12695-12695.24
INSURANCE CODE
SECTION 12695-12695.24
12695. This part shall be known and may be cited as the Access for Infants and Mothers Program. 12695.02. For purposes of this part, the definitions contained in this article shall govern the construction of this part, unless the context requires otherwise. 12695.03. "AIM-linked infant" means any infant born to a woman whose enrollment in the Access for Infants and Mothers Program begins after June 30, 2004. 12695.04. "Advisory panel" means the Managed Risk Medical Insurance Board Access for Infants and Mothers Advisory Panel created pursuant to Section 12696.5. 12695.06. "Applicant" means an individual who applies for coverage through the program. 12695.08. "Board" means the Managed Risk Medical Insurance Board created pursuant to Section 12710. 12695.10. "Case management" means the management of all physician services, both primary and specialty, and arrangements for hospitalization, post-discharge care, and followup care. 12695.12. "Comprehensive primary care services" include, but are not limited to, all of the following: (a) Preventive, screening, diagnostic, and treatment services furnished directly by a licensed clinic, either onsite or by formal written contract, on a case-managed basis, to patients who remain less than 24 hours at the clinic for an illness or injury, advice, counseling, outreach, and translation as needed. (b) Physician services. (c) Emergency first aid, perinatal, obstetric, radiology, laboratory, and nutrition services. (d) Services of advanced practice nurses or mid-level practitioners who are authorized to perform any of the services listed in this subdivision within the scope of their licensure. (e) Health education, including education regarding the harmful results of tobacco use, and information and referral services. 12695.14. "Fund" means the Perinatal Insurance Fund. 12695.16. "Health education services relating to tobacco use" means tobacco use prevention and education services, including, when appropriate, tobacco use cessation services, in accordance with protocols established by the board in coordination with the Tobacco Control Section of the State Department of Health Services. 12695.18. "Participating health plan" means any of the following plans that are 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 arrangements, or membership contracts, in consideration of premiums or other periodic charges payable to it, and that contracts with the program to provide coverage to program subscribers: (a) A private insurer holding a valid outstanding certificate of authority from the Insurance Commissioner. (b) A nonprofit membership corporation lawfully operating under the Nonprofit Corporation Law (Division 2 (commencing with Section 5000) of the Corporations Code). (c) A health care service plan as defined under subdivision (f) of Section 1345 of the Health and Safety Code. (d) A county or a city and county, in which case no license or approval from the Department of Insurance or the Department of Managed Health Care shall be required to meet the requirements of this part. (e) A comprehensive primary care licensed community clinic that is an organized outpatient freestanding health facility and is not part of a hospital that delivers comprehensive primary care services, in which case, no license or approval from the Department of Insurance or the Department of Managed Health Care shall be required to meet the requirements of this part. 12695.20. "Program" means the Access for Infants and Mothers Program. 12695.22. "Subscriber" means an individual who is eligible for and enrolled in the program. 12695.24. "Subscriber contribution" means the cost to the subscriber to participate in the program.