CHAPTER 1. The Contract [10110. - 10198.10.]
Chapter 1 enacted by Stats. 1935, Ch. 145.
§§ 10110–10198.10 · 441 sections
ARTICLE 1. General Provisions §§ 10110–10127.20 · 214 sections
- § 10110 Every person has an insurable interest in the life and health of: (a) Himself. (b) Any person on whom he depends wholly or in part for education or support.…
- § 10110.1 (a) An insurable interest, with reference to life and disability insurance, is an interest based upon a reasonable expectation of pecuniary advantage through…
- § 10110.2 An insurer shall be entitled to rely upon all statements, declarations, and representations made by an applicant for insurance relative to the insurable…
- § 10110.3 (a) An insurer may not issue an individual life insurance policy to an applicant that insures the life of the applicant’s spouse unless the applicant’s spouse…
- § 10110.4 (a) Except as allowed in subdivision (c), an insurer may not issue or deliver a corporate-owned life insurance policy. (b) “Corporate-owned life insurance…
- § 10110.5 (a) A policy or endorsement issued by an admitted life and disability insurer may contain a provision for a waiver of premium payments in the event of…
- § 10110.6 (a) If a policy, contract, certificate, or agreement offered, issued, delivered, or renewed, whether or not in California, that provides or funds life…
- § 10110.7 (a) This section, except for subdivision (i), applies to a disability insurance policy that provides coverage for hospital, medical, or surgical benefits,…
- § 10110.75 (a) This section applies to a disability insurance policy that provides coverage for hospital, medical, surgical, or prescription drug benefits, excluding a…
- § 10110.8 (a) A life or disability insurance policy other than health insurance, as defined in Section 106, issued, amended, renewed, or delivered on or after January 1,…
- § 10110.9 (a) Notwithstanding any other law, except as provided in Section 10144.56, on and after January 1, 2028, a health insurer or its delegate shall subscribe to…
- § 10111 In life or disability insurance, the only measure of liability and damage is the sum or sums payable in the manner and at the times as provided in the policy…
- § 10111.2 (a) Under a policy of disability insurance other than health insurance, as defined in Section 106, including a policy of disability income insurance, as…
- § 10111.5 An insurer shall not be liable for payments claimed under an individual or group policy of life insurance if the duty to make those payments depends upon a…
- § 10111.7 (a) An insurer shall not deny or refuse to accept an application for life insurance, or refuse to insure, refuse to renew, cancel, restrict, or otherwise…
- § 10112 Subject to Section 2459 of the Probate Code, in respect to life or disability insurance, or annuity contracts (except as provided in Sections 2500 to 2507,…
- § 10112.1 (a) An individual or group health insurance policy shall not establish either of the following: (1) Lifetime limits on the dollar value of any covered benefits…
- § 10112.2 (a) A group or individual nongrandfathered health insurance policy shall, at a minimum, provide coverage for and shall not impose any cost-sharing requirements…
- § 10112.25 (a) A health insurer that issues, sells, renews, or offers health insurance policies for health care coverage in this state, including a grandfathered health…
- § 10112.26 (a) A health insurer that issues, sells, renews, or offers a policy covering dental services shall file a report with the department, by July 31 of each year,…
- § 10112.27 (a) An individual or small group health insurance policy issued, amended, or renewed on or after January 1, 2017, shall include, at a minimum, coverage for…
- § 10112.28 (a) This section shall apply to nongrandfathered individual and group health insurance policies that provide coverage for essential health benefits, as defined…
- § 10112.281 (a) A large group health insurance policy issued, amended, or renewed on or after July 1, 2022, shall cover medically necessary basic health care services. (b)…
- § 10112.282 (a) With respect to large group health insurance, an insurer and its officials, employees, agents, and representatives shall not, directly or indirectly,…
- § 10112.29 (a) (1) For a small employer health insurance policy offered, sold, or renewed on or after January 1, 2014, the deductible under the policy shall not exceed:…
- § 10112.291 (a) For a health insurance policy issued, amended, or renewed on or after July 1, 2022, in the individual or group market, a health insurer shall monitor an…
- § 10112.295 (a) Levels of coverage for the nongrandfathered individual market are defined as follows: (1) Bronze level: A health insurance policy in the bronze level shall…
- § 10112.296 Notwithstanding paragraph (1) of subdivision (b) of Section 10112.295 and paragraph (1) of subdivision (b) of Section 10112.297, the actuarial value for a…
- § 10112.297 (a) Levels of coverage for the nongrandfathered small group market are defined as follows: (1) Bronze level: A health insurance policy in the bronze level…
- § 10112.3 (a) For purposes of this section, the following definitions shall apply: (1) “Exchange” means the California Health Benefit Exchange established in Title 22… see note
- § 10112.300 (a) (1) A small employer health benefit plan in effect on December 31, 2013, and still in effect as of the effective date of this section, that does not…
- § 10112.35 (a) An insurer providing individual coverage in the Exchange shall cooperate with requests from the Exchange to collaborate in the development of, and…
- § 10112.4 The commissioner shall, in coordination with the Director of the Department of Managed Health Care, review the Internet portal developed by the United States…
- § 10112.5 (a) (1) Notwithstanding any other provision of law, every policy or certificate of health insurance marketed, issued, or delivered to a resident of this state,…
- § 10112.6 (a) Consistent with federal law, a sponsor of a prescription drug plan authorized by the federal Medicare Prescription Drug, Improvement, and Modernization Act…
- § 10112.7 (a) A group or individual health insurance policy issued, amended, or renewed on or after January 1, 2014, that provides or covers any benefits with respect to…
- § 10112.75 (a) If a health insurer sends payment for services provided directly to the insured and not to the provider, the insurer shall send notice to the insured and…
- § 10112.8 (a) (1) Except as provided in subdivision (c), a health insurance policy issued, amended, or renewed on or after July 1, 2017, that provides benefits through…
- § 10112.81 (a) (1) By September 1, 2017, the commissioner shall establish an independent dispute resolution process for the purpose of processing and resolving a claim…
- § 10112.82 (a) (1) For services rendered subject to Section 10112.8, effective July 1, 2017, unless otherwise agreed to by the noncontracting individual health…
- § 10112.9 (a) (1) Notwithstanding Section 10273.4, an insurer, except an insurer issuing a specialized health insurance policy, issuing a policy or certificate of health…
- § 10112.95 (a) A health insurer shall provide an insured who has been displaced or whose health otherwise may be affected by a state of emergency, as declared by the…
- § 10113 Every policy of life, disability, or life and disability insurance issued or delivered within this State on or after the first day of January, 1936, by any…
- § 10113.1 The following provisions shall apply to this act: (a) “Advertisement” means any written, electronic, or printed communication or any communication by means of…
- § 10113.2 (a) This section applies to any person entering into, brokering, or soliciting life settlements pursuant to this section and Sections 10113.1 and 10113.3. (b)…
- § 10113.3 (a) A provider entering into a life settlement contract with any owner of a policy, wherein the insured is terminally ill, shall first obtain the following:…
- § 10113.35 (a) The commissioner may adopt rules and regulations reasonably necessary to implement the provisions of this act. (b) This section shall be prospective only,…
- § 10113.4 If a group life insurance policy contains a provision that makes a certificate holder’s coverage contestable on the grounds of suicide for a period following…
- § 10113.5 (a) An individual life insurance policy delivered or issued for delivery in this state shall contain a provision that it is incontestable after it has been in…
- § 10113.6 (a) An insurer that is required to deliver a life insurance policy to the owner of the policy in order to start the period running during which the owner may…
- § 10113.7 (a) An increase of premium on an individual life insurance policy that provides for premium changes by the insurer is not effective unless written notice is…
- § 10113.70 (a) (1) Whenever a flexible premium life insurance policy is subject to an adverse change in the current scale of nonguaranteed elements, as soon as…
- § 10113.71 (a) Each life insurance policy issued or delivered in this state shall contain a provision for a grace period of not less than 60 days from the premium due…
- § 10113.72 (a) An individual life insurance policy shall not be issued or delivered in this state until the applicant has been given the right to designate at least one…
- § 10113.8 (a) Each health insurer that maintains an Internet Web site shall make a downloadable copy of the comparative benefit matrix prepared pursuant to Section…
- § 10113.9 (a) This section shall not apply to vision-only, dental-only, or CHAMPUS supplement insurance, or to hospital indemnity, hospital-only, accident-only, or…
- § 10113.95 (a) A health insurer that issues, renews, or amends individual health insurance policies shall be subject to this section. (b) An insurer subject to this… see note
- § 10114 Before an insurer may pay the proceeds of any contract of life or disability insurance to any undertaker or funeral director, as beneficiary or assignee, for…
- § 10115 When a payment is made equal to the full first premium at the time an application for life insurance other than group life insurance is signed by the applicant…
- § 10116 No group life insurance policy or disability insurance policy shall be issued or delivered in this State where the premiums or any part thereof is paid or is…
- § 10116.5 (a) Every policy of disability insurance that is issued, amended, delivered, or renewed in this state on or after January 1, 1999, that provides hospital,…
- § 10117 (a) A policy of disability insurance, self-insured employee welfare benefit plan, or nonprofit hospital service plan may not provide an exception for other…
- § 10117.5 No disability insurer contract that covers hospital, medical, or surgical benefits that is issued, amended, renewed, or delivered on and after January 1, 2002,…
- § 10117.52 (a) No health insurance contract in existence or issued, amended, or renewed on or after January 1, 2013, between a health insurer and a provider or a supplier…
- § 10118 A policy of disability insurance delivered or issued for delivery in this state more than 120 days after the effective date of this section, that provides that…
- § 10119 On and after the operative date of this section: (a) No policy of disability insurance which, in addition to covering the insured, also covers members of the…
- § 10119.1 (a) This section shall apply to a health insurer that covers hospital, medical, or surgical expenses under an individual health benefit plan, as defined in…
- § 10119.2 (a) Every health insurer that offers, issues, or renews health insurance under an individual health benefit plan, as defined in subdivision (a) of Section… see note
- § 10119.3 (a) Notwithstanding any other provision of law, an agent or broker who assists an applicant in submitting an application to a health insurer has the duty to…
- § 10119.5 (a) No individual or group policy of health insurance that is issued, amended, renewed, or delivered on or after July 1, 2003, that provides maternity coverage…
- § 10119.6 (a) (1) A large group health insurance policy that is issued, amended, or renewed on or after January 1, 2026, shall provide coverage for the diagnosis and…
- § 10119.7 No group or individual policy of disability insurance which covers hospital, medical, or surgical expenses shall be issued, amended, delivered, or renewed in…
- § 10119.8 On and after January 1, 1993, every insurer issuing, amending, or renewing a policy of individual or group disability insurance that covers hospital, medical,…
- § 10119.9 (a) A disability insurance policy or certificate covering hospital, surgical, or medical expenses, that meets the definition of “health benefit plan” in…
- § 10120 If a policy of disability insurance issued, issued for delivery, or renewed in this state after the effective date of this section provides in any manner for…
- § 10120.2 (a) This section shall only apply to a disability insurer that issues a dental insurance policy pursuant to this part. (b) For purposes of this section, the…
- § 10120.3 (a) With respect to a contract between an insurer covering dental services and a dentist to provide covered dental services to insureds, the contract shall not…
- § 10120.35 (a) Notwithstanding any other law, a health insurer, including a specialized health insurer and a health insurer that issues, sells, renews, or offers a…
- § 10120.4 (a) A health insurer that issues, sells, renews, or offers a policy covering dental services, including a specialized policy of health insurance covering…
- § 10120.41 (a) For purposes of this section, the following definitions shall apply: (1) “Dental waiting period provision” means a health insurance policy provision that…
- § 10120.42 (a) To assist a provider in determining if an insured’s dental coverage is regulated by the State of California, the health insurer shall disclose whether the…
- § 10120.5 Any act by a disability insurer that covers hospital, medical, or surgical expenses that violates Section 510, Section 2056, or Section 2056.1 of the Business…
- § 10121 (a) No self-insured employee welfare benefit plan, issued or renewed on or after November 23, 1970, which contains coverage for sterilization operations or…
- § 10121.5 (a) When spouses are both employed as employees, and both have enrolled themselves and their eligible family members under a group policy of disability…
- § 10121.6 (a) No policy of group disability insurance or self-insured employee welfare benefit plan which provides hospital, medical, or surgical expense benefits for…
- § 10121.7 (a) A policy of group health insurance that provides hospital, medical, or surgical expense benefits shall provide equal coverage to employers or guaranteed…
- § 10122 If a policy of group disability insurance issued or issued for delivery or amended in this state after the effective date of this section provides in any…
- § 10122.1 On and after the effective date of this section, every policy of disability insurance which covers hospital, medical, or surgical expenses on a group basis…
- § 10122.2 If a policy of group disability insurance issued, delivered, amended, or renewed in this state on or after the effective date of this section provides in any…
- § 10123 (a) No self-insured employee welfare benefit plan, issued or renewed on or after the effective date of this section, which provides coverage for an employee…
- § 10123.1 Every self-insured employee welfare benefit plan, as defined in Section 10121, issued, amended as to benefits, or renewed after January 1, 1977, shall comply…
- § 10123.2 On and after the effective date of this section, every self-insured employee welfare benefit plan which provides coverage for hospital, medical, or surgical…
- § 10123.3 (a) No self-insured employee welfare benefit plan shall refuse to enroll any person or accept any person as a subscriber or renew any person as a subscriber…
- § 10123.31 (a) In addition to any other remedy permitted by law, the commissioner shall have the administrative authority to assess penalties specified in this section…
- § 10123.35 (a) This section shall apply to the disclosure of genetic test results contained in an applicant or enrollee’s medical records by a self-insured welfare…
- § 10123.36 (a) On or before July 1, 1999, for purposes of public disclosure, every disability insurer that covers hospital, medical, or surgical expenses, and authorizes…
- § 10123.38 (a) A health insurance policy issued, amended, or renewed on or after January 1, 2025, shall provide coverage for the prophylaxis, diagnosis, and treatment of…
- § 10123.4 If a self-insured employee welfare benefit plan issued, amended, or renewed in this state on or after the effective date of this section provides in any manner…
- § 10123.5 (a) On or after January 1, 1993, every insurer issuing group disability insurance that covers hospital, medical, or surgical expenses shall provide benefits…
- § 10123.51 (a) A health insurance policy issued, amended, or renewed on or after January 1, 2022, that provides coverage for pediatric services and preventive care, as…
- § 10123.55 (a) On or after January 1, 1993, every insurer issuing group disability insurance that covers hospital, medical, or surgical expenses shall offer benefits for…
- § 10123.6 On and after January 1, 1990, every insurer issuing group disability insurance which covers hospital, medical, or surgical expenses shall offer coverage for…
- § 10123.61 (a) Commencing January 1, 2019, a health insurer shall not issue, amend, sell, renew, or offer a policy of short-term limited duration health insurance in this…
- § 10123.65 (a) The maximum amount a health insurer may require an insured to pay at the point of sale for a covered prescription drug is the lesser of the following: (1)…
- § 10123.67 (a) On or before July 1, 1997, every disability insurer that covers hospital, medical, or surgical expenses, as described in subdivision (b), shall file with…
- § 10123.68 (a) When requested by an insured or contracting health professional who is treating an insured, a disability insurer that covers hospital, medical, or surgical…
- § 10123.7 (a) On or after January 1, 1986, an insurer issuing group health insurance shall offer coverage for orthotic and prosthetic devices and services under the…
- § 10123.8 (a) Every policy of disability insurance that provides coverage for hospital, medical, or surgical expenses, that is issued, amended, delivered, or renewed on…
- § 10123.81 (a) An individual or group policy of disability insurance or self-insured employee welfare benefit plan shall be deemed to provide coverage for mammography for…
- § 10123.82 Every policy of disability insurance which provides for the surgical procedure known as a laryngectomy and which is issued, amended, delivered, or renewed in…
- § 10123.83 (a) On or after January 1, 1995, every policy of disability insurance that covers hospital, medical, or surgical expenses and is issued, amended, delivered, or…
- § 10123.835 (a) Every individual or group policy of disability insurance that covers hospital, medical, or surgical benefits that is issued, amended, or renewed on or…
- § 10123.84 (a) The Legislature finds and declares that the unique, private, and personal relationship between women patients and their obstetricians and gynecologists…
- § 10123.85 (a) For purposes of this section, the definitions in subdivision (a) of Section 2290.5 of the Business and Professions Code apply. (b) It is the intent of the…
- § 10123.855 (a) (1) A contract between a health insurer and a health care provider for an alternative rate of payment pursuant to Section 10133 shall specify that the…
- § 10123.856 (a) If a health insurer offers a service via telehealth to an insured through a third-party corporate telehealth provider, all of the following conditions…
- § 10123.857 (a) A health insurer that issues, sells, renews, or offers a policy covering dental services, including a specialized health insurance policy covering dental…
- § 10123.86 (a) Every policy of disability insurance covering hospital, surgical, or medical expenses that is issued, amended, renewed, or delivered on or after January 1,…
- § 10123.861 (a) A health insurance policy that provides outpatient prescription drug benefits and is issued, amended, or renewed on or after the operative date of this…
- § 10123.862 (a) A health insurer shall base a medical necessity determination or the utilization review criteria that the insurer, and an entity acting on the insurer’s…
- § 10123.864 The provision of medically necessary pasteurized donor human milk obtained from a tissue bank licensed pursuant to Chapter 4.1 (commencing with Section 1635)…
- § 10123.865 (a) Commencing no later than July 1, 2012, an individual health insurance policy shall provide coverage for maternity services for all insureds covered under…
- § 10123.866 (a) Commencing no later than July 1, 2012, a group health insurance policy shall provide coverage for maternity services for all insureds covered under the…
- § 10123.867 (a) A health insurer shall develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall consist of at…
- § 10123.868 On or before January 1, 2025, a health insurer shall develop a maternal and infant health equity program that addresses racial health disparities in maternal…
- § 10123.869 (a) A contract between a health insurer and a health care provider issued, amended, or renewed on or after January 1, 2025, shall authorize a provider to…
- § 10123.87 (a) No individual or group policy of disability insurance that provides coverage for hospital, medical, and surgical benefits that is issued, amended, renewed,…
- § 10123.88 (a) Every policy of health insurance covering hospital, medical, or surgical expenses that is issued, amended, renewed, or delivered in this state on or after…
- § 10123.89 (a) On and after July 1, 2000, every policy of disability insurance issued, amended, delivered, or renewed in this state that provides coverage for hospital,…
- § 10123.9 On and after January 1, 1980, every group policy of disability insurance which covers hospital, medical, or surgical expenses on a group basis, and which…
- § 10123.91 (a) On or after January 1, 2009, every insurer that issues, amends, or renews an individual or group policy of health insurance that covers hospital, medical,…
- § 10123.10 (a) Every disability insurer transacting business in this state shall, on or after January 1, 1979, make available and offer to include in every group…
- § 10123.11 (a) No insurer shall deny a claim under a group disability policy for hospital, medical, surgical, dental, or optometric services for the sole reason that the…
- § 10123.12 Every health insurer, including those insurers that contract for alternative rates of payment pursuant to Section 10133, and every self-insured employee…
- § 10123.13 (a) Every insurer issuing group or individual policies of health insurance that cover hospital, medical, or surgical expenses, including those telehealth…
- § 10123.131 (a) An insurer shall pay a provider for duplicating all information it requests in connection with a contested claim, and for patient records, as follows: (1)…
- § 10123.132 (a) Every disability insurer that covers hospital, medical, or surgical expenses and that reviews and approves the medical necessity or appropriateness of…
- § 10123.135 (a) Every disability insurer, or an entity with which it contracts for services that include utilization review or utilization management functions, that…
- § 10123.137 (a) Each contract between a health insurer and a provider shall contain provisions requiring a fast, fair, and cost-effective dispute resolution mechanism…
- § 10123.14 On and after January 1, 1990, every self-insured employee welfare benefit plan containing hospital, medical, or surgical expense benefits or service benefits…
- § 10123.141 (a) Every policy of expense incurred hospital, medical, or surgical insurance issued, amended, or renewed on or after January 1, 1991, on a group basis, except…
- § 10123.145 (a) (1) Whenever an insurer issuing group or individual policies of disability insurance which covers hospital, medical, or surgical expenses determines that…
- § 10123.146 (a) The following definitions shall apply for purposes of this section: (1) (A) “Affirmative consent” means a dental provider’s express consent to opt in or…
- § 10123.147 (a) Every insurer issuing group or individual policies of health insurance that cover hospital, medical, or surgical expenses, including those telehealth…
- § 10123.15 Every group policy of disability insurance which covers hospital, medical, and surgical expenses on a group basis, and which offers coverage for disorders of…
- § 10123.16 Except for a preexisting condition, every disability insurer issuing policies of individual or group disability insurance in this state that offers group or…
- § 10123.17 Except for a preexisting condition, every self-insured employee welfare benefit plan in this state that offers group coverage for long-term care facility…
- § 10123.18 (a) A disability insurance policy issued, amended, or renewed on or after January 1, 2024, and that provides coverage for hospital, medical, or surgical…
- § 10123.184 (a) Every group policy of disability insurance that covers hospital, medical, or surgical expenses, and that provides maternity benefits, that is issued,…
- § 10123.185 (a) Every policy of disability insurance that covers hospital, medical, or surgical expenses and is issued, amended, delivered, or renewed in this state and…
- § 10123.19 (a) Any disability insurance policy that includes terms that require binding arbitration to settle disputes and that restrict, or provide for a waiver of, the…
- § 10123.191 (a) Notwithstanding any other law, on and after January 1, 2013, a health insurer that provides coverage for prescription drugs shall utilize and accept only…
- § 10123.192 (a) A health insurer that provides prescription drug benefits and maintains one or more drug formularies shall do all of the following: (1) Post the formulary…
- § 10123.193 (a) The Legislature hereby finds and declares all of the following: (1) The federal Patient Protection and Affordable Care Act, its implementing regulations…
- § 10123.1932 (a) (1) With respect to an individual or group policy of health insurance subject to Section 10112.28, the copayment, coinsurance, or any other form of cost…
- § 10123.1933 (a) (1) Notwithstanding Section 10123.201, a health insurer shall not subject antiretroviral drugs that are medically necessary for the prevention of AIDS/HIV,…
- § 10123.1935 (a) Notwithstanding any other law, a group or individual health insurer offering an outpatient prescription drug benefit shall provide coverage for at least…
- § 10123.194 (a) Every disability insurer that covers hospital, medical, or surgical expenses, and, as part of that coverage, also covers prescription drug benefits, and…
- § 10123.1945 (a) (1) A disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, except for a grandfathered health plan or a…
- § 10123.195 (a) A group or individual disability insurance policy issued, delivered, or renewed in this state or certificate of group disability insurance issued,…
- § 10123.196 (a) An individual or group policy of disability insurance issued, amended, renewed, or delivered on or after January 1, 2000, through December 31, 2015,…
- § 10123.1961 (a) (1) The requirements of this section shall apply to a group or individual policy or certificate of health insurance or student blanket disability insurance…
- § 10123.197 (a) A request for an exception to a health insurer’s step therapy process for prescription drugs may be submitted in the same manner as a request for prior…
- § 10123.198 (a) On and after July 1, 2011, in accordance with the requirements of subdivision (b), a health insurer that provides coverage for professional mental health…
- § 10123.199 (a) A health insurer that provides coverage for professional mental health services shall establish an Internet Web site. Each Internet Web site shall include,…
- § 10123.1991 (a) (1) A health insurer shall provide to insureds a written or electronic notice regarding the benefits of a behavioral health and wellness screening for…
- § 10123.20 (a) A health insurance policy that is issued, amended, delivered, or renewed on or after July 1, 2000, shall be deemed to provide coverage for all generally…
- § 10123.201 (a) A policy of health insurance that covers outpatient prescription drugs shall cover medically necessary drugs. The policy may provide for step therapy and…
- § 10123.202 (a) A health insurance policy issued, amended, renewed, or delivered on or after January 1, 2017, excluding specialized health insurance policies, shall be…
- § 10123.203 Commencing January 1, 2019, an insurer shall prorate an insured’s cost sharing for a partial fill of a prescription dispensed pursuant to Section 4052.10 of…
- § 10123.204 (a) A health insurance policy issued, amended, delivered, or renewed on or after July 1, 2023, that provides prescription drug benefits and maintains one or…
- § 10123.2045 (a) A health insurance policy issued, amended, or renewed on or after January 1, 2026, that provides prescription drug coverage shall not calculate an…
- § 10123.205 (a) (1) A health insurer that reports rate information pursuant to Section 10181.3 or 10181.45 shall report the information described in paragraph (2) to the…
- § 10123.206 (a) Notwithstanding any other law, an individual or group health insurance policy issued, amended, or renewed on or after January 1, 2015, that provides…
- § 10123.207 (a) Every health insurance policy, except a specialized health insurance policy, that is issued, amended, or renewed on or after January 1, 2022, shall provide…
- § 10123.208 (a) A health insurance policy issued, amended, renewed, or delivered on or after January 1, 2022, excluding specialized health insurance policies, shall…
- § 10123.209 (a) A health insurance policy that is issued, amended, delivered, or renewed on or after July 1, 2024, shall include coverage for medically necessary biomarker…
- § 10123.210 (a) A health insurer that provides health coverage to the employees of a religious employer that does not include coverage and benefits for both abortion and…
- § 10123.211 (a) (1) A health insurance policy that is issued, amended, or renewed on or after July 1, 2025, excluding a specialized health insurance policy, shall provide…
- § 10123.21 On or after July 1, 1995, every individual or group policy of disability insurance that provides hospital, medical, or surgical coverage entered into, amended,…
- § 10123.22 (a) A health insurer shall not deny coverage that is otherwise available under the health insurance policy for the costs of solid organ or other tissue…
- § 10124 (a) A self-insured employee welfare benefit plan delivered or issued for delivery in this state more than 120 days after the effective date of this section,…
- § 10124.7 Each self-insured employee benefit plan issued or renewed on or after the effective date of this section shall provide, where feasible, that benefits for…
- § 10125 (a) On and after January 1, 1974, every insurer issuing group disability insurance which covers hospital, medical, or surgical expenses shall offer coverage…
- § 10125.1 (a) Every insurer issuing disability insurance that covers hospital, medical, or surgical expenses that offers coverage for a service that is within the scope…
- § 10125.2 (a) A pharmacy benefit manager that contracts with a health insurer shall comply with Article 6.1 (commencing with Section 1385.001) of Chapter 2.2 of Division…
- § 10126 Every policy of group disability insurance issued, amended, or renewed on or after January 1, 1977, which provides hospital, medical, or surgical expense…
- § 10126.5 If a disability insurance policy between an insurer that covers hospital, medical, or surgical expenses and a provider requires that the provider accept, as…
- § 10126.6 (a) Every policy of disability insurance that provides hospital, medical, or surgical coverage under a health benefit plan, defined in subdivision (a) of…
- § 10126.61 (a) A health insurance policy issued, amended, or renewed on or after July 1, 2025, shall establish a process to reimburse for services provided by a community…
- § 10126.65 (a) (1) Notwithstanding Section 10352, a health insurance policy issued, amended, or renewed on or after January 1, 2020, shall provide that if an insured or…
- § 10126.66 (a) (1) Unless otherwise required by this chapter, a health insurance policy issued, amended, or renewed on or after January 1, 2024, shall require an insured…
- § 10127 On and after January 1, 1974, every self-insured employee welfare benefit plan that provides coverage for hospital, medical, or surgical expenses shall offer…
- § 10127.09 Notwithstanding any other law, a disability insurance policy that provides hospital, medical, surgical, prescription drug, or nursing benefits, except a policy…
- § 10127.1 (a) No policy of disability insurance providing loss of time benefits shall contain any provision for a reduction of such benefits during a benefit period…
- § 10127.15 Any provision contained in a policy of disability insurance or a self-insured employee welfare benefit plan for a reduction of loss of time benefits during a…
- § 10127.2 Each policy of disability insurance issued or renewed on or after the effective date of this section, which policy provides benefits that accrue after a…
- § 10127.21 Any data submitted by a health insurer to the United States Secretary of Health and Human Services, or his or her designee, for purposes of the risk adjustment…
- § 10127.3 On and after January 1, 1985, every insurer issuing group disability insurance which covers hospital, medical, or surgical expenses shall offer coverage for…
- § 10127.4 (a) Except as provided in subdivisions (b) and (c), no contract that is issued, amended, renewed, or delivered on or after January 1, 1999, between a…
- § 10127.5 Every application for, certificate of, and policy of credit life or credit disability insurance shall set forth a statement in bold capital letters indicating…
- § 10127.7 Every policy of individual life insurance with a face value of less than ten thousand dollars ($10,000) which is delivered or issued for delivery in this state…
- § 10127.8 (a) The purpose of this section is to assure truthful and adequate disclosure of all material and relevant information in the advertising of term life…
- § 10127.9 (a) (1) Every individual life insurance policy and every individual annuity contract that is initially delivered or issued for delivery in this state on and…
- § 10127.10 (a) Every policy of individual life insurance and every individual annuity contract that is initially delivered or issued for delivery to a senior citizen in…
- § 10127.11 Every insurer and life agent offering for sale individual life insurance policies or individual annuity contracts that are initially delivered or issued for…
- § 10127.12 Whenever an insurer provides an annual statement to a senior citizen policyowner of an individual life insurance policy or an individual annuity contract…
- § 10127.13 (a) All individual life insurance policies and individual annuity contracts for senior citizens that contain a charge upon surrender, partial surrender, excess…
- § 10127.14 (a) The department and the Department of Managed Health Care shall compile information required by this section and Section 1363.06 of the Health and Safety…
- § 10127.16 (a) (1) After the termination of the pilot program under Section 10127.15, a health insurer shall continue to provide coverage under the same terms and…
- § 10127.17 (a) The Life and Annuity Consumer Protection Fund is hereby created as a special account within the Insurance Fund. Each insurer admitted to transact insurance…
- § 10127.18 (a) On and after January 1, 2005, a health insurer issuing individual policies of health insurance that ceases to offer individual coverage in this state shall…
- § 10127.19 (a) Commencing March 1, 2013, and at least annually thereafter, a health insurer, not including a health insurer offering specialized health insurance…
- § 10127.20 (a) Beginning on July 1, 2023, and annually thereafter, a health insurer offering a qualified health plan through the Exchange shall report to the commissioner…
ARTICLE 1.5. Discontinuance of Group Life Insurance and Discontinuance and Replacement of Group Disability Insurance §§ 10128–10128.4 · 5 sections
- § 10128 The provisions of this article shall apply to all policies of group life insurance issued in this state pursuant to the provisions of Sections 10202, 10202.7,…
- § 10128.1 In this article, unless the context otherwise requires: (a) “Carrier” means the insurance company, nonprofit hospital service corporation, or other entity…
- § 10128.2 Every policy containing a life insurance benefit shall contain a reasonable extension of such benefit upon discontinuance of the policy with respect to…
- § 10128.3 (a) Any carrier providing replacement coverage with respect to hospital, medical or surgical benefits on an expense-incurred or service basis within a period…
- § 10128.4 This article shall apply to all policies issued, delivered, amended, or renewed in this state after January 1, 1977. A policy subject to the provisions of this…
ARTICLE 1.7. California Cobra Program §§ 10128.50–10128.59 · 10 sections
- § 10128.50 (a) This article shall be known as the California Continuation Benefits Replacement Act, or “Cal-COBRA.” (b) It is the intent of the Legislature that continued…
- § 10128.51 (a) “Continuation coverage” means extended coverage under the group benefit plan under which an eligible employee or eligible dependent is currently covered,…
- § 10128.52 The continuation coverage requirements of this article do not apply to the following individuals: (a) Individuals who are entitled to Medicare benefits or…
- § 10128.53 (a) Every disability insurer, that provides coverage under a group benefit plan to an employer, including those policies and contracts that provide vision-only…
- § 10128.54 (a) Every insurer’s evidence of coverage for group benefit plans subject to this article, that is issued, amended, or renewed on or after January 1, 1999,…
- § 10128.55 (a) Every group benefit plan contract between a disability insurer and an employer subject to this article that is issued, amended, or renewed on or after July…
- § 10128.56 A qualified beneficiary electing continuation coverage shall pay to the disability insurer, on or before the due date of each payment but not more frequently…
- § 10128.57 (a) The continuation coverage provided pursuant to this article shall terminate at the first to occur of the following: (1) In the case of a qualified…
- § 10128.58 A disability insurer subject to this article shall not be obligated to provide continuation coverage to a qualified beneficiary pursuant to this article if an…
- § 10128.59 (a) A health insurer that provides coverage under a group benefit plan to an employer shall offer an insured who has exhausted continuation coverage under…
ARTICLE 2. Transfer §§ 10129–10133.14 · 32 sections
- § 10129 Sections 10130 and 10131 do not apply to group life policies, to group disability policies, or to individual disability policies providing a benefit for loss…
- § 10129.5 Sections 10130 and 10131 do not apply to annuity contracts which are within the scope of Section 401(g) of the Internal Revenue Code of the United States.
- § 10130 A life or disability policy may pass by transfer, will or succession to any person, whether or not the transferee has an insurable interest. Such transferee…
- § 10131 Notice to an insurer of a transfer of a life or disability policy is not necessary to preserve the validity of the policy unless expressly required by the…
- § 10132 The beneficiary under a life policy which provides for the payment of its proceeds in periodical installments, may be restrained by its provisions from…
- § 10133 (a) Upon written consent of the insured first obtained with respect to a particular claim, any disability insurer shall pay group insurance benefits contingent…
- § 10133.1 Insurers shall provide group policyholders with a current roster of institutional and professional providers under contract to provide services at alternative…
- § 10133.15 (a) Commencing July 1, 2016, a health insurer that contracts with providers for alternative rates of payment pursuant to Section 10133 shall publish and…
- § 10133.2 When any disability insurer negotiates and enters into a contract with professional or institutional providers to provide services at alternative rates of…
- § 10133.3 When any self-insured governmental plan, as defined in Section 12671, negotiates and enters into a contract with professional or institutional providers to…
- § 10133.4 (a) For purposes of insurers that contract with providers for alternate rates pursuant to Section 10133, a primary care provider includes a “nonphysician…
- § 10133.5 (a) The commissioner shall, on or before January 1, 2004, promulgate regulations applicable to health insurers which contract with providers for alternative…
- § 10133.52 (a) On or before July 1, 2026, the department shall issue instructions to health insurers to report all covered health care services subject to prior…
- § 10133.53 (a) (1) A health insurance policy that is issued, renewed, or amended on or after July 1, 2017, that provides benefits through contracts with providers for…
- § 10133.54 (a) This section applies to policies of health insurance, as defined by subdivision (b) of Section 106. The requirements of this section apply to all health…
- § 10133.55 (a) (1) Except as provided in paragraph (2), every disability insurer covering hospital, medical, and surgical expenses on a group basis that contracts with…
- § 10133.56 (a) (1) A health insurer that enters into a contract with a professional or institutional provider to provide services at alternative rates of payment pursuant…
- § 10133.6 It is the intent of the Legislature to ensure that the citizens of this state receive high-quality health care coverage in the most efficient and…
- § 10133.64 (a) A contract issued, amended, renewed, or delivered on or after January 1, 2015, by or on behalf of a health insurer and a provider or supplier shall not…
- § 10133.641 (a) A contract between a health insurer and a provider of health care services shall not contain any term that would result in termination or nonrenewal of the…
- § 10133.65 (a) This section shall be known and may be cited as the Health Care Providers’ Bill of Rights. (b) No contract issued, amended, or renewed on or after January…
- § 10133.66 A health insurer shall comply with all the following: (a) Deadlines shall not be imposed for the receipt of a claim from a professional provider who submits a…
- § 10133.661 On or before July 1, 2006, the commissioner, pursuant to his or her authority under Section 12921.1, shall also complete all of the following duties: (a)…
- § 10133.67 Pursuant to Section 12921, the commissioner may also agree to payment to a health care provider who submitted a claim for health care benefits provided to an…
- § 10133.7 (a) On and after January 1, 1994, any disability insurer shall pay group insurance benefits contingent upon, or for expenses incurred on account of,…
- § 10133.8 (a) The commissioner shall, on or before January 1, 2006, promulgate regulations applicable to all individual and group policies of health insurance…
- § 10133.9 Within a year after the health insurer’s assessment pursuant to paragraph (2) of subdivision (b) of Section 10133.8, health insurers shall report to the…
- § 10133.10 (a) An insurer that markets, advertises, or produces educational materials for a health insurance policy, as defined in Section 106, in the individual or small…
- § 10133.11 (a) An insurer shall notify insureds and members of the public of all of the following information: (1) The availability of language assistance services,…
- § 10133.12 (a) Commencing January 1, 2027, or when final federal rules are implemented, whichever occurs later, the department shall require a health insurer to establish…
- § 10133.13 (a) (1) Within six months after the department issues guidance pursuant to paragraph (1) of subdivision (d), and no later than March 1, 2025, a health insurer…
- § 10133.14 No later than March 1, 2025, a health insurer subject to Section 10133.13 shall include information within or accessible from the insurer’s provider directory,…
ARTICLE 2.3. Transfers of Structured Settlement Payment Rights §§ 10134–10139.5 · 11 sections
- § 10134 For the purposes of this article, the following terms have the following meanings: (a) “Buyer’s first right of refusal” means any provision in the transfer…
- § 10135 (a) This article is only applicable to transfers entered into on or after January 1, 2000. (b) Notwithstanding subdivision (a), the changes to this article…
- § 10136 (a) No direct or indirect transfer of structured settlement payment rights by a payee to which this article applies shall be effective, and no structured…
- § 10137 A transfer of structured settlement payment rights is void unless a court reviews and approves the transfer and finds the following conditions are met: (a) The…
- § 10138 (a) A transfer agreement, as defined in subdivision (o) of Section 10134, shall not include any provision described in the paragraphs below. Any inclusion of a…
- § 10139 The transferee shall retain, for three years after the date of the last payment under the structured settlement agreement, or for five years after the date of…
- § 10139.1 Any subsequent transfer of any additional structured settlement payments between the payee and transferee may be made only after compliance with all of the…
- § 10139.2 Any notice required by this article shall be deemed to have been given if addressed to the recipient’s last known address and deposited, first class postage…
- § 10139.3 (a) None of the provisions of this article may be waived by the payee. (b) Compliance with the requirements set forth in Sections 10136, 10137, and 10138 shall…
- § 10139.4 A violation of this article by a transferee shall constitute an unfair business practice pursuant to Chapter 5 (commencing with Section 17200) of Part 2 of…
- § 10139.5 (a) A direct or indirect transfer of structured settlement payment rights is not effective and a structured settlement obligor or annuity issuer is not…
ARTICLE 2.5. Discriminatory Practices §§ 10140–10145.4 · 27 sections
- § 10140 (a) No admitted insurer, licensed to issue life or disability insurance, shall fail or refuse to accept an application for that insurance, to issue that…
- § 10140.1 (a) This section shall apply to the disclosure of genetic test results contained in an applicant or enrollee’s medical records by an admitted insurer licensed…
- § 10140.2 (a) Notwithstanding Section 10140, a health insurance policy issued, amended, or renewed on or after January 1, 2011, shall not be subject to premium, price,…
- § 10140.5 (a) In addition to any other remedy permitted by law, the commissioner shall have the administrative authority to assess penalties specified in this section…
- § 10141 No application for insurance or insurance investigation report furnished by such an insurer to its agents or employees for use in determining the insurability…
- § 10142 Nothing in this article shall prohibit use in an application for life or disability insurance of a question asking for the birthplace of an applicant if such…
- § 10143 (a) No insurance company licensed in this state shall refuse to issue or sell or renew any policy of life or disability insurance after appropriate application…
- § 10144 No insurer issuing, providing, or administering any contract of individual or group insurance providing life, annuity, or disability benefits applied for and…
- § 10144.1 A disability insurer that denies coverage for an experimental medical procedure or plan of treatment for a claimant with a terminal illness, which for the…
- § 10144.2 (a) No disability insurer covering hospital, medical, or surgical expenses shall deny, refuse to insure, refuse to renew, cancel, restrict, or otherwise…
- § 10144.3 (a) No admitted insurer licensed to issue life insurance shall refuse to accept an application for insurance, refuse to issue or renew a policy, cancel a…
- § 10144.4 (a) A large group health insurance policy shall provide all covered mental health and substance use disorder benefits in compliance with the federal Paul…
- § 10144.5 (a) (1) Every disability insurance policy issued, amended, or renewed on or after January 1, 2021, that provides hospital, medical, or surgical coverage shall…
- § 10144.51 (a) (1) Every health insurance policy shall also provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than…
- § 10144.52 (a) A disability insurer that provides hospital, medical, or surgical coverage shall base any medical necessity determination or the utilization review…
- § 10144.53 (a) (1) A disability insurance policy issued, amended, renewed, or delivered on or after January 1, 2024, that is required to provide coverage for medically…
- § 10144.54 (a) An insurance policy issued, amended, renewed, or delivered on or after July 1, 2023, shall cover the cost of developing an evaluation pursuant to Section…
- § 10144.55 (a) Every policy of disability income insurance, as defined in subdivision (c) of Section 799.01, that is of a short-term limited duration of two years or…
- § 10144.56 (a) For provider contracts issued, amended, or renewed on and after January 1, 2023, a disability insurer that provides coverage for mental health and…
- § 10144.565 Except as provided in Section 10144.56, within one year of the operative date of this section, a health insurer or its delegate that credentials health care…
- § 10144.57 (a) Coverage of mental health and substance use disorder treatment pursuant to Section 10144.5 includes behavioral health crisis services that are provided to…
- § 10144.58 For services provided to an insured under a disability insurance policy issued, amended, or renewed on or after July 1, 2025, a disability insurer subject to…
- § 10144.6 No disability insurer may utilize any information regarding whether a beneficiary’s psychiatric inpatient admission was made on a voluntary or involuntary…
- § 10145 No insurer issuing, providing, or administering any contract of individual or group insurance providing life, annuity, or disability benefits applied for and…
- § 10145.2 (a) Every policy of disability insurance that is issued, amended, or renewed on or after July 1, 2002, that covers hospital, medical, or surgery expenses shall…
- § 10145.3 (a) Every disability insurer that covers hospital, medical, or surgical benefits shall provide an external, independent review process to examine the insurer’s…
- § 10145.4 (a) An individual or group health insurance policy that is issued, amended, or renewed on or after January 1, 2020, shall not: (1) Deny a qualified insured’s…
ARTICLE 2.6. Underwriting on the Basis of Test of Genetic Characteristics §§ 10146–10149.1 · 5 sections
- § 10146 The purposes of this article are to establish standards regarding unfair discrimination among individuals of the same class in the underwriting of life or…
- § 10147 As used in this article: (a) “Disability income insurance” means insurance against loss of occupational earning capacity arising from injury, sickness, or…
- § 10148 No insurer shall require a test for the presence of a genetic characteristic for the purpose of determining insurability other than for those policies that are…
- § 10149 (a) All underwriting activities undertaken by insurers pursuant to this article shall be subject to all applicable provisions of Article 6.6 (commencing with…
- § 10149.1 (a) This section shall apply to the disclosure of the results of a test for a genetic characteristic requested by an insurer pursuant to this article. (b) Any…
ARTICLE 3. Policy Provisions Required §§ 10150–10154 · 6 sections
- § 10150 The provisions of this article shall not apply to annuities, industrial policies or to term contracts issued for periods of twenty years or less.
- § 10150.1 This article is not applicable to life policies issued on or after the operative date as to such policies of Article 3a, Chapter 1, Part 2, Division 2.
- § 10151 Every contract or policy of life insurance (excluding additional benefits specified therein or issued in connection therewith for accidental death or…
- § 10152 In lieu of the application of the provisions for automatic insurance upon nonpayment of premium the policy may be surrendered to the insurer at its home…
- § 10153 No agreement between the insurer and the policy holder or applicant for insurance contrary to the foregoing shall be held to waive any of the provisions of…
- § 10154 Any life policy issued upon the life of a resident of this State and delivered within this State, which does not contain an automatic nonforfeiture value in…
ARTICLE 3a. Standard Nonforfeiture Law for Life Insurance §§ 10159.1–10167.5 · 17 sections
- § 10159.1 (a) This article is applicable only to policies and contracts issued on or after the operative date as to such policies or contracts of this article. (b) The…
- § 10159.2 After December 31, 1943, any insurer may file with the commissioner a written notice of its election to comply with the provisions of this article as to any or…
- § 10160 Except as provided in Section 10165, no policy of life insurance shall be delivered or issued for delivery in this state unless it shall contain in substance…
- § 10161 Any cash surrender value available under the policy in the event of default in a premium payment due on any policy anniversary, whether or not required by…
- § 10162 Any paid-up nonforfeiture benefit available under the policy in the event of default in a premium payment due on any policy anniversary shall be such that its…
- § 10163 This section shall not apply to policies issued on or after the operative date of Section 10163.2 as defined therein. Except as provided in the third paragraph…
- § 10163.1 (a) In the case of ordinary policies issued on or after the operative date of this subdivision as defined herein, all adjusted premiums and present values…
- § 10163.2 (a) This section shall apply to all policies issued on or after the operative date of this section as defined herein. Except as provided in subdivision (g),…
- § 10163.3 In the case of any plan of life insurance that provides for future premium determination, the amounts of which are to be determined by the insurance company…
- § 10163.35 (a) Notwithstanding any other provision of law, the form of any policy, contract, or certificate providing life insurance that is subject to this article shall…
- § 10164 Any cash surrender value and any paid-up nonforfeiture benefit available under the policy in the event of default in a premium payment due at any time other…
- § 10164.1 This section shall apply to all policies issued on or after January 1, 1986. Any cash surrender value available under the policy in the event of default in a…
- § 10164.2 (a) For a policy of individual life insurance that is surrendered by the policy owner, the insurer shall return to the owner all moneys due in relation to that…
- § 10165 This article shall not apply to any of the following: (a) Reinsurance. (b) Group insurance. (c) Pure endowment. (d) Annuity or reversionary annuity contract.…
- § 10166 No agreement between the insurer and the policyholder or applicant for insurance contrary to this article shall be held to waive any of the provisions of this…
- § 10167 Any policy to which this article is applicable which does not contain a paid-up nonforfeiture benefit shall be construed as granting nonparticipating paid-up…
- § 10167.5 (a) Whenever a nonforfeiture benefit is implemented by a life insurer in connection with a defaulting policyowner, the insurer shall provide a notice to the…
ARTICLE 3b. Standard Nonforfeiture Law for Individual Deferred Annuities §§ 10168–10168.10 · 15 sections
- § 10168 This article shall not apply to any reinsurance, group annuity purchased under a retirement plan or plan of deferred compensation established or maintained by…
- § 10168.1 In the case of contracts issued on or after the operative date of this article as defined in Section 10168.10, no contract of annuity, except as stated in…
- § 10168.2 (a) This section shall apply to contracts issued before January 1, 2004, and may be applied by a company, on a contract-form-by-contract-form basis, to any…
- § 10168.25 (a) This section shall apply to contracts issued on and after January 1, 2006, and may be applied by a company, on a contract-form-by-contract-form basis, to…
- § 10168.3 Any paid-up annuity benefit available under a contract shall be such that its present value on the date annuity payments are to commence is at least equal to…
- § 10168.4 Contracts that provide cash surrender benefits shall comply with all of the following: (a) Cash surrender benefits available prior to maturity shall not be…
- § 10168.45 (a) (1) For an individual annuity contract subject to this article that is surrendered by the contract owner, the insurer shall return to the owner all moneys…
- § 10168.5 For contracts which do not provide cash surrender benefits, the present value of any paid-up annuity benefit available as a nonforfeiture option at any time…
- § 10168.6 For the purpose of determining the benefits calculated under Sections 10168.4 and 10168.5, the following apply: (a) In the case of annuity contracts under…
- § 10168.7 Any contract which does not provide cash surrender benefits or does not provide death benefits at least equal to the minimum nonforfeiture amount prior to the…
- § 10168.8 Any paid-up annuity, cash surrender or death benefits available at any time, other than on the contract anniversary under any contract with fixed scheduled…
- § 10168.9 For any contract which provides, within the same contract by rider or supplemental contract provision, both annuity benefits and life insurance benefits that…
- § 10168.92 The commissioner may adopt regulations to implement the provisions of this article.
- § 10168.93 (a) Notwithstanding any other provision of law, the form of any annuity contract that is subject to this article shall be filed by the obligor under the…
- § 10168.10 After the effective date of this article, any company may file with the commissioner a written notice of its election to comply with the provisions of this…
ARTICLE 3.5. Appeals Seeking Independent Medical Review §§ 10169–10169.5 · 5 sections
- § 10169 (a) Commencing January 1, 2001, there is hereby established in the department the Independent Medical Review System. (b) For the purposes of this chapter,…
- § 10169.1 (a) If there is an imminent and serious threat to the health of the insured, as specified in subdivision (c) of Section 10169.3, all necessary information and…
- § 10169.2 (a) The department shall contract with one or more independent medical review organizations in the state to conduct reviews for purposes of this article. The…
- § 10169.3 (a) Upon receipt of information and documents related to a case, the medical professional reviewer or reviewers selected to conduct the review by the…
- § 10169.5 (a) After considering the results of a competitive bidding process and any other relevant information on program costs, the commissioner shall establish a…
ARTICLE 4. Payment and Proceeds §§ 10170–10180 · 35 sections
- § 10170 Life insurance may be made payable as follows: (a) On the death of the insured. (b) On his or her surviving a specified period. (c) Periodically as long as he…
- § 10171 Any life policy or other agreement relating to the holding or payment of the proceeds of a life policy may provide that the proceeds thereof or payments…
- § 10172 Notwithstanding Sections 751 and 1100 of the Family Code and Section 249.5 of the Probate Code, when the proceeds of, or payments under, a life insurance…
- § 10172.5 (a) Notwithstanding any other provision of law, each insurer admitted to transact life insurance, credit life insurance, or accidental death insurance in this…
- § 10173 When a policy of life insurance is assigned in writing the insurer may deal with the assignee in any manner not inconsistent with the terms of said assignment…
- § 10173.2 When a policy of life insurance is, after the effective date of this section, assigned in writing as security for an indebtedness, the insurer shall, in any…
- § 10174 Policies of disability insurance, as defined in Section 106, that provide for death benefits, shall, as to those death benefits, be subject to Sections 10172,…
- § 10175 Nothing contained in Sections 10172, 10173 or 10174 shall affect any claim or right to any policy or the proceeds thereof, or payments thereunder, as between…
- § 10175.5 (a) No disability insurance contract with a physician and surgeon, physician and surgeon group, or other licensed health care practitioner shall contain any…
- § 10176 (a) In disability insurance, the policy may provide for payment of medical, surgical, chiropractic, physical therapy, speech pathology, audiology, acupuncture,…
- § 10176.1 As of the effective date of the amendments to this section enacted at the 1969 Regular Session of the Legislature all disability policies shall be construed to…
- § 10176.2 As an alternative to the exclusion permitted by Section 10176, a disability insurance policy may provide that services of a licensed physical therapist,…
- § 10176.25 (a) As an alternative to an exclusion permitted by Section 10176, a disability insurance policy may provide that services of a registered dietitian or other…
- § 10176.3 The amendments to Section 10176 and the addition of Section 10176.2 enacted at the 1971 Regular Session of the Legislature shall be applicable only to those…
- § 10176.4 For purposes of establishing the fact of disability in credit disability insurance, disability insurance or life insurance, chiropractors’ certifications of…
- § 10176.5 Disability insurance which is written or issued for delivery outside California in a state the laws of which require recognition of psychologists licensed in…
- § 10176.6 On and after January 1, 1982, every policy of disability insurance which is issued, amended, delivered, or renewed that covers hospital, medical, or surgical…
- § 10176.61 (a) An insurer issuing, amending, delivering, or renewing a disability insurance policy on or after January 1, 2000, that covers hospital, medical, or surgical…
- § 10176.7 (a) Disability insurance where the insurer is licensed to do business in this state and which provides coverage under a contract of insurance which includes…
- § 10176.8 A disability insurance policy may provide that services of a respiratory care practitioner certified pursuant to Chapter 8.3 (commencing with Section 3700) of…
- § 10176.9 No policy, contract, or agreement coming within the provisions of this article, issued, entered into or renewed on or after July 1, 1984, shall be deemed to…
- § 10176.10 (a) On or after January 1, 1994, no disability insurer issuing policies covering hospital, surgical, or medical expenses delivered or renewed in this state or…
- § 10176.11 (a) An insurer that provides a policy of health insurance shall accept premium payments from the following third-party entities without the need to comply with…
- § 10177 (a) A self-insured employee welfare benefit plan may provide for payment of professional mental health expenses upon a reimbursement basis, or for the…
- § 10177.5 A self-insured employee welfare benefit plan which is written or issued for delivery outside California in a state the laws of which require recognition of…
- § 10177.6 On and after the effective date of this section, a self-insured employee welfare benefit plan shall not prohibit the insured from selecting any person who is…
- § 10177.7 On and after January 1, 1982, every self-insured employee welfare benefit plan which is issued, amended, delivered, or renewed that covers hospital, medical,…
- § 10177.8 (a) A self-insured employee welfare benefit plan doing business in this state and providing coverage that includes California residents but that may be written…
- § 10177.9 (a) It is the intent of the Legislature that all persons licensed in this state to engage in the practice of dentistry shall be accorded equal professional…
- § 10178 No admitted insurer, union trust fund which administers health, medical, or surgical insurance, or employer which has an insurance company administering its…
- § 10178.3 (a) In order to prevent the improper selling, leasing, or transferring of a health care provider’s contract, it is the intent of the Legislature that every…
- § 10178.4 (a) When a contracting agent sells, leases, or transfers a health provider’s contract to a payor, the rights and obligations of the provider shall be governed…
- § 10178.5 (a) Every self-insured employee welfare benefit plan issued, amended, or renewed on and after January 1, 1987, that offers coverage for medical transportation…
- § 10179 A disability insurer that offers or provides coverage for any services that are legally within the scope of the practice of podiatric medicine, as defined in…
- § 10180 (a) A disability insurer which negotiates and enters into a contract with professional providers to provide services at alternative rates of payment pursuant…
ARTICLE 4.5. Review of Rate Increases §§ 10181–10181.14 · 17 sections
- § 10181 For purposes of this article, the following definitions shall apply: (a) (1) “Blended” means a rating method that combines community rating and experience…
- § 10181.2 This article shall apply to a health insurance policy offered in the individual or group market in California, including a health insurance policy covering…
- § 10181.3 (a) (1) A health insurer shall file with the department all required rate information for grandfathered individual and grandfathered and nongrandfathered group…
- § 10181.31 (a) Upon receiving notice of a rate change, a large group contractholder that has coverage that is experience rated in whole or blended and that meets the…
- § 10181.35 (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…
- § 10181.4 (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…
- § 10181.45 (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…
- § 10181.46 (a) A health insurer, not including a specialized health insurance policy, shall annually report to the department the information described in subdivision (c)…
- § 10181.5 Notwithstanding any provision in a contract between a health insurer and a provider, the department may request from a health insurer any information required…
- § 10181.6 (a) A filing submitted under this article shall be actuarially sound. (b) (1) The health insurer shall contract with an independent actuary or actuaries…
- § 10181.7 (a) Notwithstanding Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code, all information submitted under this article shall be…
- § 10181.8 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…
- § 10181.9 (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…
- § 10181.10 (a) (1) A health insurer shall annually provide claims data at no charge to a large group purchaser if the large group purchaser requests the information and…
- § 10181.11 (a) Whenever it appears to the department that any person has engaged, or is about to engage, in any act or practice constituting a violation of this article,…
- § 10181.13 The department shall do all of the following in a manner consistent with applicable federal laws, rules, and regulations: (a) Provide data to the United States…
- § 10181.14 (a) This section shall apply only to a specialized health insurance policy covering dental services, as defined in Section 10120.41. (b) On or after January 1,…
ARTICLE 5. Exemptions and Miscellaneous Provisions Relating to Insurance Contracts §§ 10190–10192 · 5 sections
- § 10190 The provisions of Sections 800, 801, 802, 803, and 804 shall not apply to life insurance.
- § 10191 (a) The commissioner may, from time to time as conditions warrant, after notice and hearing, promulgate such reasonable rules and regulations, and amendments…
- § 10191.1 (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…
- § 10191.5 (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…
- § 10192 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…
ARTICLE 6. Medicare Supplement Policies §§ 10192.1–10192.24 · 31 sections
- § 10192.1 All Medicare supplement policies and certificates shall comply with the provisions of subdivision (b) of Section 10291.5 and Chapter 7 (commencing with Section…
- § 10192.2 The purpose of this article is to provide for the reasonable standardization of coverage and simplification of terms and benefits of Medicare supplement…
- § 10192.3 (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…
- § 10192.4 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…
- § 10192.5 A policy or certificate shall not be advertised, solicited, or issued for delivery as a Medicare supplement policy or certificate unless the policy or…
- § 10192.55 (a) With regard to Medicare supplement policies, all insurers, brokers, agents, and others engaged in the business of insurance owe a policyholder or a…
- § 10192.6 (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…
- § 10192.7 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,…
- § 10192.8 The following standards are applicable to all Medicare supplement policies or certificates advertised, solicited, or issued for delivery on or after January 1,…
- § 10192.81 The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state with an effective…
- § 10192.9 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,…
- § 10192.91 The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state with an effective…
- § 10192.92 The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state to individuals newly…
- § 10192.10 (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…
- § 10192.11 (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,…
- § 10192.12 (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…
- § 10192.13 (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…
- § 10192.14 (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…
- § 10192.15 (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…
- § 10192.16 (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…
- § 10192.165 (a) (1) As prescribed in this chapter, the commissioner shall have the administrative authority to assess penalties against issuers, brokers, agents, and other…
- § 10192.17 (a) Medicare supplement policies and certificates shall include a renewal, continuation, or conversion provision. The language or specifications of the…
- § 10192.18 (a) Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant…
- § 10192.185 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…
- § 10192.19 (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…
- § 10192.195 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…
- § 10192.20 (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…
- § 10192.21 (a) In recommending the purchase or replacement of any Medicare supplement policy or certificate, an agent shall make reasonable efforts to determine the…
- § 10192.22 (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…
- § 10192.23 (a) If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate, the replacing issuer shall waive any time…
- § 10192.24 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…
ARTICLE 7. Preexisting Condition Provisions §§ 10198.6–10198.10 · 6 sections
- § 10198.6 For purposes of this article, the following definitions shall apply: (a) “Health benefit plan” means any group or individual policy of health insurance, as…
- § 10198.61 (a) For purposes of this article, “health benefit plan” does not include policies or certificates of specified disease or hospital confinement indemnity…
- § 10198.7 (a) A health benefit plan for group coverage shall not impose any preexisting condition provision or waivered condition provision upon any individual. (b) (1)…
- § 10198.8 This article applies to all health benefit plans that provide benefits to residents of this state regardless of the situs of the contract or group master…
- § 10198.9 A health benefit plan for group coverage shall not establish rules for eligibility, including continued eligibility, of an individual, or dependent of an…
- § 10198.10 This article shall become operative on January 1, 2014.