California Health and Safety Code Section 1363.1 requires that any health plan using binding arbitration to settle disputes must disclose information about the agreement to the subscriber/enrollee at the point of enrollment.
California carriers include the arbitration language on their paper enrollment forms and the language may vary by carrier and the carrier may present different variations of the agreement to enrollees in small group vs. large group plans.
Employee Navigator will be collecting current arbitration language from California carriers and building these disclosures at the system level. These disclosures will be available for you to pull into your medical plan configuration and present to employees during the enrollment process.
The Arbitration Language disclosures will also display on the Universal system generated enrollment forms when these forms are generated.
We will continue to add the arbitration language for additional carriers and will update the list of carriers as the disclosures are added to the system.
An updated list of carriers with CA Arbitration Language loaded in Employee Navigator can be accessed using the link below.
Note: To request California Arbitration Language be loaded into Employee Navigator for a new carrier, Premier Users may submit a request to Employee Navigator Support. Please attach or include a link to the carrier's current enrollment form(s).
California Medical Plans
Supported Enrollment Products:
System Generated pdf Enrollment Forms - Please see the article for details and requirements on generating the universal pdf Enrollment Forms.
When building or editing a medical plan, the Carrier Form drop down menu on the Policy Info page will display the "Arbitration Language" form if one is available for the Carrier. When the form is selected, the "?" icon can be selected to view the language included in the form.
To configure a medical plan to display the carrier California Arbitration Language disclosure during the employee enrollment flow and on the PDF Enrollment form if desired, follow the steps below on the medical plan.
From the plan Policy Information tab
- Carrier - The plan carrier must be set to match a carrier on our list of Carriers with California Arbitration Language disclosures.
- Situs State - If necessary, set the Situs State to California. See the section on State Settings below for additional information.
- Generate PDF Enrollment Form - check this box to auto generate the system pdf enrollment form to include the Arbitration Language and Agreement Date.
- Carrier Form - This field will populate based on the Carrier selected for your plan. If multiple forms are displayed in the drop down menu, select the Form titles "[Carrier] Arbitration Language".
- Carrier Form Group Size - Select from the options to "Use large group form" or "Use small group form". If the carrier has indicated different versions of the Arbitration Language based on group size, this will tell the system which form to use for the group. If no group size is selected, the small group form will be used.
To display the California Carrier Arbitration language, the company or individual plan settings must indicate the state of California.
There are multiple places in the system in which to indicate that the plan enrollments should pull any carrier arbitration language/disclosures configured for California.
The most standard place to designate a state at the company level is the State field on the Company Profile. In some instances, however, the state indicated in the company address may not be the same as the company's benefit plan situs. In this case, the Situs State field on the company Profile may be used.
From the Company Settings tab > COMPANY > Profile > select one of the following options:
- Set the company State to California if the company is located in California
- Set the company Situs State to California if the company is not located in California, but the company's benefit plan situs is CA.
The Plan level situs state is used to identify a different situs state for a plan when the contract state varies from the state or the situs state on the company profile.
Select the plan from the Plan List > POLICY INFO > Policy Info > set the Situs State to California.
Please note the following system logic used to determine the situs state of a plan:
- Plan level Situs State. If none, move to #2.
- Company level Situs State. If none, move to #3.
- Company level State.