(a)Health care service plans may enter into contractual agreements with qualified associations, as defined in subdivision (b), under which these qualified associations may assume responsibility for performing specific administrative services, as defined in this section, for qualified association members. Health care service plans that enter into agreements with qualified associations for assumption of administrative services shall establish uniform definitions for the administrative services that may be provided by a qualified association or its third-party administrator. The health care service plan shall permit all qualified associations to assume one or more of these functions when the health care service plan determines the qualified association demonstrates the administrative capacity to assume these functions.
(b)For the purposes of this section, a qualified association is a nonprofit corporation comprised of a group of individuals or employers who associate based solely on participation in a specified profession or industry that conforms to all of the following requirements:
(1)It accepts for membership any individual or small employer meeting its membership criteria.
(2)It does not condition membership directly or indirectly on the health or claims history of any person.
(3)It uses membership dues solely for and in consideration of the membership and membership benefits, except that the amount of the dues shall not depend on whether the member applies for or purchases insurance offered by the association.
(4)It is organized and maintained in good faith for purposes unrelated to insurance.
(5)It existed on January 1, 1972, and has been in continuous existence since that date.
(6)It has a constitution and bylaws or other analogous governing documents that provide for election of the governing board of the association by its members.
(7)It offered, marketed, or sold health coverage to its members for 20 continuous years prior to January 1, 1993.
(8)It agrees to offer only to association members any plan contract.
(9)It agrees to include any member choosing to enroll in the plan contract offered by the association, provided that the member agrees to make required premium payments.
(10)It complies with all provisions of this article.
(11)It had at least 10,000 enrollees covered by association sponsored plans immediately prior to enactment of Chapter 1128 of the Statutes of 1992.
(12)It applies any administrative cost at an equal rate to all members purchasing coverage through the qualified association.
(c)A qualified association shall comply with Section 1357.52.