Title INS — California Ins. Code
0 chapters · 3,633 sections in this title.
Ins. Code § 10199 Section 10199
0.3K chars
The purpose of the chapter is to promote the public interest, to prevent unfair and unlawful health care business practices, and to promote adequate consumer and employer advance notice of changes in the cost and benefits of health coverage in order to allow for comparative shopp…
Ins. Code § 10199.1 Section 10199.1
5.3K chars
(a) (1) An insurer or nonprofit hospital service plan or administrator acting on its behalf shall not terminate a group master policy or contract providing hospital, medical, or surgical benefits, increase premiums or charges therefor, reduce or eliminate benefits thereunder, or …
Ins. Code § 10199.2 Section 10199.2
0.6K chars
(a) The written notice described in subdivisions (a) and (b) of Section 10199.1 shall state in italics and in 12-point type the actual dollar amount and the specific percentage of the premium rate increase. Further, the notice shall describe in plain understandable English and hi…
Ins. Code § 10199.3 Section 10199.3
0.6K chars
There shall be no liability on the part of, and no cause of action of any nature shall arise against, any entity required to provide the notice or its authorized representatives, or agents, for any statement made, unless shown to have been made with malice in fact, by any of them…
Ins. Code § 10199.4 Section 10199.4
0.2K chars
Proof of mailing a notice and the reason therefor to the appropriate entity or individual at the last known mailing address shall be sufficient proof of the notice required by this chapter.
Ins. Code § 10199.44 Section 10199.44
0.9K chars
(a) On or after January 1, 1994, every insurer issuing, amending, or renewing group disability insurance which covers hospital, medical, or surgical expenses shall notify the group policyholders in writing of the cancellation of the group policy and shall include in their contrac…
Ins. Code § 10199.46 Section 10199.46
0.9K chars
(a) On or after January 1, 1994, every nonprofit hospital service plan issued, amended, or renewed that covers hospital, medical, or surgical expenses on a group basis shall notify the group contractholders in writing of the cancellation of the plan contract and shall include in …
Ins. Code § 10199.48 Section 10199.48
1.1K chars
(a) No health insurer shall, with regard to a group contract, change the premium rates or applicable copayments or coinsurances or deductibles for the length of the contract, except as specified in subdivision (b), during any of the following time periods: (1) After the group pol…
Ins. Code § 10199.49 Section 10199.49
1.0K chars
(a) This section shall apply to grandfathered health insurance policies and nongrandfathered health insurance policies in the individual or small group markets that are issued, amended, or renewed on or after January 1, 2017. (b) Notwithstanding paragraph (1) of subdivision (b) o…
Ins. Code § 10199.5 Section 10199.5
0.3K chars
The commissioner may, as conditions warrant, pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, adopt reasonable regulations, and amendments and additions thereto, as are necessary to administer this chapter.
Ins. Code § 10199.6 Section 10199.6
0.9K chars
(a) The commissioner shall have the administrative authority to assess penalties against insurers, nonprofit hospital service plans, administrators, and insurance producers, and other entities engaged in the business of insurance or other persons or entities for violations of thi…
Ins. Code § 10199.7 Section 10199.7
1.2K chars
(a) Any production agent, administrator, or other person or entity engaged in the business of insurance, other than an insurer, who violates this chapter is liable for administrative penalties of not less than two hundred fifty dollars ($250) for the first violation. (b) Any prod…
Ins. Code § 10199.8 Section 10199.8
0.5K chars
In addition to any other penalty provided by law or the availability of any administrative procedure, if an insurer, after notice and hearing, is found to have violated this chapter, or regulations adopted pursuant to this chapter, or knowingly permits any person to do so, the co…
Ins. Code § 10199.9 Section 10199.9
0.3K chars
This chapter applies to all master group policies and master group nonprofit hospital service plan contracts providing hospital, medical, or surgical benefits, regardless of policy or contract situs, coverage under which is solicited in any manner in this state.
Ins. Code § 10231 Section 10231
0.1K chars
Unless the context requires otherwise, the definitions in this article shall govern the construction of this chapter.
Ins. Code § 10231.2 Section 10231.2
1.6K chars
“Long-term care insurance” includes any insurance policy, certificate, or rider advertised, marketed, offered, solicited, or designed to provide coverage for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services that are provided in a setting…
Ins. Code § 10231.3 Section 10231.3
4.0K chars
(a) For the purposes of this section, the following definitions apply: (1) An “alternate plan of care” means a plan of care that includes a specification of long-term care services, providers, or places of care that are not specifically defined as covered services, providers, or …
Ins. Code § 10231.4 Section 10231.4
0.3K chars
“Applicant” means either of the following: (a) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits. (b) In the case of a group long-term care insurance policy, the proposed certificate holder.
Ins. Code § 10231.5 Section 10231.5
0.2K chars
“Certificate” means any certificate issued under a group long-term care insurance policy, which policy has been delivered or issued for delivery in this state.
Ins. Code § 10231.6 Section 10231.6
3.8K chars
“Group long-term care insurance” means a long-term care insurance policy which is delivered or issued for delivery in this state and issued to any of the following: (a) One or more employers or labor organizations, or a trust or to the trustees of a fund established by one or mor…
Ins. Code § 10231.8 Section 10231.8
0.3K chars
“Policy” means any policy, contract, subscriber agreement, rider or endorsement delivered or issued for delivery in this state by an insurer, fraternal benefit society, nonprofit hospital service plan, or any similar organization, regulated by the commissioner.
Ins. Code § 10232 Section 10232
3.2K chars
(a) No group long-term care insurance coverage may be offered or sold to a resident of this state under a group policy issued in another state to a group described in subdivision (d) of Section 10231.6, unless the commissioner has determined that the requirements imposed by subdi…
Ins. Code § 10232.1 Section 10232.1
2.6K chars
(a) Every policy that is intended to be a qualified long-term care insurance contract as provided by Public Law 104-191 shall be identified as such by prominently displaying and printing on page one of the policy form and the outline of coverage and in the application the followi…
Ins. Code § 10232.2 Section 10232.2
2.1K chars
(a) Every insurer that offers policies or certificates that are intended to be federally qualified long-term care insurance contracts, including riders to life insurance policies providing long-term care coverage, shall fairly and affirmatively concurrently file, offer, and marke…
Ins. Code § 10232.3 Section 10232.3
3.6K chars
(a) All applications for long-term care insurance except that which is guaranteed issue, shall contain clear, unambiguous, short, simple questions designed to ascertain the health condition of the applicant. Each health-related question shall contain only one health status inquir…
Ins. Code § 10232.4 Section 10232.4
1.6K chars
(a) No long-term care insurance policy or certificate other than a group policy or certificate, as described in subdivision (a) of Section 10231.6, shall use a definition of preexisting condition which is more restrictive than a condition for which medical advice or treatment was…
Ins. Code § 10232.5 Section 10232.5
0.6K chars
On or after January 1, 1990, no long-term care insurance policy may be delivered or issued for delivery in this state which does any of the following: (a) Preconditions the availability of benefits on prior hospitalization. (b) Conditions eligibility for benefits provided in an i…
Ins. Code § 10232.6 Section 10232.6
0.5K chars
The commissioner may adopt regulations establishing loss ratio standards for long-term care insurance policies provided that a specific reference to long-term care insurance policies is contained in the regulation. Any regulations adopted by the commissioner shall substantially r…
Ins. Code § 10232.65 Section 10232.65
1.2K chars
In addition to any other requirements of law, the following shall apply to a long-term care insurance policy: (a) The insurer 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 pr…
Ins. Code § 10232.7 Section 10232.7
1.2K chars
(a) An applicant for a long-term care insurance policy or a certificate, other than an applicant for a certificate issued under a group long-term care insurance policy issued to a group as described in subdivisions (a) and (b) of Section 10231.6, shall have the right to return th…
Ins. Code § 10232.8 Section 10232.8
11.6K chars
(a) In every long-term care policy or certificate that is not intended to be a federally qualified long-term care insurance contract and provides home care benefits, the threshold establishing eligibility for home care benefits shall be at least as permissive as a provision that …
Ins. Code § 10232.81 Section 10232.81
0.5K chars
Every long-term care policy, certificate, or rider that purports to provide benefits of home care, community-based services, and residential care facility services under the California Partnership for Long-Term Care Program established by Section 22000 of the Welfare and Institut…
Ins. Code § 10232.9 Section 10232.9
4.4K chars
(a) Every long-term care policy or certificate that purports to provide benefits of home care or community-based services, shall provide at least the following: (1) Home health care. (2) Adult day care. (3) Personal care. (4) Homemaker services. (5) Hospice services. (6) Respite …
Ins. Code § 10232.92 Section 10232.92
3.4K chars
Every long-term care policy or certificate covering confinement in a nursing facility shall also include a provision with the following features: (a) Care in a residential care facility must be covered. “Residential care facility” means a facility licensed as a residential care f…
Ins. Code § 10232.93 Section 10232.93
0.7K chars
Every long-term care policy or certificate shall define the maximum lifetime benefit as a single dollar amount that may be used interchangeably for any home- and community-based services defined in Section 10232.9, assisted living benefit defined in Section 10232.92, or instituti…
Ins. Code § 10232.95 Section 10232.95
0.3K chars
Every long-term care policy or certificate that provides reimbursement for care in a nursing facility shall cover and reimburse for per diem expenses, as well as the costs of ancillary supplies and services, up to but not to exceed the maximum lifetime daily facility benefit of t…
Ins. Code § 10232.96 Section 10232.96
0.5K chars
When a policy or certificate holder of an insurance contract issued prior to December 31, 1996, requests a material modification to the contract as defined by federal law or regulations, the insurer, prior to approving such a request, shall provide written notice to the policy or…
Ins. Code § 10232.97 Section 10232.97
0.4K chars
In every long-term care policy or certificate that covers care in a nursing facility, the threshold establishing eligibility for nursing facility care shall be no more restrictive than a provision that the insured will qualify if either one of two criteria are met: (a) Impairment…
Ins. Code § 10233 Section 10233
0.3K chars
Precedent to the payment of benefits for any care covered by the terms of the policy, any insurer offering long-term care insurance as described in Section 10231.2 may obtain a written declaration by a physician, independent needs assessment agency, or any other source of indepen…
Ins. Code § 10233.2 Section 10233.2
1.5K chars
Long-term care insurance may not: (a) Be canceled, nonrenewed, or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder. (b) Contain a provision establishing a new waiting period in the…
Ins. Code § 10233.25 Section 10233.25
0.3K chars
No long-term care policy or certificate that is issued, amended, renewed, or delivered on and after January 1, 2002, shall contain a provision that prohibits or restricts any health facilities’ compliance with the requirements of Section 1262.5 of the Health and Safety Code.
Ins. Code § 10233.3 Section 10233.3
0.3K chars
If a policy or certificate replaces another long-term care policy or certificate, the replacing insurer shall waive any time periods applicable to preexisting conditions and probationary periods to the extent that similar exclusions have been satisfied under the original policy o…
Ins. Code § 10233.4 Section 10233.4
0.2K chars
No long-term care insurance benefits may be reduced because of out-of-pocket expenditures by the insured or on behalf of the insured by a family member of the insured or by any other individual.
Ins. Code § 10233.5 Section 10233.5
7.5K chars
(a) An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means which prominently direct the attention of the recipient to the document and its purpose. (b) In the case of agent solicitations,…
Ins. Code § 10233.6 Section 10233.6
0.7K chars
A certificate issued pursuant to a group long-term care insurance policy, which policy is delivered or issued for delivery in this state, shall include all of the following: (a) A description of the principal benefits and coverage provided in the policy. (b) A statement of the pr…
Ins. Code § 10233.7 Section 10233.7
0.1K chars
No policy may be advertised, marketed, or offered as long-term care or nursing home insurance unless it complies with this chapter.
Ins. Code § 10233.8 Section 10233.8
1.2K chars
(a) A long-term care insurance policy or certificate issued, amended, renewed, or delivered on or after January 1, 2020, shall not do any of the following based solely and without any additional actuarial risks upon the status of a person as a living organ donor: (1) Refuse to in…
Ins. Code § 10234 Section 10234
0.3K chars
The commissioner shall, as required by this chapter, or from time to time as conditions warrant, pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, adopt reasonable regulations, and amendments and additions thereto, …
Ins. Code § 10234.2 Section 10234.2
1.1K chars
(a) In addition to all other powers and remedies vested in the commissioner by law, the commissioner shall have administrative authority to assess the penalties prescribed in this article for violation of any provision in this chapter against insurers, brokers, agents, and other …
Ins. Code § 10234.3 Section 10234.3
1.3K chars
(a) Any broker, agent, or other entity determined by the commissioner to engage in the business of insurance, other than an insurer, who violates this chapter is liable for an administrative penalty of not less than two hundred fifty dollars ($250) for each first violation. The p…