and the department, in collaboration with...

CHAPTER 16.2 - Transition of Healthy Families Program Enrollees to Medi-Cal

Section 12694.1. - 12694.1. (a) Pursuant to Sections 14005.26 and 14005.27 of the...

Section 12694.2. - 12694.2. All civil service employees who are currently employed by...

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California Code DIVISION 2 - CLASSES OF INSURANCE PART 6.2 - HEALTHY FAMILIES

California Code
DIVISION 2 - CLASSES OF INSURANCE
PART 6.2 - HEALTHY FAMILIES