Cal. Code Regs. Tit. 10, § 6866 - Conflict of Interest Standards

Current through Register 2022 Notice Reg. No. 16, April 25, 2022

(a) Certified Application Entities and Certified Application Counselors must disclose to the Exchange and any consumers any relationships with Qualified Health Plans, insurance affordability programs, or other potential conflicts of interest.
(b) Certified Application Entities and Certified Application Counselors shall not concurrently hold a license issued by the California Department of Insurance.
(c) Certified Application Entities and Certified Application Counselors shall not employ, be employed by, be in partnership with, or receive any remuneration arising out of functions performed under this Article, or from any individual or entity currently licensed by the California Department of Insurance.
(d) Certified Application Entities and Certified Application Counselors shall:
(1) Create a written plan to remain free of conflicts of interest while carrying out functions under this Article. This plan shall be made available upon request to the Exchange;
(2) Provide information to consumers about the full range of QHP options and insurance affordability programs for which they are eligible; and
(3) Disclose to the Exchange and to each consumer who receives application assistance from the entity or individual:
(A) Any lines of insurance business, not covered by the restrictions on participation and prohibitions on conduct in this section, which the entity or individual intends to sell while carrying out the Consumer Assistance functions;
(B) Any existing employment relationships, or any former employment relationships within the last five years, with any health insurance issuers or issuers of stop loss insurance, or subsidiaries of health insurance issuers or issuers of stop loss insurance, including any existing employment relationships between a spouse or domestic partner and any health insurance issuers or issuers of stop loss insurance, or subsidiaries of health insurance issuers or issuers of stop loss insurance; and
(C) Any existing or anticipated financial, business, or contractual relationship with one or more health insurance issuers or issuers of stop loss insurance, or subsidiaries of health insurance issuers or issuers of stop loss insurance.

Notes

Cal. Code Regs. Tit. 10, § 6866

Note: Authority cited: Section 100504, Government Code. Reference: Section 100502, Government Code; and 45 C.F.R. Sections 155.205, 155.210 and 155.225.

1. New section filed 7-6-2015 as an emergency pursuant to Government Code section 100504(a)(6); operative 7-6-2015 (Register 2015, No. 28). Senate Bill 833 (Stats. 2016, c.30) modified Government Code section 100504(a)(6) to extend the date upon which a Certificate of Compliance must be transmitted to OAL; a Certificate of Compliance must be transmitted to OAL by 7-6-2020 pursuant to Government Code section 100504(a)(6) or emergency language will be repealed by operation of law on the following day.
2. Editorial correction of History 1 (Register 2018, No. 37).
3. New section filed 6-7-2019; operative 6-7-2019 pursuant to Government Code section 11343.4(b)(3) (Register 2019, No. 23).

The following state regulations pages link to this page.



State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.