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California - Compensation & Benefit Legislation

CALIFORNIA - AASHOWME

Demonstrates www.BenefitsReview.com™. Illustrates insurance carriers' coverages within the State.

 

CALIFORNIA - ADOPTED CHILD HEALTH CARE MANDATE

OBRA 1993 (Federal) requires group health plans to honor medical and child support orders. Also, plans must treat adopted children like biological children covered by the plan, and plans are precluded from applying pre-existing condition exclusions to an adopted child where no such exclusion applies to a newborn biological child. Health plans that covered the cost of pediatric vaccines as of May 1, 1993, and fail to continue that level of coverage, will be subject to an excise tax penalty applicable to plans that fail to meet the health care continuation coverage requirements under OBRA 1993.

 

Mandatory coverage of birth of adopted children is included in state's newborn health care mandate.

 

Preventive care for children: employer option, including screening for blood lead levels in children.

 

(California Insurance Code Sections 10018, 10119, 10119.5, 10119.6, 10123.55, 10123.9, 11512.35)

 

CALIFORNIA - ALCOHOLISM & DRUG ABUSE

Employer option (alcoholism treatment only).

 

Minimum yearly inpatient coverage: no statutory requirement.

 

Minimum yearly outpatient coverage: no statutory requirement.

 

Minimum lifetime coverage: no statutory requirement.

 

(California Insurance Code Section 1123.6.)

 

CALIFORNIA - CAFETERIA PLAN TAX LAWS

State income tax, unemployment insurance tax on salary reduction: No. Follows FUTA.

 

CALIFORNIA - CONTINUATION OF COVERAGE CONVERSIONS

Events Triggering Continuation of Coverage:

 

Death: Yes. (90 days minimum continuation of coverage.)

 

Job Termination: Yes. (90 days minimum continuation of coverage.)

 

Reduction of Hours: Yes. (90 days minimum continuation of coverage.)

 

Divorce or Legal Separation: Yes. (90 days minimum continuation of coverage.)

 

Medicare Eligibility: Yes. (90 days minimum continuation of coverage.)

 

Other Provisions: Labor dispute, 6 months minimum continuation of coverage; dependent child exceeding age for dependent status, 90 days minimum continuation of coverage. Employees who have worked for an employer for at least 5 years and who are 60 or older may continue beyond COBRA coverage to age 65, or when other coverage is available, or the group policy is terminated.

 

Early Termination of Continuation of Coverage: Becoming eligible for similar benefits, termination of group policy; failure to make a timely payment; remarriage (of either spouse); reemployed and eligible for benefits; insured establishes residence outside of state. (California Insurance Code Sections 10116, 10116.5, 12692, 10128.50)

 

CALIFORNIA - COORDINATION OF BENEFITS

Requires use of the birthday rule if coordinating benefits (effective January 1, 1987). Based on 1984 National Association of Insurance Commissioner Rules model. (California Admin. Code tit. 10 Sections 2232.52 to 2232.59)

 

CALIFORNIA - COST-OF-LIVING

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian cost-of-living data and U.S. Automobile Cost Survey.

 

CALIFORNIA - DRUG TESTING AND EMPLOYEE ASSISTANCE BENEFITS

Who is Covered by Statute: All private employers with 25 or more employees.

 

Applicant Testing: State has no statutory requirements.

 

Employee Testing: Employee testing is allowed.

 

How Test Results are Used: Employer may refuse to hire, and may discharge, an employee who, because of his/her current use of alcohol or drugs, either is unable to perform his/her duties or cannot perform them in a manner that would endanger his/her health or safety or health or safety of others

 

Enforcement of Statutes: State has no statutory requirements.

 

Employee Remedies: State has no statutory requirements.

 

Employer Penalties: State has no statutory requirements.

 

Who Pays for Testing: State has no statutory requirements.

 

Employee Assistance Benefits: State has no statutory requirements.

 

Other Requirements: Employer must make reasonable efforts to keep confidential the fact that an employee was enrolled in a rehabilitation program.

 

(California Labor Code Sections 1025, 1026.)

 

CALIFORNIA - GROUP HEALTH CODE ADDITIONS (MANDATED)

Adopted Children: Policies must cover adopted children from the moment the child is placed in physical custody of the insured. (California Insurance Code Section 10119(a); Health & Safety Code Section 1373(c))

 

Biologically-Based Mental Disorders: Policies that offer coverage of disorders of the brain also must offer the same coverage for biologically based severe mental disorders including schizophrenia, schizo-affective disorder, bipolar and delusional depressions, and pervasive developmental disorder. (California Insurance Code Section 10123.15)

 

Breast Reconstruction, Prostheses, and Mammography Screening: Costs must be covered if surgical services for mastectomy are covered. (California Insurance Code Sections 10123.8, 10123.81, 11512.10, 11512.29, Health & Safety Code Section 1 367.65)

 

Cervical Cancer Screening: Screening costs must be covered if treatment or surgery for cervical cancer is covered. (California Insurance Code Sections 10123.18, 11512.155)

 

Complications of Pregnancy: Policies that provide maternity benefits from conception cannot limit coverage of involuntary complications of pregnancy (such as toxemia) unless such limits apply generally to all benefits paid under the plan. (California Insurance Code Sections 10119.5, 11512.13; Health & Safety Code Section 1373.4)

 

Coverage Continuation and Conversion: Policies that allow continuation of coverage of an employee following termination of employment must provide the same continuation terms to the employee's dependents. (California Insurance Code Section 10122 ; Health & Safety Code Section 1373(e).) Policies must provide continuation rights of 90 days to employees and to spouses and dependents who cease to be eligible because of termination of marriage or death of the employee, and spouses and dependents must be afforded the same conversion rights as those afforded to the employee under the policy. (California Insurance Code Sections 10126, 11512.6, 12692; Health & Safety Code Sections 1373.1, .2, .62.) Health care service plans must provide employees covered by a group contract terminated by the employer an opportunity to convert to individual coverage. (California Health & Safety Code Section 1373.6.) Employees Over Age 60: Individuals who have worked for an employer for at least 5 years and who are over 60 years of age on the date on which employment ends must be offered coverage for themselves and their spouses beyond the date on which continuing coverage under federal COBRA ends. Coverage may be continued until individuals reach age 65 or until they are covered by another group health plan. Replacement Plans: A carrier may offer a replacement plan within 60 days from the date of discontinuance of a plan. The replacement plan must cover all employees and dependents who were validly covered under the previous plan on the date of plan discontinuation. (SB761, 1995) (California Health & Safety Code Sections 1373.621, 1399.63; California Insurance Code Sections 10116.5 10128.3, 11512.03; California Labor Code Section 2800.2.)

 

DES: Policies may not limit coverage of conditions attributable to diethylstibestrol (DES). (California Insurance Code Sections 10119.7, 11512.195.)

 

Domestic Violence: Insurers must not deny, limit, refuse to renew, or terminate coverage to individuals on the basis that they have been victims of domestic violence; insurers also may not charge such individuals different rates for the same coverage. (AB1973, 1995) (Health & Safety Code Section 1374.75; California Insurance Code Section 10144.2.)

 

Genetic Characteristics: Effective until January 1, 2002, insurers are prohibited from offering or providing different terms, conditions, or benefits, on the basis of an individual's genetic characteristics. Genetic testing results must not be released to any third party without proper written authorization; individuals or plans guilty of such action shall incur civil penalties. (SB1020, 1995) (California Health & Safety Code Sections 1374.7, 1374.9; California Insurance Code Sections 10123.3, 10140, 10147, 11512.95, 10123.31, 10123.35, 10140.1, 10140.5, 11512.96, 11512.965.)

 

Handicapped Dependents: Coverage for dependent children cannot be terminated while a child is incapable of employment due to mental retardation or physical handicap and chiefly dependent on the insured. (California Insurance Code Sections 10277, 10278, 11512.15; Health & Safety Code Section 1373(d).) Insurers must offer group policies with coverage for physically handicapped members under the same conditions afforded other members. (California Insurance Code Sections 10122.1, 10123.1, 11512.7.)

 

Managed Care: Patients must be allowed to select any participating primary care provider in the service area. (SB1151, 1995) (Health & Safety Code Sections 1345, 1373.3.) Plans must give patients 30-day prior written notifications of terminations of services provided by medical groups, individual providers, or individual providers within medical groups. (AB1840, 1995) (California Insurance Code Sections 1367, 1373.65; Health & Safety Code Section 1371.25.)

 

Mastectomy: Health care service plans that cover mastectomy and prosthetic devices and reconstructive surgery due to mastectomy also must cover mammography screening and diagnostics. (California Health & Safety Code Section 1367.65.)

 

Medicare Supplemental Policies: Coverage for applicants age 65 or older who apply for supplemental plans must not be denied or conditioned upon health status if they submit applications for a plan within six months after enrolling for benefits under Medicare Part B. Replacement Policies: Medicare supplemental plans (in effect for less than 6 months) which are replaced by similar plans must waive the time periods applicable to pre-existing conditions to the extent these periods were covered under an original plan; however, Medicare supplemental plans (in effect for more than 6 months) must prohibit limitations based on pre-existing conditions. (SB687, 1995) (Health & Safety Code Section 1358.20; California Insurance Code Sections 10194.8, 10197.05.)

 

Newborns: Policies must cover newborn children from the moment of birth. (California Insurance Code Section 10119(a); Health & Safety Code § 1371(c).)

 

Policies For Small Employers: Under the Health Insurance Plan of California, insurers must guarantee issuance and renewal to small business, limit exclusions for pre-existing conditions, allow workers to carry insurance from one job to another, and base premiums on a modified community rating. Chapter 1128, statutes of 1992. A small employer is one that was actively engaged in business on at least 50 percent of the working days during the preceding calendar quarter and employed at least three, but no more than 50 workers, the majority of whom were employed in California. (AB 503, 1995) (California Health & Safety Code Sections 1357, 1357.05, 1357.12; California Insurance Code Sections 10700, 10707, 10714.)

 

Progressive, Degenerative, and Dementing Illnesses: Policies that provide coverage of long-term care or home-based care cannot exclude these illnesses, including Alzheimer's disease. (California Insurance Code Sections 10123.16, 11512.77; Health & Safety Code Section 1373.4.)

 

Providers: Physicians, surgeons, dentists, podiatrists, optometrists, opticians, chiropractors, psychologists, physical therapists: Group disability plans must reimburse plan participants for services of such providers. (California Insurance Code Section 10176, 10176.2.) Clinical social workers, occupational therapists, marriage, family, and child counselors, speech pathologists, audiologists, and certain psychiatric nurses must be covered when insured is referred by licensed physician or surgeon. (California Insurance Code Section 10176.) Acupuncturists must be covered if acupuncture is included as a benefit. (California Insurance Code Section 10176.25.) Psychiatric health facilities: Health care service plans that cover professional mental health services provided by a general acute care hospital or acute psychiatric hospital and that do not place a limit on providers must cover such services performed by a psychiatric health facility, as defined. (California Health & Safety Code Section 1373(h)(1).)

Sterilization: Policies that provide coverage of sterilization procedures cannot limit coverage due to reasons for the sterilization. (California Insurance Code Sections 10120, 11512.1; Health & Safety Code Section 1373(b).)

 

Surgical Procedures: Insurers must cover surgical procedures for conditions directly affecting the joints and upper and lower jawbone. (California Insurance Code Section 1282.)

 

Optional Benefits: Insurers are required to offer to employers, under terms agreed on between the insurer and the group policy holder, optional insurance coverage for the following services or conditions: acupuncture, alcoholism treatment, orthotic and prosthetic devices and services, infertility treatment (except in vitro fertilization), prenatal diagnosis of genetic disorders, mental or nervous disorders, preventive care of children, and footwear for those suffering from foot disfigurement. (California Insurance Code Sections 10119.6, 10123.5, .6, .7, .9, .10, .111, 10125, 10127, 11512.12, .14, .17, .175, .178, .18, .20, .23, .28, NS .5; Health & Safety Code Sections 1373.10, 1367.2.)

 

CALIFORNIA - GROUP HEALTH FOR SMALL EMPLOYERS

For insurance plans offered to small employers:

 

Eligibility Criteria: 3 - 50 employees with the majority being employed within the state. Any guaranteed association.

 

Restrictions on premiums: Yes.

 

Restrictions on cancellation: Yes.

 

Pre-existing Conditions: Pre-existing provision shall not exceed 6 months following effective date of coverage.

 

(California Insurance Code Sections 10700 et seq.)

 

CALIFORNIA - GROUP LIFE CODE ADDITIONS

Employer required to pay part of premium: Yes.

 

Percent of employees who must elect coverage (if employees pay part of premium): 75%.

 

Percent of employees who must be covered if employer pays all of premium: No statutory requirements.

 

Minimum number of employees in group plan: 10.

 

Employer prohibited as beneficiary: Yes.

 

Grace period (days): No statutory requirements.

 

Mandatory conversion: Yes.

 

Other provisions: None. (California Insurance Code Sections 10202, 10209)

 

CALIFORNIA - HOLIDAYS

January 1, Washington's Birthday (or 3rd Monday in February), Memorial Day (or last Monday in May), July 4, Labor Day (or 1st Monday in September), Veterans Day, and December 25 are state holidays in all 50 states and in the District of Columbia. Other holidays under State law include: Martin Luther King's birthday (or 3rd Monday in January), Lincoln's Birthday, Columbus Day (or 2nd Monday in October), Sunday. Other: Thanksgiving is not a holiday under state law. Any holiday proclaimed by the Governor. If January 1, February 12, July 4, September 9, November 1, or December 25 falls on Sunday, following Monday is a holiday; if November 11 falls on Saturday, preceding Friday is a holiday. (California Government Code Section 6700, 6701-6703, 6708-6717)

 

CALIFORNIA - IMMIGRATION (PREVAILING WAGE POLICY)

See U.S. Federal General Administrative Letter 1-2000

 

CALIFORNIA - JURY DUTY & WITNESS TIME OFF

Employer Restriction For Discharging Employee For Taking Leave For Jury Service: Yes.

 

Remedies and Penalties: Employee can bring civil action for reinstatement and reimbursement for lost wages and work benefits. Employer who willfully refuses to rehire an eligible employee is guilty of a misdemeanor.

 

Other Requirements: Employee must give employer reasonable prior notice. (California Labor Code Section 230)

 

Employer Restriction For Discharging Employee For Taking Leave to be a Witness: Yes, unless employee is a litigant by reason of his/her own misconduct (public employees). Private sector employee cannot be discriminated against if reasonable notice of service is given.

 

Remedies and Penalties: Private sector employee is entitled to reinstatement, lost wages, and benefits. Failure to restore employee is a misdemeanor.

 

Other Requirements: Employee is entitled to employer intercession services asking employer to minimize loss of pay and benefits because of employee's participation in criminal justice system. (California Government Code Section 1230, 1230.1)

 

CALIFORNIA - LEAVES OF ABSENCE

Employers Subject to Leave Laws: Employers with more than 50 employees.

 

Criteria for Eligibility: Employed for at least 1 continuous year for a minimum of 1,250 hours per year.

 

Maximum length of leave: 12 weeks in a 12 month period.

 

Paid Leave: State does not require paid leave. Employee benefits such as sick time or vacation time may be used.

 

Acceptable Reasons for Leave: Birth/adoption of a child or care of foster child; illness of employee, child, spouse or parent.

 

Employment Guarantees After Leave: Entitled to reinstatement in the same or equivalent position and at the level of seniority held prior to leave.

 

Use of Vacation or other Time-off Benefits: Employer may require use of all time off benefits before receiving leave benefits.

 

Certification Required: Employer may require certification of illness if leave is taken to care for an ill child, spouse or parent, as well as require a second or third opinion at the employer's expense.

 

Effect of Leave on Other Benefits: All benefits continue while on leave, the same as for other unpaid leave.

 

Effect of Seniority Accrual During Leave: Seniority continues while on leave.

 

Minimum Requirements for Notification to Employer: Reasonable advance notice to employer is required

 

Conditions for Denial of a Request For Leave: If leave extends beyond 12 weeks in a 12 month period, if child's other parent is on leave or unemployed, if employee requesting leave is among top 10% of highest paid employees, or if leave will create undue hardship for employer. (California Government Code Sections 12945, 12945.2.)

 

See U.S. Federal Family and Medical Leave Act

 

CALIFORNIA - LONG TERM DISABILITY CODE ADDITIONS

State does not require employer to provide long term disability benefits; although many employers do in order to remain competitive in hiring/retention of employees.

 

See LEAVES OF ABSENCE (above), WORKERS' COMPENSATION (below) and Americans With Disabilities Act

 

CALIFORNIA - MANDATED PROVIDERS

Optometrists, chiropractors, dentists, podiatrists, psychologists, social workers, nurse practitioners or midwives. Mandatory coverage for marriage, family and child counselors; speech pathologists; audiologists; acupuncturists; physical and occupational therapists; psychiatric mental health nurses, pharmacists, telemedicine, and opticians. Direct access to obstetrician/gynecologist is mandatory. (California Insurance Code Sections 10123.84, 10123.85, 10125.1, 10176, 10179, 10353)

 

CALIFORNIA - MENTAL HEALTH CARE

Employer option, for specified disorders.

 

Minimum yearly inpatient coverage: No statutory requirements.

 

Minimum outpatient coverage: No statutory requirements.

 

Minimum lifetime coverage: No statutory requirements. (California Insurance Code Sections 10123.15, 10125)

 

CALIFORNIA - MINIMUM WAGE

$6.75 per hour (effective January 1, 2002).
 

Exemptions: Certain outside sales, certain students (sub-minimum wage of 85%). Apprentices and handicapped in special environments may be exempt by special license. (California Labor Code Sections 1171, 1173, 1191, 1192; California Constitution art. XIV, Section 1; California Code of Regulations title 8 Section 11100 - Order Number MW-88. Regulations are set by the Industrial Welfare Commission.)

 

See U.S. Federal U.S. Minimum Wage

 

CALIFORNIA - NEW HIRE REPORTING

Who is required to report: All employers.

 

Who must be reported: New and rehired employees.

 

Exempt from reporting: Employees earning less than $300 per month; employees under 18 years of age.

 

Form(s) to file: State form, W-4 form, any other hiring document or by any other means authorized by the state.

 

Filing deadline: Within 20 days of hire.

 

Employer information to be included: Name, address, and state EIN.

 

Employee information to be included: Name, including first initial and last name, address, and SSN.

 

Penalty for failure to report: Fine of $24 per employee ($490 if conspiracy) may be imposed.

 

(California Unemployment Insurance Code Section 1088.5)

 

CALIFORNIA - NEWBORN CARE MANDATE

Mandated coverage.

 

Preventive care for children: Employer option, including screening for blood lead levels in children. (California Insurance Code Sections 10018, 10119, 10119.5, 10119.6, 10123.55, 10123.9, 11512.35)

 

CALIFORNIA - PARENTAL LEAVE

See U.S. Federal Family and Medical Leave Act

 

CALIFORNIA - PRE-EXISTING CONDITIONS

For insurance plans offered to small employers, pre-existing condition provision shall not exclude coverage for a period beyond 6 months following the effective date of coverage. (Annals California Insurance Code Sections 23-86-101 et seq.)

 

See U.S. Federal Health Insurance Portability & Accountability Act

 

CALIFORNIA - PROTECTED CLASSIFICATIONS

Age:  Yes, older than 40.

Race:  Yes.

Color: Yes.

National Origin: Yes.

Ancestry: Yes.

Religion:  Yes.

Sex: Yes.

Pregnancy: Yes.

Sexual Harassment: Yes.

 

(California Government Code Sections 12940, 12941, 12945.)

 

CALIFORNIA - SALARY SURVEY

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian wages & salaries (covering 3,000 positions).

 

CALIFORNIA - SHORT TERM DISABILITY CODE ADDITIONS

Covered Employers: 1 or more employees.

 

Employer Contribution:  None required.

 

Covered Employees:  Earning $300 or more in wages in base period.

 

Employee Contribution:  0.57% of first $31,767 in wages.

 

Weekly Benefit Amount:      $50 - $336.

 

Waiting Period:  7 days; may be waived with hospitalization.

 

Coordinated with Workers' Compensation:  Yes.

 

Responsible Agency:     

Employment Development Department

Disability Insurance Office

P.O. Box 13140

Sacramento, CA 95813

 

CALIFORNIA - TERMINATION & SEVERANCE PAY

Date pay is due if employee is discharged: Immediately.

 

Date due if employee resigns: Within 72 hours.

 

Wages: Yes.

 

Vacation Pay: Yes.

 

Holiday: No.

 

Sick leave: No.

 

Severance: No.

 

(California Labor Code Sections 201, 202, 227.3, 2926)

 

CALIFORNIA - UNEMPLOYMENT TAX

Employer Contributions:

 

 

Voluntary Contribution Provision: Yes. Before last working day in March.

(California Unemployment Insurance Code Sections 977, 982, 1086-1095).

 

CALIFORNIA - VACATION PAY

See CALIFORNIA - TERMINATION & SEVERANCE PAY (above)

 

CALIFORNIA - VOTING TIME OFF

Yes. Enough time that will enable employee to vote when added to the voting time available outside of working hours. Only 2 hours will be compensated. Time off will occur at end or beginning of employee's regular work shift. (California Election Code Sections 14000, 14001, 14002; California Labor Code Sections 1101, 1102)

 

CALIFORNIA - WORKER HOURS AND OVERTIME

Effective January 1, 2000 (For non-exempt workers): 8 hours labor constitutes a day's work. Any work in excess of 8 hours in a workday and any work in excess of 40 hours in any workweek, and the first 8 hours of work on the seventh day of work in any workweek, shall be compensated at the rate of 11/2 times the regular rate of pay. Any work in excess of 12 hours in one day shall be compensated at a rate of no less than 2 times the regular rate of pay for an employee. Also, any work in excess of 8 hours on the seventh day of a work week shall be compensated at the rate of no less than 2 times the regular rate of pay. (California Labor Code Section 510)

 

CALIFORNIA - WORKERS' COMPENSATION

Private Employers: Mandatory as to all employments. Elective coverage for working members of a partnership and for working officers and directors of a private corporation who are sole shareholders.

 

Public Employers: Mandatory as to all public employments except clerks and deputies serving without remuneration, and to regional occupational centers, programs or school districts offering training to pupils outside attendance area. Volunteers in a sheriff's reserve are covered if locality adopts a resolution stating they are covered.

 

Exceptions: Charity workers and volunteer member workers at camps, etc., operated by non-profit organizations. Employer sponsored bowling teams. Domestics who work less than 52 hours during preceding 90 days or earn less that $100. Students in sports events (excludes amateur athletic participants who are not employees.)

 

Special Coverage Provisions: Voluntary as to excepted employments and sponsoring agencies of Economic Opportunity Programs. Employer not liable for injury due to off-duty recreational, social or athletic duty not part of work-related activities. (U.S. Chamber of Commerce, 1994 Analysis of Workers' Compensation Laws.)