reglab/housing_qa huggingface dataset:
CA Ins Code § 10123.6 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 1 - The Contract|ARTICLE 1 - General Provisions|Section 10123.6.

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 the treatment of alcoholism under such terms and conditions as may be agreed upon between the group policyholder and the insurer. Every insurer shall communicate the availability of such coverage to all group policyholders and to all prospective group policyholders with whom they are negotiating.If the group subscriber or policyholder agrees to such coverage or to coverage for treatment of chemical dependency, or nicotine use, the treatment may take place in facilities licensed to provide alcoholism or chemical dependency services under Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code.Treatment for nicotine use may be subject to separate deductibles, copayments, and overall cost limitations as determined by the policy.(Amended by Stats. 1989, Ch. 688, Sec. 2.)
CA Ins Code § 10123.61 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 1 - The Contract|ARTICLE 1 - General Provisions|Section 10123.61.

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 state.(b) For purposes of this section, “short-term limited duration health insurance” means health insurance coverage provided pursuant to a health insurance policy that has an expiration date specified in the policy that is less than 12 months after the original effective date of the coverage.(Added by Stats. 2018, Ch. 687, Sec. 4. (SB 910) Effective January 1, 2019.)
CA Ins Code § 10123.65 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 1 - The Contract|ARTICLE 1 - General Provisions|Section 10123.65.

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) The applicable cost-sharing amount for the prescription drug.(2) The retail price.(b) A health insurer shall not require a pharmacist or pharmacy to charge or collect from an insured a cost-sharing amount that exceeds the total retail price for the prescription drug.(c) The payment rendered shall constitute the applicable cost sharing and shall apply to the deductible, if any, and also to the maximum out-of-pocket limit in the same manner as if the insured had purchased the prescription drug by paying the cost-sharing amount.(Added by Stats. 2018, Ch. 770, Sec. 3. (AB 2863) Effective January 1, 2019.)
CA Ins Code § 10123.67 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 1 - The Contract|ARTICLE 1 - General Provisions|Section 10123.67.

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 the department a written policy, which is not subject to approval or disapproval by the department, describing the manner in which the insurer determines if a second medical opinion is medically necessary and appropriate. Notice of the policy and information regarding the manner in which an insured may receive a second medical opinion shall be provided to all insureds in the insurer’s evidence of coverage. The written policy shall describe the manner in which requests for a second medical opinion are reviewed by the insurer.(b) This section shall only apply to disability insurers covering hospital, medical, or surgical expenses that contract with providers for alternative rates pursuant to Section 10133 or 11512 and that limit payments under those policies to services secured by insureds from providers charging alternative rates pursuant to the contracts.(c) Nothing in this section shall require the disability insurer to cover services or provide benefits that are not otherwise covered under the terms and conditions of the plan contract, nor to provide services through providers who are not under contract with the plan.(Added by Stats. 1996, Ch. 1091, Sec. 2. Effective January 1, 1997.)
CA Ins Code § 10123.7 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 1 - The Contract|ARTICLE 1 - General Provisions|Section 10123.7.

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 terms and conditions that may be agreed upon between the group policyholder and the insurer. An insurer shall communicate the availability of that coverage to all group policyholders and to all prospective group policyholders with whom the insurer is negotiating. Coverage for prosthetic devices shall include original and replacement devices, as prescribed by a physician and surgeon or doctor of podiatric medicine acting within the scope of his or her license. Coverage for orthotic devices shall provide for coverage if the device, including original and replacement devices, is prescribed by a physician and surgeon or doctor of podiatric medicine acting within the scope of his or her license, or is ordered by a licensed health care provider acting within the scope of his or her license. An insurer shall have the right to conduct a utilization review to determine medical necessity before authorizing these services.(b) Notwithstanding subdivision (a), on and after July 1, 2007, the amount of the benefit for orthotic and prosthetic devices and services shall be no less than the annual and lifetime benefit maximums applicable to all benefits in the policy. A copayment, coinsurance, deductible, and maximum out-of-pocket amount applied to the benefit for orthotic and prosthetic devices and services shall be no more than the most common amounts contained in the policy.(c) This section shall not apply to Medicare supplement, vision-only, dental-only, or CHAMPUS supplement insurance, or to hospital indemnity, hospital-only, accident-only, or specified disease insurance that does not pay benefits on a fixed benefit, cash payment only basis.(Amended by Stats. 2018, Ch. 687, Sec. 5. (SB 910) Effective January 1, 2019.)
CA Ins Code § 10123.8 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 1 - The Contract|ARTICLE 1 - General Provisions|Section 10123.8.

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 or after January 1, 2000, shall provide coverage for screening for, diagnosis of, and treatment for, breast cancer.(b) No policy of disability insurance that provides coverage for hospital, medical, or surgical expenses shall deny enrollment or coverage to an individual solely due to a family history of breast cancer, or who has had one or more diagnostic procedures for breast disease but has not developed or been diagnosed with breast cancer.(c) Every policy of disability insurance shall cover screening and diagnosis of breast cancer, consistent with generally accepted medical practice and scientific evidence, upon the referral of the insured’s participating physician.(d) Treatment for breast cancer under this section shall include coverage for prosthetic devices or reconstructive surgery to restore and achieve symmetry for the patient incident to a mastectomy. Coverage for prosthetic devices and reconstructive surgery shall be subject to the deductible and coinsurance conditions applied to the mastectomy and all other terms and conditions applicable to other benefits.(e) As used in this section, “mastectomy” means the removal of all or part of the breast for medically necessary reasons, as determined by a licensed physician and surgeon. Partial removal of a breast includes, but is not limited to, lumpectomy, which includes surgical removal of the tumor with clear margins.(f) As used in this section, “prosthetic devices” means the provision of initial and subsequent devices pursuant to an order of the patient’s physician and surgeon.(g) For purposes of this section, disability insurance does not include accident only, credit, disability income, specified disease and hospital confinement indemnity, coverage of Medicare services pursuant to contracts with the United States government, Medicare supplement, long-term care insurance, dental, vision, coverage issued as a supplement to liability insurance, insurance arising out of a workers’ compensation or similar law, automobile medical payment insurance, or insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance.(Amended by Stats. 2012, Ch. 449, Sec. 4. (SB 255) Effective January 1, 2013.)
CA Ins Code § 10123.81 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 1 - The Contract|ARTICLE 1 - General Provisions|Section 10123.81.

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 screening or diagnostic purposes upon the referral of a participating nurse practitioner, participating certified nurse-midwife, participating physician assistant, or participating physician, providing care to the patient and operating within the scope of practice provided under existing law.(b) This section does not prevent the application of copayment or deductible provisions in a policy, nor does this section require that a policy be extended to cover any other procedures under an individual or a group policy. This section does not authorize a policyholder to receive the services required to be covered by this section if those services are furnished by a nonparticipating provider, unless the policyholder is referred to that provider by a participating physician, nurse practitioner, or certified nurse-midwife providing care.(c) This section shall not apply to specialized health insurance, Medicare supplement insurance, CHAMPUS supplement insurance, or TRI-CARE supplement insurance, or to hospital indemnity, accident-only, or specified disease insurance.(Amended by Stats. 2018, Ch. 687, Sec. 6. (SB 910) Effective January 1, 2019.)
CA Ins Code § 10123.82 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 1 - The Contract|ARTICLE 1 - General Provisions|Section 10123.82.

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 this state on or after January 1, 1993, shall include coverage for prosthetic devices to restore a method of speaking for the patient incident to the laryngectomy.Coverage for prosthetic devices shall be subject to the deductible and coinsurance conditions applied to the laryngectomy, and all other terms and conditions applicable to other benefits. As used in this section, “laryngectomy” means the removal of the larynx for medically necessary reasons, as determined by a licensed physician and surgeon.Any provision in any policy issued, amended, delivered, or renewed in this state on or after January 1, 1993, which is in conflict with this section shall be of no force or effect.As used in this section, “prosthetic devices” means and includes the provision of initial and subsequent prosthetic devices, including installation accessories, pursuant to an order of the patient’s physician and surgeon. “Prosthetic devices” does not include electronic voice producing machines.(Added by Stats. 1992, Ch. 808, Sec. 2. Effective January 1, 1993.)
CA Ins Code § 10123.83 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 1 - The Contract|ARTICLE 1 - General Provisions|Section 10123.83.

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 renewed in this state shall include obstetrician-gynecologists as eligible primary care physicians provided they meet the insurer’s written eligibility criteria for all specialists seeking primary care physician status.(b) For purposes of this section, the term “primary care physician” means a physician, as defined in Section 14254 of the Welfare and Institutions Code, who has the responsibility for providing initial and primary care to patients, for maintaining the continuity of patient care, and for initiating referral for specialist care. This means providing care for the majority of health care problems, including, but not limited to, preventive services, acute and chronic conditions, and psychosocial issues.(Amended by Stats. 1995, Ch. 353, Sec. 1. Effective January 1, 1996.)
CA Ins Code § 10123.835 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 1 - The Contract|ARTICLE 1 - General Provisions|Section 10123.835.

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 after January 1, 1999, shall be deemed to provide coverage for the screening and diagnosis of prostate cancer, including, but not limited to, prostate-specific antigen testing and digital rectal examinations, when medically necessary and consistent with good professional practice.(b) Nothing in this section shall be construed to require an individual or group policy to cover the surgical and other procedures known as radical prostatectomy, external beam radiation therapy, radiation seed implants, and combined hormonal therapy, or to prevent application of deductible or copayment provisions contained in the policy, nor shall this section be construed to require that coverage under an individual or group policy be extended to any other procedures.(c) This section shall not apply to specified accident, specified disease, hospital indemnity, Medicare supplement, or long-term care health insurance policies.(Added by renumbering Section 10123.83 (as added by Stats. 1998, Ch. 839) by Stats. 2009, Ch. 234, Sec. 11. (AB 299) Effective January 1, 2010.)
CA Ins Code § 10123.84 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 1 - The Contract|ARTICLE 1 - General Provisions|Section 10123.84.

10123.84.  (a) The Legislature finds and declares that the unique, private, and personal relationship between women patients and their obstetricians and gynecologists warrants direct access to obstetrical and gynecological physician services.(b) Each policy of disability insurance that covers hospital, medical, or surgical expenses, and that is issued, amended, delivered, or renewed in this state, shall allow a policyholder the option to seek obstetrical and gynecological physician services directly from an obstetrician and gynecologist or directly from a participating family physician and surgeon designated by the plan as providing obstetrical and gynecological services.(c) In implementing this section, a disability insurer may establish reasonable requirements governing utilization protocols and the use of obstetricians and gynecologists or family physicians and surgeons, as provided for in subdivision (b), if those requirements are consistent with the intent of this section, are customarily applied to other physicians and surgeons, including primary care physicians and surgeons, to whom the policyholder has direct access, and are no more restrictive for the provision of obstetrical and gynecological physician services. A policyholder shall not be required to obtain prior approval from another physician, another provider, or the insurer prior to obtaining direct access to obstetrical and gynecological physician services, but the insurer may establish reasonable requirements for the participating obstetrician and gynecologist or the family physician and surgeon, as provided in subdivision (b), to communicate with the policyholder’s primary care physician regarding the policyholder’s condition, treatment, and any need for followup care.(d) This section does not diminish the requirements of Section 10123.83.(Amended by Stats. 2019, Ch. 632, Sec. 13. (AB 1622) Effective January 1, 2020.)
CA Ins Code § 10123.85 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 1 - The Contract|ARTICLE 1 - General Provisions|Section 10123.85.

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 Legislature to recognize the practice of telehealth as a legitimate means by which an individual may receive health care services from a health care provider without in-person contact with the health care provider.(c) A health insurer shall not require that in-person contact occur between a health care provider and a patient before payment is made for the services appropriately provided through telehealth, subject to the terms and conditions of the contract entered into between the policyholder or contractholder and the insurer, and between the insurer and its participating providers or provider groups, and pursuant to Section 10123.855.(d) A health insurer shall not limit the type of setting where services are provided for the patient or by the health care provider before payment is made for the covered services appropriately provided by telehealth, subject to the terms and conditions of the contract between the policyholder or contractholder and the insurer, and between the insurer and its participating providers or provider groups, and pursuant to Section 10123.855.(e) Notwithstanding any other law, this section does not authorize a health insurer to require the use of telehealth if the health care provider has determined that it is not appropriate.(Amended by Stats. 2019, Ch. 867, Sec. 4. (AB 744) Effective January 1, 2020.)
CA Ins Code § 10123.865 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 1 - The Contract|ARTICLE 1 - General Provisions|Section 10123.865.

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 the policy.(b) For purposes of this section, “maternity services” include prenatal care, ambulatory care maternity services, involuntary complications of pregnancy, neonatal care, and inpatient hospital maternity care, including labor and delivery and postpartum care. This definition of “maternity services” shall remain in effect until the time as federal regulations and guidance issued pursuant to the federal Patient Protection and Affordable Care Act (Public Law 111-148) define the scope of benefits to be provided under the maternity benefit requirement of that act, after which time the definition of that term under the federal act and associated regulations and guidance shall apply for purposes of this section.(c) This section shall not apply to specialized health insurance, Medicare supplement insurance, CHAMPUS supplement insurance, or TRI-CARE supplement insurance, or to hospital indemnity, accident-only, or specified disease insurance.(Amended by Stats. 2018, Ch. 687, Sec. 7. (SB 910) Effective January 1, 2019.)
CA Ins Code § 10123.866 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 1 - The Contract|ARTICLE 1 - General Provisions|Section 10123.866.

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 policy.(b) For purposes of this section, “maternity services” include prenatal care, ambulatory care maternity services, involuntary complications of pregnancy, neonatal care, and inpatient hospital maternity care, including labor and delivery and postpartum care. This definition of “maternity services” shall remain in effect until the time as federal regulations and guidance issued pursuant to the federal Patient Protection and Affordable Care Act (Public Law 111-148) define the scope of benefits to be provided under the maternity benefit requirement of that act, after which time the definition of that term under the federal act and associated regulations and guidance shall apply for purposes of this section.(c) This section shall not apply to specialized health insurance, Medicare supplement insurance, CHAMPUS supplement insurance, or TRI-CARE supplement insurance, or to hospital indemnity, accident-only, or specified disease insurance.(Amended by Stats. 2018, Ch. 687, Sec. 8. (SB 910) Effective January 1, 2019.)
CA Ins Code § 10123.867 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 1 - The Contract|ARTICLE 1 - General Provisions|Section 10123.867.

10123.867.  (a) By July 1, 2019, a health insurer shall develop a maternal mental health program designed to promote quality and cost-effective outcomes. The program shall be developed consistent with sound clinical principles and processes. The program guidelines and criteria shall be made available upon request to medical providers, including a contracting obstetric provider.(b) For the purposes of this section, the following terms have the following meanings:(1) “Contracting obstetric provider” means an individual who is certified or licensed pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code, or an initiative act referred to in that division, and who is contracted with the insured’s health insurer to provide services under the insured’s health insurance policy.(2) “Maternal mental health” means a mental health condition that occurs during pregnancy or during the postpartum period and includes, but is not limited to, postpartum depression.(c) This section shall not apply to specialized health insurers, except behavioral health-only insurers that provide coverage for professional mental health services.(Added by Stats. 2018, Ch. 755, Sec. 3. (AB 2193) Effective January 1, 2019.)