Cal. Code Regs. Tit. 10, § 6700 - Definitions

In addition to the definitions in Section 6410 of Article 2 of this chapter, for purposes of this article, the following terms shall mean:

(a) Cold-Calling: A Certified Plan-Based Enrollment Entity (PBEE) or Certified Plan Based-Enroller's (PBE's) unsolicited outgoing phone calls that were not prompted by a permissible lead, to an individual that has not expressed an interest in the PBEE's QHPs in the Individual Exchange. Permissible leads include lists that are consumer opt-in and outreach to a PBEE's current or former members.
(b) Consumer: For the purposes of this article, Consumer shall mean the following targeted populations:
(1) Issuer's non-group members that meet the requirements of a Qualified Individual in Section 6410 of Article 2 of this chapter;
(2) Issuer's members receiving coverage required by the Consolidated Omnibus Budget and Reconciliation Act of 1985 ( "COBRA") and the California Continuation Benefits Replacement Act, or Health and Safety Code Section 1366.20 et seq. ( "Cal-COBRA") that meet the requirements of a Qualified Individual;
(3) Issuer's current members meeting the requirements of a Qualified Individual, or those current members terminating their individual or group coverage including 25 year old dependents;
(4) Qualified Individuals interested in obtaining health care coverage through the Exchange; and
(5) Individuals eligible for other Insurance Affordability Programs, as defined in Section 6410 of Article 2 of this chapter (e.g. Medi-Cal).
(c) Enrollment Assistance: A PBE may provide the following direct enrollment assistance to Consumers in the Individual Exchange, provided that the PBE meets the requirements set forth in this article:
(1) Applying for an eligibility determination or redetermination for coverage through the Exchange;
(2) Applying for Insurance Affordability Programs;
(3) Facilitating the enrollment in a QHP offered by the Issuer; and
(4) If the consumer is determined eligible for Medi-Cal following the process in Section 6710(a)(11).

Notes

Cal. Code Regs. Tit. 10, § 6700

Note: Authority cited: Sections 100503 and 100504, Government Code. Reference: 45 Code of Federal Regulations, Sections 155.20, 155.415, 156.265 and 156.1230.

1. New article 9 (sections 6700-6718) and section filed 9-30-2013 as an emergency; operative 9-30-2013 (Register 2013, No. 40). A Certificate of Compliance must be transmitted to OAL by 4-1-2014 or emergency language will be repealed by operation of law on the following day.
2. New article 9 (sections 6700-6718) and section refiled 4-1-2014 as an emergency; operative 4-1-2014 (Register 2014, No. 14). A Certificate of Compliance must be transmitted to OAL by 6-30-2014 or emergency language will be repealed by operation of law on the following day.
3. New article 9 (sections 6700-6718) and section refiled 6-26-2014 as an emergency; operative 7-1-2014 (Register 2014, No. 26). A Certificate of Compliance must be transmitted to OAL by 9-29-2014 or emergency language will be repealed by operation of law on the following day.
4. New article 9 (sections 6700-6718) and section refiled with amendment of subsections (a), (c) and (c)(4) 10-2-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 ( Stats. 2014, c. 31 ); operative 10-2-2014 (Register 2014, No. 40). A Certificate of Compliance must be transmitted to OAL by 9-30-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.

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