Cal. Code Regs. Tit. 10, § 6650 - Definitions

(a) For purposes of this Article, the following terms shall have the following associated meanings:

Authorized Contact: The individual appointed by the Certified Enrollment Entity to manage the agreement with the Exchange.

Certified Enrollment Counselor: An individual who is certified by the Exchange pursuant to Sections 6654 or 6656 to provide one-on-one Consumer Assistance. A Certified Enrollment Counselor shall be registered in either the In-Person Assistance or the Navigator Program, but not both.

Certified Enrollment Entity: An entity or individual registered by the Exchange to provide one-on-one Consumer Assistance. A Certified Enrollment Entity shall be registered in the In-Person Assistance Program and/or the Navigator Program.

Consumer: A person or entity seeking information on eligibility and enrollment or seeking application assistance with a health insurance or health related product available through the Exchange. The term consumer includes, but is not limited to, an applicant, an application filer, authorized representative, employer, qualified employee, qualified employer, qualified individual, small employer, or enrollee as defined in Section 6410 of Article 2 of this Chapter.

Consumer Assistance: The programs and activities created under 45 C.F.R. § 155.205(d) to provide one-on-one assistance to consumers.

Financial Contact: The individual appointed by the Certified Enrollment Entity to communicate fiscal matters with the Exchange.

In-Person Assistance Program (IPA Program): The Program whereby Certified Enrollment Entities affiliate with Certified Enrollment Counselors to provide face-to-face Consumer Assistance.

In-Person Assister: A Certified Enrollment Counselor who is affiliated pursuant to Section 6654 with a Certified Enrollment Entity who is registered in the IPA Program.

Certified Enrollment Counselor: An individual who is certified by the Exchange pursuant to Sections 6654 or 6656 to provide one-on-one Consumer Assistance. A Certified Enrollment Counselor shall be registered in either the In-Person Assistance or the Navigator Program, but not both.

Navigator: A Certified Enrollment Counselor who is affiliated pursuant to Section6656 with a Certified Enrollment Entity that is registered in the Navigator Program.

Navigator Program: The Program whereby Certified Enrollment Entities are awarded grants for conducting Outreach & Education and Consumer Assistance.

Outreach & Education: The programs and activities created under 45 C.F.R. § 155.205(e) to educate consumers about the Exchange and insurance affordability programs in order to encourage participation.

Personally Identifiable Information: Any information, including electronic, paper or any other media, that identifies or describes an individual, or can be used to distinguish or trace an individual's identity, including, but not limited to, his or her name, social security number, physical description, date, place of birth, mother's maiden name, home address, home telephone number, education, financial matters, medical or employment history, biometric records, and statements made by, or attributed to, the individual, that alone or when combined with other personal or identifying information can be linked or is linkable to a specific individual. Personally Identifiable Information includes Protected Health Information (PHI), as defined in the Health Insurance Portability and Accountability Act of 1996 ( 42 U.S.C. section 1320d-d8 ).

Primary Contact: The individual appointed by the Certified Enrollment Entity to be a liaison with the Exchange.

Notes

Cal. Code Regs. Tit. 10, § 6650

Note: Authority cited: Sections 100502 and 100504, Government Code. Reference: Sections 100502 and 100503, Government Code; and 45 C.F.R. §§ 155.205, 155.210 and 155.215.

1. New article 8 (sections 6650-6670) and section filed 7-15-2013 as an emergency; operative 7-15-2013 (Register 2013, No. 29). A Certificate of Compliance must be transmitted to OAL by 1-13-2014 or emergency language will be repealed by operation of law on the following day.
2. Repealed by operation of Government Code section 11346.1(g) (Register 2014, No. 7).
3. New article 8 (sections 6650-6670) and section filed 2-10-2014 as an emergency pursuant to Government Code section 11346.1, subdivision (h); operative 2-10-2014 (Register 2014, No. 7). A Certificate of Compliance must be transmitted to OAL by 5-12-2014 or emergency language will be repealed by operation of law on the following day.
4. New article 8 (sections 6650-6670) and section refiled 5-12-2014 as an emergency pursuant to Government Code section 11346.1, subdivision (h); operative 5-12-2014 (Register 2014, No. 20). A Certificate of Compliance must be transmitted to OAL by 8-11-2014 or emergency language will be repealed by operation of law on the following day.
5. New article 8 (sections 6650-6670) and section refiled with amendments 7-21-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 ( Stats 2014, c. 31 ); operative 7-21-2014 (Register 2014, No. 30). A Certificate of Compliance must be transmitted to OAL by 7-15-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.

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