CA Health & Safety Code Section 1399.845

For purposes of this article, the following definitions shall apply:

(a)

“Child” means a child described in Section 22775 of the Government Code and subdivisions (n) to (p), inclusive, of Section 599.500 of Title 2 of the California Code of Regulations.

(b)

“Dependent” means the spouse or registered domestic partner, or child, of an individual, subject to applicable terms of the health benefit plan.

(c)

“Exchange” means the California Health Benefit Exchange created by Section 100500 of the Government Code.

(d)

“Family” means the subscriber and his or her dependent or dependents.

(e)

“Grandfathered health plan” has the same meaning as that term is defined in Section 1251 of PPACA.

(f)

“Health benefit plan” means any individual or group health care service plan contract that provides medical, hospital, and surgical benefits. The term does not include a specialized health care service plan contract, a health care service plan contract provided in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), the Healthy Families Program (Part 6.2 (commencing with Section 12693) of Division 2 of the Insurance Code), the Access for Infants and Mothers Program (Part 6.3 (commencing with Section 12695) of Division 2 of the Insurance Code), or the program under Part 6.4 (commencing with Section 12699.50) of Division 2 of the Insurance Code, or Medicare supplement coverage, to the extent consistent with PPACA.

(g)

“Policy year” means the period from January 1 to December 31, inclusive.

(h)

“PPACA” means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued pursuant to that law.

(i)

“Preexisting condition provision” means a contract provision that excludes coverage for charges or expenses incurred during a specified period following the enrollee’s effective date of coverage, as to a condition for which medical advice, diagnosis, care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.

(j)

“Rating period” means the calendar year for which premium rates are in effect pursuant to subdivision (d) of Section 1399.855.

(k)

“Registered domestic partner” means a person who has established a domestic partnership as described in Section 297 of the Family Code.