Cal. Ins. Code § 10954. Determining rate of health benefit plan for child; factors considered; limitations; notice relating to increased premiums; maintenance of coverage; rate identical to standard risk rate; documentation of coverage history; uniform model notice: Child Access to Health Insurance – California

Status: Enacted
Year Enacted: 2010
Year Amended: 2013
File: Download

A carrier may use the following characteristics of an eligible child for purposes of establishing the rate of the health benefit plan for that child, where consistent with federal regulations under PPACA: age, geographic region, and family composition, plus the health benefit plan selected by the child or the responsible party for a child. During any open enrollment period or for late enrollees, the rate for any child due to health status shall not be more than two times the standard risk rate for a child. The rate for a child shall be subject to a 20-percent surcharge above the highest allowable rate on a child applying for coverage. If expressly permitted under PPACA and any rules, regulations, or guidance issued pursuant to that act, a carrier may rate a child based on health status during any period other than an open enrollment period if the child is not a late enrollee.


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