III.B · Group Medical Expense Insurance
Who can be a group policyholder
Group insurance is one master policy issued to a policyholder, such as an employer, that covers many people at once. California's Insurance Code calls health insurance "disability insurance," and Sections 10270.5 through 10270.57 list which groups qualify and how many people each must cover.
Employer (§10270.5(a)(1)): at least 2 employees, or employees together with their dependents or spouses.
Association under (a)(3): at least 2 members and at least 25% of all eligible members, or of a class of members. Example: 600 eligible members means at least 150 must be covered.
Association under (a)(4): at least 100 members at the outset, in active existence for at least 2 years, with bylaws requiring regular meetings at least once a year. The premium may come from the association, its members, the covered persons, or a combination.
Creditor group (§10270.505): a lender may insure debtors who repay in substantially equal installments. The group must have at least 10 new entrants each year. The policy is issued on the creditor's application, is payable to the creditor or its successor, and premiums are paid by or through the creditor.
Newspaper carriers (§10270.57): a trustee for self-employed individuals, with or without employees of their own, who all contract with the same newspaper publisher. The policy must cover at least 10 of them, with amounts set by a plan that precludes individual selection.
Who counts as an employee (§10270.55): officers, managers and employees of subsidiaries and affiliates the policyholder controls may be treated as the policyholder's employees. A corporate director is not, unless the director is also a bona fide employee doing more than a director's usual duties.
Remember
· Employer group: at least 2 employees.
· Association (a)(3): at least 2 members and 25% of eligible members.
· Creditor group: 10 new entrants a year; payable to the creditor.
· Newspaper carriers: at least 10; no individual choice of amounts.
CA
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