Title INS — California Ins. Code
0 chapters · 3,633 sections in this title.
Ins. Code § 10181.35 Section 10181.35
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(a) It is the intent of the Legislature in enacting this section to ensure that insureds benefit from reductions in the rate of growth in health care costs as a result of the establishment of the Office of Health Care Affordability. (b) In submitting rates for review consistent w…
Ins. Code § 10181.4 Section 10181.4
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(a) For large group health insurance policies, all health insurers shall file with the department at least 60 days prior to implementing any rate change all required rate information for unreasonable rate increases. This filing shall be concurrent with the written notice describe…
Ins. Code § 10181.45 Section 10181.45
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(a) For large group health insurance policies, a health insurer shall file with the department the weighted average rate increase for all large group benefit designs during the 12-month period ending January 1 of the following calendar year. The average shall be weighted by the n…
Ins. Code § 10181.46 Section 10181.46
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(a) A health insurer, not including a specialized health insurance policy, shall annually report to the department the information described in subdivision (c) for all grandfathered and nongrandfathered products that the insurer offers and sells in the individual market, includin…
Ins. Code § 10181.5 Section 10181.5
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Notwithstanding any provision in a contract between a health insurer and a provider, the department may request from a health insurer any information required under this article or PPACA.
Ins. Code § 10181.6 Section 10181.6
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(a) A filing submitted under this article shall be actuarially sound. (b) (1) The health insurer shall contract with an independent actuary or actuaries consistent with this section. (2) A filing submitted under this article shall include a certification by an independent actuary…
Ins. Code § 10181.7 Section 10181.7
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(a) Notwithstanding Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code, all information submitted under this article shall be made publicly available by the department except as provided in subdivision (b). (b) (1) The contracted rates between a heal…
Ins. Code § 10181.8 Section 10181.8
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A health insurance policy subject to Section 10181.3 or 10181.4 shall file a separate schedule documenting the cost savings associated with Section 10176.11 and the impact on rates.
Ins. Code § 10181.9 Section 10181.9
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(a) On or before July 1, 2012, the commissioner may issue guidance to health insurers regarding compliance with this article. This guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of …
Ins. Code § 1019 Section 1019
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Upon the issuance of an order of liquidation under section 1016, the rights and liabilities of any such person and of creditors, policyholders, shareholders and members, and all other persons interested in its assets, including the State of California, shall, unless otherwise dir…
Ins. Code § 10190 Section 10190
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The provisions of Sections 800, 801, 802, 803, and 804 shall not apply to life insurance.
Ins. Code § 10191 Section 10191
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(a) The commissioner may, from time to time as conditions warrant, after notice and hearing, promulgate such reasonable rules and regulations, and amendments and additions thereto, as are necessary or advisable, to establish and maintain a procedure for the filing and approval of…
Ins. Code § 10191.1 Section 10191.1
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(a) In order to streamline the department’s file review process for life and disability insurance forms, the commissioner may develop and publish all of the following: (1) Procedural requirements for file submission. (2) Guidelines and checklists that list and interpret applicabl…
Ins. Code § 10191.5 Section 10191.5
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(a) (1) The commissioner shall request that a multistate regulatory support organization commission a study to examine and report on the extent to which the uniform standards set forth in the Interstate Insurance Product Regulation Compact developed by the Interstate Insurance Pr…
Ins. Code § 10192 Section 10192
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If a policy of life insurance becomes paid up pursuant to a paid up nonforfeiture benefit, the insurer shall send a notice to the owner of the policy not later than six months after the date the paid up nonforfeiture benefit becomes effective, and once every five years thereafter…
Ins. Code § 10192.1 Section 10192.1
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All Medicare supplement policies and certificates shall comply with the provisions of subdivision (b) of Section 10291.5 and Chapter 7 (commencing with Section 10600) of Part 2 of Division 2, regardless of the situs of the contract.
Ins. Code § 10192.10 Section 10192.10
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(a) (1) This section shall apply to Medicare Select policies and certificates, as defined in this section. (2) A policy or certificate shall not be advertised as a Medicare Select policy or certificate unless it meets the requirements of this section. (b) For the purposes of this…
Ins. Code § 10192.11 Section 10192.11
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(a) (1) An issuer shall not deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in this state, nor discriminate in the pricing of a policy or certificate because of the health status, claims experience, receipt of he…
Ins. Code § 10192.12 Section 10192.12
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(a) (1) With respect to the guaranteed issue of a Medicare supplement policy, eligible persons are those individuals described in subdivision (b) who seek to enroll under the policy during the period specified in subdivision (c), and who submit evidence of the date of termination…
Ins. Code § 10192.13 Section 10192.13
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(a) An issuer shall comply with Section 1882(c)(3) of the federal Social Security Act (as enacted by Section 4081(b)(2)(C) of the federal Omnibus Budget Reconciliation Act of 1987 (OBRA), Public Law 100-203) by doing all of the following and by certifying compliance on the Medica…
Ins. Code § 10192.14 Section 10192.14
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(a) (1) (A) With respect to loss ratio standards, a Medicare supplement policy form or certificate form shall not be advertised, solicited, or issued for delivery unless the policy form or certificate form can be expected, as estimated for the entire period for which rates are co…
Ins. Code § 10192.15 Section 10192.15
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(a) An issuer shall not advertise, solicit, or issue for delivery a policy or certificate to a resident of this state unless the policy form or certificate form has been filed with and approved by the commissioner in accordance with filing requirements and procedures prescribed b…
Ins. Code § 10192.16 Section 10192.16
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(a) An issuer or other entity may provide commission or other compensation to an agent or other representative for the sale of a Medicare supplement policy or certificate only if the first year commission or other first year compensation is no more than 200 percent of the commiss…
Ins. Code § 10192.165 Section 10192.165
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(a) (1) As prescribed in this chapter, the commissioner shall have the administrative authority to assess penalties against issuers, brokers, agents, and other entities engaged in the business of insurance or any other person or entity for violations of this article. (2) Upon a s…
Ins. Code § 10192.17 Section 10192.17
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(a) Medicare supplement policies and certificates shall include a renewal, continuation, or conversion provision. The language or specifications of the provision shall be consistent with the type of contract issued. The provision shall be appropriately captioned and shall appear …
Ins. Code § 10192.18 Section 10192.18
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(a) Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant currently has Medicare supplement, Medicare Advantage, Medi-Cal coverage, or another health insurance policy or certificate i…
Ins. Code § 10192.185 Section 10192.185
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In addition to any other requirements of law, the following shall apply to a Medicare supplement policy: (a) The issuer shall not require an amount greater than one month’s premium to be submitted with an application for the policy of insurance if interim coverage is not provided…
Ins. Code § 10192.19 Section 10192.19
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(a) An issuer shall provide a copy of any Medicare supplement advertisement intended for use in this state whether through written, radio, or television medium to the commissioner for review at least 30 days before dissemination of the advertisement. The advertisement shall compl…
Ins. Code § 10192.195 Section 10192.195
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The commissioner may prescribe by regulation a standard form and the contents of an informational brochure for persons eligible for Medicare by reason of age which is intended to improve the buyer’s ability to select the most appropriate coverage and improve the buyer’s understan…
Ins. Code § 10192.2 Section 10192.2
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The purpose of this article is to provide for the reasonable standardization of coverage and simplification of terms and benefits of Medicare supplement policies, to facilitate public understanding and comparison of those policies, to eliminate provisions contained in those polic…
Ins. Code § 10192.20 Section 10192.20
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(a) An issuer, directly or through its producers, shall do each of the following: (1) Establish marketing procedures to ensure that any comparison of policies by its agents or other producers will be fair and accurate. (2) Establish marketing procedures to ensure that excessive i…
Ins. Code § 10192.21 Section 10192.21
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(a) In recommending the purchase or replacement of any Medicare supplement policy or certificate, an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement. (b) Any sale of a Medicare supplement policy or certificate that wil…
Ins. Code § 10192.22 Section 10192.22
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(a) On or before March 1 of each year, an issuer shall report the following information for every individual resident of this state for which the issuer has in force more than one Medicare supplement policy or certificate: (1) Policy and certificate number. (2) Date of issuance. …
Ins. Code § 10192.23 Section 10192.23
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(a) If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate, the replacing issuer shall waive any time periods applicable to preexisting conditions, waiting periods, elimination periods, and probationary periods in the new Medicar…
Ins. Code § 10192.24 Section 10192.24
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This section applies to all policies with policy years beginning on or after May 21, 2009. (a) In addition to the requirements set forth under Sections 10140 and 10143, an issuer of a Medicare supplement policy or certificate shall adhere to the requirements imposed by the federa…
Ins. Code § 10192.3 Section 10192.3
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(a) Except as otherwise provided in this section or in Sections 10192.7, 10192.12, 10192.13, 10192.16, and 10192.21, this article shall apply to all Medicare supplement policies advertised, solicited, or issued for delivery in this state on or after January 1, 2001, and to all ce…
Ins. Code § 10192.4 Section 10192.4
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The following definitions apply for the purposes of this article: (a) “Applicant” means: (1) The person who seeks to contract for insurance benefits, in the case of an individual Medicare supplement policy. (2) The proposed certificate holder, in the case of a group Medicare supp…
Ins. Code § 10192.5 Section 10192.5
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A policy or certificate shall not be advertised, solicited, or issued for delivery as a Medicare supplement policy or certificate unless the policy or certificate contains definitions or terms that conform to the requirements of this section. (a) (1) “Accident,” “accidental injur…
Ins. Code § 10192.55 Section 10192.55
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(a) With regard to Medicare supplement policies, all insurers, brokers, agents, and others engaged in the business of insurance owe a policyholder or a prospective policyholder a duty of honesty, and a duty of good faith and fair dealing. (b) Conduct of an insurer, broker, or age…
Ins. Code § 10192.6 Section 10192.6
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(a) Except for permitted preexisting condition clauses as described in Sections 10192.7, 10192.8, and 10192.81, a policy or certificate shall not be advertised, solicited, or issued for delivery as a Medicare supplement policy if the policy or certificate contains limitations or …
Ins. Code § 10192.7 Section 10192.7
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A policy or certificate shall not be advertised, solicited, or issued for delivery as a Medicare supplement policy or certificate prior to January 1, 2001, unless it meets or exceeds requirements applicable pursuant to this code that were in effect prior to that date.
Ins. Code § 10192.8 Section 10192.8
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The following standards are applicable to all Medicare supplement policies or certificates advertised, solicited, or issued for delivery on or after January 1, 2001, and with an effective date prior to June 1, 2010. A policy or certificate shall not be advertised, solicited, or i…
Ins. Code § 10192.81 Section 10192.81
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The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state with an effective date on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered, or issued for delivery in t…
Ins. Code § 10192.9 Section 10192.9
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The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state on or after July 1, 1992, and with an effective date prior to June 1, 2010. (a) An issuer shall make available to each prospective policyholde…
Ins. Code § 10192.91 Section 10192.91
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The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state with an effective date on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered, or issued for delivery in t…
Ins. Code § 10192.92 Section 10192.92
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The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state to individuals newly eligible for Medicare on or after January 1, 2020. A policy or certificate that provides coverage of the Medicare Part B …
Ins. Code § 10198.10 Section 10198.10
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This article shall become operative on January 1, 2014.
Ins. Code § 10198.6 Section 10198.6
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For purposes of this article, the following definitions shall apply: (a) “Health benefit plan” means any group or individual policy of health insurance, as defined in Section 106. The term does not include coverage of Medicare services pursuant to contracts with the United States…
Ins. Code § 10198.61 Section 10198.61
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(a) For purposes of this article, “health benefit plan” does not include policies or certificates of specified disease or hospital confinement indemnity provided that the carrier offering those policies or certificates complies with the following: (1) The carrier files, on or bef…
Ins. Code § 10198.7 Section 10198.7
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(a) A health benefit plan for group coverage shall not impose any preexisting condition provision or waivered condition provision upon any individual. (b) (1) A nongrandfathered health benefit plan for individual coverage shall not impose any preexisting condition provision or wa…