Cal. Code Regs. tit. 10 § 6666

Current through Register 2024 Notice Reg. No. 36, September 6, 2024

Section 6666 - Conflict of Interest Standards

(a) Certified Enrollment Entities and Certified Enrollment Counselors shall not concurrently hold a license issued by the California Department of Insurance.

(b) Certified Enrollment Entities and Certified Enrollment Counselors shall not employ, be employed by or be in partnership with, or receive any remuneration arising out of functions performed under this Article from any individual or entity currently licensed by the California Department of Insurance.

(c) Certified Enrollment Entities and Certified Enrollment Counselors shall:

(1) Not be:

(A) Health insurance issuers or stop loss insurance issuers;

(B) Subsidiaries of health insurance issuers or stop loss insurance issuers;

(C) Associations that include members of, or lobby on behalf of, the insurance industry; or

(D) Recipients of any direct or indirect consideration from any health insurance issuer or stop loss insurance issuer in connection with the enrollment of any individuals or employees in a QHP or non-QHP.

(2) Submit to the Exchange a written attestation that the entity or individual:

(A) Is not a health insurance issuer or issuer of stop loss insurance;

(B) Is not a subsidiary of a health insurance issuer or issuer of stop loss insurance;

(C) Is not an association that includes members of, or lobbies on behalf of, the insurance industry; and

(D) Will not receive any consideration directly or indirectly from any health insurance issuer or issuer of stop loss insurance in connection with the enrollment of any individuals or employees in a QHP or non-QHP.

(3) Create a written plan to remain free of conflicts of interest while carrying out Consumer Assistance functions under this Article, which shall be made available upon request to the Exchange.

(4) Provide information to consumers about the full range of QHP options and insurance affordability programs for which they are eligible.

(5) 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 relationships 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.

Cal. Code Regs. Tit. 10, § 6666

1. New section filed 7-15-2013 as an emergency; operative 7-15-2013 (Register 2013, No. 29). A Certificate of Compliance must be transmitted to OAL by 1-13-2014 or emergency language will be repealed by operation of law on the following day.
2. Repealed by operation of Government Code section 11346.1(g) (Register 2014, No. 7).
3. New section filed 2-10-2014 as an emergency pursuant to Government Code section 11346.1, subdivision (h); operative 2-10-2014 (Register 2014, No. 7). A Certificate of Compliance must be transmitted to OAL by 5-12-2014 or emergency language will be repealed by operation of law on the following day.
4. New section refiled 5-12-2014 as an emergency pursuant to Government Code section 11346.1, subdivision (h); operative 5-12-2014 (Register 2014, No. 20). A Certificate of Compliance must be transmitted to OAL by 8-11-2014 or emergency language will be repealed by operation of law on the following day.
5. New section refiled 7-21-2014 as an emergency pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 857 (Stats 2014, c. 31); operative 7-21-2014 (Register 2014, No. 30). A Certificate of Compliance must be transmitted to OAL by 7-15-2015 pursuant to Government Code section 100504 or emergency language will be repealed by operation of law on the following day.
6. Senate Bill 75 (Stats. 2015, Ch. 18) modified Government Code section 100504(a)(6) to change the date upon which a Certificate of Compliance must be transmitted to OAL. Pursuant to Government Code section 100504(a)(6), as modified by Senate Bill 75 (Stats. 2015, Ch. 18), a Certificate of Compliance must be transmitted to OAL by 2-10-2017 or the language in the emergency order of 7-21-2014 will be repealed by operation of law on the following day (Register 2015, No. 38).
7. Certificate of Compliance as to 7-21-2014 order transmitted to OAL 11-6-2015 and filed 12-23-2015 (Register 2015, No. 52).

Note: Authority cited: Sections 100502 and 100504, Government Code. Reference: Sections 100502 and 100503, Government Code; and 45 C.F.R. §§ 155.205, 155.210 and 155.215.