California

Insurance Code

4,514 sections, each with the official text and a plain-English explanation of what it means for you.

• § 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 contract or otherwise penalize the provi
• § 10133.65 — (a) This section shall be known and may be cited as the Health Care Providers’ Bill of Rights.
• § 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 claim on behalf of an insured or pursuant
• § 10133.661 — On or before July 1, 2006, the commissioner, pursuant to his or her authority under Section 12921.
• § 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 insured that are covered under the insured
• § 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, hospitalization or medical or surgical aid to the p
• § 10133.8 — (a) The commissioner shall, on or before January 1, 2006, promulgate regulations applicable to all individual and group policies of health insurance establishing standards and requirements to provide
• § 10133.9 — Within a year after the health insurer’s assessment pursuant to paragraph (2) of subdivision (b) of Section 10133.
• § 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 agreement or related documents that obligate
• § 10135 — (a) This article is only applicable to transfers entered into on or after January 1, 2000.
• § 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 settlement obligor or annuity issuer shall be
• § 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 transfer of the structured settlement pa
• § 10138 — (a) A transfer agreement, as defined in subdivision (o) of Section 10134, shall not include any provision described in the paragraphs below.
• § 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 the transfer, whichever date is later, a
• § 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 requirements of this article.
• § 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 paid, in the United States mail not less th
• § 10139.3 — (a) None of the provisions of this article may be waived by the payee.
• § 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 Division 7 of the Business and Professions C
• § 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 required to make any payment directly or indirec
• § 1014 — Whenever the commissioner makes any seizure as provided in section 1013, it shall, on the demand of the commissioner, be the duty of the sheriff of any county of this State, and of the police departme
• § 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 insurance to an applicant therefor, or issue or
• § 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 to issue life or disability insurance, ex
• § 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, or charge differentials because of the sex
• § 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 against life or disability insurers for vio
• § 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 of the applicant shall carry any identifi
• § 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 question is used only to identify the appl
• § 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 solely by reason of the fact that the pe
• § 10144 — No insurer issuing, providing, or administering any contract of individual or group insurance providing life, annuity, or disability benefits applied for and issued on or after January 1, 1984, shall
• § 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 purposes of this section refers to an incurab
• § 10144.2 — (a) No disability insurer covering hospital, medical, or surgical expenses shall deny, refuse to insure, refuse to renew, cancel, restrict, or otherwise terminate, exclude, or limit coverage or charge
• § 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 policy, or deny coverage under a policy becaus
• § 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 Wellstone and Pete Domenici Mental Health Pari
• § 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 provide coverage for medically necessary
• § 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 July 1, 2012.
• § 10144.52 — (a) A disability insurer that provides hospital, medical, or surgical coverage shall base any medical necessity determination or the utilization review criteria that the insurer, and any entity acting
• § 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 necessary treatment of mental health and su
• § 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 5977.
• § 10144.55 — (a) Every policy of disability income insurance, as defined in subdivision (c) of Section 799.
• § 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 substance use disorders and that credentials heal
• § 10144.565 — Except as provided in Section 10144.
• § 10144.57 — (a) Coverage of mental health and substance use disorder treatment pursuant to Section 10144.
• § 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 Section 10144.
• § 10144.6 — No disability insurer may utilize any information regarding whether a beneficiary’s psychiatric inpatient admission was made on a voluntary or involuntary basis for the purpose of determining eligibil
• § 10145 — No insurer issuing, providing, or administering any contract of individual or group insurance providing life, annuity, or disability benefits applied for and issued on or after January 1, 1986, shall
• § 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 provide coverage for a vaccine for acqui
• § 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 coverage decisions regarding experimenta
• § 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 participation in an approved clinical tria
• § 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 disability income insurance on the basis of t
• § 10147 — As used in this article: (a) “Disability income insurance” means insurance against loss of occupational earning capacity arising from injury, sickness, or disablement, and includes insurance which pro
• § 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 contingent on review or testing for othe
• § 10149 — (a) All underwriting activities undertaken by insurers pursuant to this article shall be subject to all applicable provisions of Article 6.
• § 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.
• § 1015 — Immediately after such seizure, the commissioner shall institute a proceeding as provided for in section 1011 and thereafter shall proceed in accordance with the provisions of this article.
• § 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 disability) hereinafter made by any person or corp
• § 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 office, upon due application by the legal owner
• § 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 sections 10151 and 10152.
• § 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 conformity with section 10151 shall be cons
• § 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.
• § 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 all of its policies after a specified da
• § 1016 — (a) If at any time after the issuance of an order under Section 1011, or if at the time of instituting any proceeding under this article, including under Section 1011, it shall appear to the commissio
• § 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 the following provisions, or corresponding
• § 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 Section 10160, shall be an amount not less th
• § 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 present value as of such anniversary shal
• § 10163 — This section shall not apply to policies issued on or after the operative date of Section 10163.
• § 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 referred to in this article shall be calculat
• § 10163.2 — (a) This section shall apply to all policies issued on or after the operative date of this section as defined herein.
• § 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 based on then estimates of future experienc
• § 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 be filed by the obligor under the policy
• § 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 than on the policy anniversary, shall be ca
• § 10164.1 — This section shall apply to all policies issued on or after January 1, 1986.
• § 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 policy as expeditiously as possible, but
• § 10165 — This article shall not apply to any of the following: (a) Reinsurance.
• § 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 article.
• § 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 term insurance as a nonforfeiture benefit
• § 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 policyowner which explains that action and
• § 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 an employer (including a partnership or s
• § 10168.1 — In the case of contracts issued on or after the operative date of this article as defined in Section 10168.
• § 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 after a specified date before the se
• § 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 contract issued on or after January 1, 2004,
• § 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 any contract issued on or after January 1,
• § 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 the minimum nonforfeiture amount on that d
• § 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 less than the present value as of the date o
• § 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 due in relation to that contract as exped
• § 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 prior to maturity shall not be less than th
• § 10168.6 — For the purpose of determining the benefits calculated under Sections 10168.
• § 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 commencement of any annuity payments shal
• § 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 considerations, shall be calculated with all
• § 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 are in excess of the greater of cash surre
• § 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 contract with the commissioner before it is mar
• § 10169 — (a) Commencing January 1, 2001, there is hereby established in the department the Independent Medical Review System.
• § 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.
• § 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.
• § 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 independent medical review organization shall prom
• § 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 reasonable, per-case reimbursement schedule t
• § 1017 — (a) In the commissioner’s application for an order for the liquidation of a domestic corporation, or at any time thereafter, the commissioner may apply for, and the court shall make, an order dissolvi
• § 10170 — Life insurance may be made payable as follows: (a) On the death of the insured.
• § 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 thereunder shall not be subject to transfer, an
• § 10172 — Notwithstanding Sections 751 and 1100 of the Family Code and Section 249.
• § 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 state that fails or refuses to pay the pr
• § 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 until the insurer has received at its hom
• § 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 case in which it has received written notic
• § 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, 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 all persons other than the insurer.
• § 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 incentive plan that includes specific payme
• § 10176 — (a) In disability insurance, the policy may provide for payment of medical, surgical, chiropractic, physical therapy, speech pathology, audiology, acupuncture, professional mental health, dental, hosp
• § 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 be in compliance with Section 10176, and
• § 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 certificates of group disability insuranc
• § 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 subdivision (c): (1) A Ryan White HIV/AI
• § 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, licensed pursuant to Section 2630 of the Busine
• § 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 nutrition professional meeting the qualific
• § 10176.3 — The amendments to Section 10176 and the addition of Section 10176.
• § 10176.4 — For purposes of establishing the fact of disability in credit disability insurance, disability insurance or life insurance, chiropractors’ certifications of disability when made within the scope of th
• § 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 such state for services performed within t
• § 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 expenses on a group basis shall offer cove
• § 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 expenses shall include coverage for the
• § 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 California residents but which may be writt
• § 10176.8 — A disability insurance policy may provide that services of a respiratory care practitioner certified pursuant to Chapter 8.
• § 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 contain any provision restricting the liabi
• § 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 exclusion of those services, and provision may be
• § 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 psychologists licensed in such state for ser
• § 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 the holder of a certificate or license und
• § 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, or surgical expenses on a group basis shal
• § 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 or issued for delivery outside of Califo
• § 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 status and privileges, without regard to the
• § 10178 — No admitted insurer, union trust fund which administers health, medical, or surgical insurance, or employer which has an insurance company administering its health services program, shall deny, for th
• § 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 arrangement that results in a payor paying a
• § 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 by the underlying contract between the he
• § 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 services, shall contain a provision provi
• § 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 Section 2472 of the Business and Professio
• § 1018 — The recording in the office of a county recorder of any county in the State of an order entered pursuant to section 1011, 1016 or 1017 shall impart the same notice that would be imparted by the record
• § 10180 — (a) A disability insurer which negotiates and enters into a contract with professional providers to provide services at alternative rates of payment pursuant to Section 10133 of the Insurance Code, sh
• § 10181 — For purposes of this article, the following definitions shall apply: (a) (1) “Blended” means a rating method that combines community rating and experience rating methods.
• § 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 otherwise meets the requirements of this s
• § 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, including the filing of inaccurate or unj
• § 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 Secretary of Health and Human Services o
• § 10181.14 — (a) This section shall apply only to a specialized health insurance policy covering dental services, as defined in Section 10120.
• § 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 dental services and a specialized health ins
• § 10181.3 — (a) (1) A health insurer shall file with the department all required rate information for grandfathered individual and grandfathered and nongrandfathered group health insurance policies at least 120 d
• § 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 criteria in subdivision (e), may apply within
• § 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 a result of the establishment of the Offi
• § 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 required rate information for unreasonable
• § 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 designs during the 12-month period ending
• § 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) for all grandfathered and nongrandfather
• § 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 under this article or PPACA.
• § 10181.6 — (a) A filing submitted under this article shall be actuarially sound.
• § 10181.7 — (a) Notwithstanding Division 10 (commencing with Section 7920.
• § 10181.8 — A health insurance policy subject to Section 10181.
• § 10181.9 — (a) On or before July 1, 2012, the commissioner may issue guidance to health insurers regarding compliance with this article.
• § 1019 — 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 interest
• § 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 and additions thereto, as are necessary or
• § 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 following: (1) Procedural requirements for
• § 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 uniform standards set forth in the Intersta
• § 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 than six months after the date the paid
• § 10192.1 — All Medicare supplement policies and certificates shall comply with the provisions of subdivision (b) of Section 10291.
• § 10192.10 — (a) (1) This section shall apply to Medicare Select policies and certificates, as defined in this section.
• § 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, nor discriminate in the pricing of a poli
• § 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 enroll under the policy during the period
• § 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 Reconciliation Act of 1987 (OBRA), Public Law 1
• § 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 delivery unless the policy form or certificate
• § 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 form has been filed with and approved by the
• § 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 certificate only if the first year commis
• § 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 entities engaged in the business of insu
• § 10192.17 — (a) Medicare supplement policies and certificates shall include a renewal, continuation, or conversion provision.
• § 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 currently has Medicare supplement, Medicare A
• § 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 than one month’s premium to be submitted wit
• § 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 to the commissioner for review at least
• § 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 which is intended to improve the buyer’s a
• § 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 policies, to facilitate public understanding an
• § 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 by its agents or other producers will be
• § 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 appropriateness of a recommended purchase or r
• § 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 force more than one Medicare supplement
• § 10192.23 — (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, w
• § 10192.24 — This section applies to all policies with policy years beginning on or after May 21, 2009.
• § 10192.3 — (a) Except as otherwise provided in this section or in Sections 10192.
• § 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 case of an individual Medicare supplement p
• § 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 certificate contains definitions or terms that co
• § 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 prospective policyholder a duty of honesty, and
• § 10192.6 — (a) Except for permitted preexisting condition clauses as described in Sections 10192.
• § 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, unless it meets or exceeds requirements appl
• § 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, 2001, and with an effective date prior t
• § 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 date on or after June 1, 2010.
• § 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, 1992, and with an effective date prior to
• § 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 date on or after June 1, 2010.
• § 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 eligible for Medicare on or after January
• § 10198.10 — This article shall become operative on January 1, 2014.
• § 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 defined in Section 106.
• § 10198.61 — (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 polici
• § 10198.7 — (a) A health benefit plan for group coverage shall not impose any preexisting condition provision or waivered condition provision upon any individual.
• § 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 policyholder.
• § 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 individual, to enroll under the terms of the p
• § 10199 — 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
• § 10199.1 — (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, inc
• § 10199.2 — (a) The written notice described in subdivisions (a) and (b) of Section 10199.
• § 10199.3 — 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 st
• § 10199.4 — 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.
• § 10199.44 — (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 wr