SECTIONS 131540-131541 - California Statutes

HEALTH AND SAFETY CODE

SECTION 131540-131541

131540. (a) (1) The cost of the health care coverage provided
through the program shall be paid through a combination of
contributions paid by the small business, premiums paid by
participating employees, and county, federal, state, or private
sector funding made available for this purpose.
(2) The local initiative may determine the amount of the employer
contribution for each participating eligible employee, which shall
not exceed one hundred fifty dollars ($150) per month, and the amount
of the employee premium, which shall not exceed seventy-five dollars
($75) per month. The local initiative may adjust employer
contribution and employee premium levels after the first year if
necessary for changes in health care costs.
(3) The local initiative may structure the required employee
premium amounts according to a schedule that takes into account the
individual employee's age or income level, or both, in a manner
similar, but not necessarily identical, to that described in Section
12693.43 of the Insurance Code, pertaining to the Healthy Families
Program.
(4) The local initiative shall establish copayment levels and
amounts in a manner substantially similar to that described in
Section 12693.615 of the Insurance Code, pertaining to the Healthy
Families Program.
(5) For purposes of the program, "applicable rate charged for a
covered employee" in Section 1366.26 means the total premium amount
paid to the health plan on behalf of an employee, including amounts
paid by the small business on behalf of the employee, the premium
paid by the employee, and any county, federal, state, or private
sector funding, which funding shall include the value of the
discounted rates negotiated pursuant to subdivision (b), as
apportioned to the employee. The program shall submit to the
Department of Managed Health Care the procedures the local initiative
will use for purposes of establishing the rates to be paid by a
person eligible for continuation coverage under Section 1366.26, and
the department shall only approve those procedures if it determines
that they are consistent with the requirements of the Cal-COBRA
program.
(b) In order to enhance the affordability of coverage offered
through the program to eligible small businesses and employees, the
county and the local initiative shall negotiate discounted rates for
services provided to participants in the program by providers
operated by the county or by providers with whom, or with which, the
county has contracted to provide health care services.

131541. The local initiative shall be authorized to establish,
participate in, or apply to funding sources in the public and private
sectors for purposes of providing or securing premium subsidies for
eligible employees, pursuant to fair and equitable procedures to be
established by the local initiative.