SECTIONS 12705 - California Statutes

INSURANCE CODE

SECTION 12705

12705. For the purposes of this part, the following terms have the
following meanings:
(a) "Applicant" means an individual who applies for major risk
medical coverage through the program.
(b) "Board" means the Managed Risk Medical Insurance Board.
(c) "Fund" means the Major Risk Medical Insurance Fund, from which
the program may authorize expenditures to pay for medically
necessary services which exceed subscribers' contributions, and for
administration of the program.
(d) "Major risk medical coverage" means the payment for medically
necessary services provided by institutional and professional
providers.
(e) "Participating health plan" means a private insurer (1)
holding a valid outstanding certificate of authority from the
Insurance Commissioner, a nonprofit membership corporation lawfully
operating under the Nonprofit Corporation Law (Division 2 (commencing
with Section 5000) of the Corporations Code), or a health care
service plan as defined under subdivision (f) of Section 1345 of the
Health and Safety Code, which is lawfully engaged in providing,
arranging, paying for, or reimbursing the cost of personal health
care services under insurance policies or contracts, medical and
hospital service agreements, or membership contracts, in
consideration of premiums or other periodic charges payable to it,
and (2) which contracts with the program to administer major risk
medical coverage to program subscribers.
(f) "Plan rates" means the total monthly amount charged by a
participating health plan for a category of risk.
(g) "Program" means the California Major Risk Medical Insurance
Program.
(h) "Subscriber" means an individual who is eligible for and
receives major risk medical coverage through the program, and
includes a member of a federally recognized California Indian tribe.
(i) "Subscriber contribution" means the portion of participating
health plan rates paid by the subscriber, or paid on behalf of the
subscriber by a federally recognized California Indian tribal
government. If a federally recognized California Indian tribal
government makes a contribution on behalf of a member of the tribe,
the tribal government shall ensure that the subscriber is made aware
of all the health plan options available in the county where the
member resides.