Source: https://californiainsurancelawblog.wordpress.com/2011/05/03/health-insurance-post-claims-underwriting-california-insurance-commissioner%E2%80%99s-2010-regulations/
Timestamp: 2019-04-22 00:58:22+00:00

Document:
Insurers subject to the INSURANCE CODE, not the Health and Safety Code, are governed by Insurance Code § 10384 as it relates to post-claims underwriting. [Nazaretyan v. California Physicians Service (2010) 182 Cal.App.4h 1601, 1608, 107 Cal.Rptr.3d 137] Insurers licensed under the HEALTH AND SAFETY CODE must comply with Health and Safety Code § 1389.3 as it relates to post-claims underwriting. [Nazaretyan v. California Physicians Service (2010) 182 Cal.App.4th 1601, 1608, 107 Cal.Rptr.3d 137] See § U11:2 Post-claims underwriting; health insurance, infra.
In Nieto v. Blue Shield of California Life and Health Ins. Co. (2010) 181 Cal.App.4th 60, 103 Cal.App.3d 906, the Court of Appeal affirmed on multiple grounds the insurer’s rescission based upon intentional or unintentional failure to disclose material information in an application. [Nieto v. Blue Shield of California Life and Health Ins. Co., 181 Cal.App.4th at pages 76-77] Nieto, supra, held that the ‘medical underwriting requirements’ in Hailey v. California Physicians Service (2007) 158 Cal.App.4th 452, 463, 69 Cal.Rptr.3d 789 do not apply to an insurer licensed under the insurance code. [Nazaretyan v. California Physicians Service (2010) 182 Cal.App.4th 1601, 1608-1609, 107 Cal.Rptr.3d 137] See “Medical Underwriting” defined, infra.
The Department of Insurance has adopted regulations governing the Insurance Commissioner’s evaluation of the clarify and simplicity of questions on a health history questionnaire intended to be used for medical underwriting by the insurer. The regulations prohibit insurers from rescinding, cancelling or limiting an insurance contract unless they can meet the standards set for avoiding prohibited post claims underwriting or if the insurer is unable to prove fraudulent claims or fraudulent assertions on the applications for coverage. The regulations define prohibited post-claims underwriting and set detailed standards that insurers must meet before they can legally rescind an individual’s health insurance coverage. [Title 10 Cal. Code Regs. §§ 2274.70 – 2274.78 (2010)] See § APPENDIX K (Insurance Commissioner Regulations enacted 2010).
7. include any questions which solicits or is reasonably calculated to solicit information regarding an HIV test result. [Cal. Code Regs. § 2274.73(e)(1)-(7)] See § A78 APPLICATION [§ A78:10 Rescission by insurer; CGL policy].
* BOLD references are to Mr. Cornblum’s 2-Volume legal treatise CALIFORNIA INSURANCE LAW DICTIONARY AND DESK REFERENCE. The new 3-Volume 2011 Edition to be published by West Publishing mid-2011. You may purchase the treatise by clicking here.

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 § 2274