reglab/statecodes huggingface dataset:
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1 - Document Submission and Approval Procedures; Fees › Section 2214 - Rate Schedules

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Where the rates to be used with a submitted document are required to be filed
				  or approved, they shall be included with the initial submission of the
				  document. The Commissioner will charge a separate fee for action on a rate
				  schedule.
(b) An insurer submitting
				  a revision of previously filed or approved rate schedules shall also submit a
				  cover letter that specifies:
(1) The nature
				  of the revision relative to the previously filed or approved rate schedules,
				  including whether it will result in increases in premiums charged to existing
				  insureds;
(2) The date of filing or
				  approval of the rate schedule being revised; and,
(3) The form numbers and approval dates of
				  the forms with which the revised rates are to be used.
(4) The Commissioner reserves the right to
				  request additional information concerning revised rate
				  schedules.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1 - Document Submission and Approval Procedures; Fees › Section 2215 - Classifications of Risks

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Classifications of risks which must be filed with the
					 Commissioner may either be included with a document with which they are to be
					 used or may be submitted separately. Once a classification of risks has been
					 filed, it may be used with any appropriate documents filed or approved before
					 or after its date of filing by the Commissioner.
1.
					 Incorporation of former section
					 2215 into section
					 2216 and renumbering of former
					 section 2214 to section
					 2215, including repealer and new
					 NOTE filed 2-11-97; operative 3-13-97 (Register 97, No. 7).
2.
					 Amendment of NOTE filed 2-4-2016; operative 4-1-2016 (Register 2016, No.
					 6).
Note: Authority cited: Sections
						742.43,
						779.21,
						10192.3,
						10234,
						10327,
						10704,
						12921.6 and
						12973.9,
						Insurance Code. Reference: Sections
						742.42,
						779.8,
						795.5,
						1320,
						10112.5,
						10113.95(c),
						10123.36,
						10123.135,
						10123.137(d),
						10133.5,
						10181.3,
						10192.13(a)(7),
						10192.14(b)(1),
						10192.15,
						10198.61,
						10231.2,
						10231.6,
						10232,
						10236.11,
						10236.13,
						10270.93,
						10271,
						10271.1,
						10290,
						10292,
						10295.2,
						10436,
						10705,
						10717,
						10753.05,
						10753.17,
						12921.6 and
						12973.9,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1 - Document Submission and Approval Procedures; Fees › Section 2218 - Workers' Compensation Forms and Rates

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Workers' compensation policy forms,
				  endorsement forms, or ancillary agreements that are submitted to the Insurance
				  Commissioner are excluded from the requirements of Sections
				  2204,
				  2205,
				  2216 and
				  2217 of these regulations.
				  Sections 2250 et seq. govern the
				  submission, approval and use of workers' compensation policy forms, endorsement
				  forms, ancillary agreements, and notices.
(b) Workers' compensation rates shall be
				  filed as provided in Sections
				  2509.30 et seq. of this
				  chapter.
1. Amendment
					 filed 1-21-81; effective thirtieth day thereafter (Register 81, No.
					 4).
2. Amendment filed 12-30-83; designated effective 1-1-84
					 pursuant to Government Code Section
					 11346.2
					 (d) (Register 84, No. 1).
3.
					 Amendment of section heading and section and repealer and new NOTE filed
					 2-11-97; operative 3-13-97 (Register 97, No. 7).
4. Repealer and new
					 subsection (a) and amendment of subsection (b) and NOTE filed 2-2-2016;
					 operative 4-1-2016 (Register 2016, No. 6).
5. Amendment of NOTE
					 filed 2-4-2016; operative 4-1-2016 (Register 2016, No.
					 6).
Note: Authority cited: Section
						12921(a),
						Insurance Code. Reference: Sections
						11650,
						11651,
						11652,
						11653,
						11654,
						11655,
						11656,
						11656.7,
						11656.8,
						11656.9,
						11657,
						11658,
						11659,
						11660,
						11661,
						11661.5,
						11661.6,
						11662,
						11663,
						11664,
						11734,
						11736 and
						11751.5,
						Insurance Code; and Section
						2509.30 et seq., California Code
						of Regulations, Title 10.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1 - Document Submission and Approval Procedures; Fees › Section 2218.1 - Effective Date. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Amendment
					 of section and repealer and new NOTE filed 2-11-97; operative 3-13-97 (Register
					 97, No. 7).
2. Repealer filed 2-2-2016; operative 4-1-2016 (Register
					 2016, No. 6).
Note: Authority cited: Sections
						742.43,
						779.21,
						9080.1,
						10163.3,
						10195.1,
						10234,
						10327,
						10489.93,
						10506,
						10704,
						11027,
						11029,
						11066,
						11069,
						11521.5,
						11658,
						12250 and
						12973.9,
						Insurance Code. Reference: Sections
						742.42,
						779.8,
						795.5,
						1320,
						9080.1,
						10112.5,
						10163.3,
						10195.1,
						10195.45,
						10195.65,
						10205,
						10225,
						10231.6,
						10232,
						10270,
						10270.1,
						10270.2,
						10270.3,
						10270.5,
						10270.507,
						10270.57,
						10270.9,
						10270.93,
						10290,
						10292,
						10436,
						10489.93,
						10506,
						10705,
						10717,
						11027,
						11029,
						11066,
						11069,
						11522,
						11658 and
						12250,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1 - Document Submission and Approval Procedures; Fees › Section 2218.2 - Authority; Purpose; Application

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) This regulation is promulgated under the
				  authority granted to the Commissioner in Section
				  10191 of
				  the Insurance Code. Its purpose is to establish and maintain a procedure for
				  the filing and approval of group and blanket life and disability documents
				  written by admitted insurers or non-profit hospital service plans in California
				  pursuant to the provisions of Section
				  10191, in lieu of the requirements
				  for the submission, filing or approval of such documents otherwise set forth in
				  the Insurance Code.
(b) This
				  regulation is applicable to all insurers and non-profit hospital service plans
				  authorized to transact life or disability business in California and to all
				  group and blanket life and disability documents to be issued or delivered in
				  California, excepting certificates and other documents used under policies
				  validly authorized and issued in other jurisdictions and other documents
				  specifically excepted herein or by statute. All documents subject to this
				  regulation will be filed in accord with this regulation after its effective
				  date.
1. New
					 Sections 2218.2 through
					 2218.10 filed 4-27-70; designated
					 effective 7-1-70 (Register 70, No. 18).
Note: Authority cited for Sections
						2218.2 through
						2218.10; Section
						10191,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1 - Document Submission and Approval Procedures; Fees › Section 2218.3 - Prior Inconsistent Regulation Superseded. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Repealer
					 filed 2-11-97; operative 3-13-97 (Register 97, No.
					 7).
Note: Authority cited: Sections
						742.43,
						779.21,
						10195.1,
						10234,
						10327,
						10506 and
						10704,
						Insurance Code. Reference: Sections
						742.42,
						779.8,
						1320,
						10112.5,
						10195.1,
						10195.45,
						10195.65,
						10205,
						10225,
						10231.6,
						10232,
						10270,
						10270.1,
						10270.2,
						10270.3,
						10270.5,
						10270.507,
						10270.57,
						10270.9,
						10270.93,
						10290,
						10292,
						10436,
						10506,
						10705,
						10717,
						11066 and
						11069,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1 - Document Submission and Approval Procedures; Fees › Section 2218.4 - Insurer's Responsibility to Comply

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Approval under Section
					 10191 is in lieu of prior
					 substantive review and does not constitute prior text approval except to the
					 extent that certain language may be described or defined in any document
					 guidelines adopted by the Department. It is the responsibility of the insurer
					 to effect compliance with all applicable statutory provisions, regulations, and
					 any guidelines adopted by the Department.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1 - Document Submission and Approval Procedures; Fees › Section 2218.5 - Filing Procedure; Approvals; Disapprovals

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) All submissions are to include:
(1) A cover letter complying with §
											2205.
(2) A Document Submission Formset complying
				  with §
											2216 and one copy of all relevant
				  Certificates of Compliance set forth in Section
				  2218.9 below. When a submission
				  does not contain a policy, one or more documents may be submitted under one
				  Certificate of Compliance and the Document Submission Formset shall indicate
				  the policy forms or category of forms with which each document will be used,
				  and the Certificate shall be marked to indicate which affirmations are relevant
				  to which document. When a submission contains a policy, only that policy and
				  its related forms may be included.
(3) One copy of the submitted forms if the
				  documents do not vary from applicable statutes or regulations, or two copies if
				  there are any substantive variations. All such variations are to be clearly
				  marked or indicated on both copies and where not inconsistent with this
				  regulation shall be filed in conformity with Sections
				  2200-2217.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1 - Document Submission and Approval Procedures; Fees › Section 2218.6 - Subsequent Review of Approved Forms

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Documents which are returned to the insurer by the
					 Department as approved and filed for use under Section
					 10191, as provided in Section
					 2218.5 (b)(1) of
					 this regulation, may be subsequently reviewed by the Insurance Commissioner
					 when the Insurance Commissioner deems necessary. The review by the Commissioner
					 shall be based upon the guidelines in effect on the date the document was
					 filed.
1. Change
					 without regulatory effect amending section filed 7-14-2021 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2021, No. 29). Filing deadline specified in Government
					 Code section
					 11349.3(a)
					 extended 60 calendar days pursuant to Executive Order
					 N-40-20.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1 - Document Submission and Approval Procedures; Fees › Section 2218.7 - Guidelines; Adoption by Commissioner

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
To facilitate compliance with this regulation, the
					 Commissioner will adopt which the initial guidelines were developed appropriate
					 guidelines. The guidelines will be periodically brought to date by appropriate
					 revisions, and such revisions will be developed in the same manner in which the
					 initial guidelines were developed.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1 - Document Submission and Approval Procedures; Fees › Section 2218.8 - Submission Forms

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
All documents submitted under this regulation shall be
					 accompanied by a Document Submission form and the appropriate Certificate or
					 Certificates of Compliance. In the event a document applies to both group life
					 and group disability, it shall be accompanied by a Group Life Certificate of
					 Compliance and a Group Disability Certificate of Compliance. Such Certificates
					 shall use 8-point or larger type sizes.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1 - Document Submission and Approval Procedures; Fees › Section 2218.9 - Document Submission Forms and Certificates of Compliance

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Specimen copies of the following forms are available from
					 the Legal Division of the Department of Insurance. Submitters are responsible
					 for obtaining their own supplies of such forms.
Document Submission Formset
Group Life Certificate of Compliance
Group Disability Certificate of Compliance
Blanket life Certificate of Compliance
Blanket Disability Certificate of Compliance
Tuition Refund Certificate of Compliance
1. Repealer
					 and new section filed 1-9-86; designated effective 2-2-86 pursuant to
					 Government Code Section
					 11346.2(d)
					 (Register 86, No. 2).
Note: Authority cited: Sections
						779.21,
						10191,
						10506 and
						10507.4,
						Insurance Code. Reference: Sections
						779.8,
						779.13,
						10205,
						10205.5,
						10205.6,
						10225,
						10270.1,
						10270.2,
						10270.3,
						10270.5,
						10270.57,
						10270.9,
						10270.91,
						10270.92,
						10270.93,
						10290,
						10292,
						10506,
						10507.2,
						11066,
						11069,
						11512.4,
						11513,
						11513.1,
						11513.2,
						11515 and
						11658,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1 - Document Submission and Approval Procedures; Fees › Section 2218.10 - Forms Requiring Prior Substantive Review

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) This regulation shall control the filing
				  of all group and blanket life and group disability insurance documents required
				  by law to be filed by the Sections cited in Ins. C. §
										10191 except the following which
				  must submitted for prior substantive review in accord with contemporary
				  Department standards:
(1) Document filings
				  involving concepts of insurance or types of coverage which may be considered as
				  uncommon or unusual and which are not encompassed in any form of the insurer
				  authorized by this Department at the time of the said filing, nor in any form
				  filed in this State from which the submitted form has been copied.
(2) Documents proposed for use in transacting
				  either group life, group disability, blanket life insurance in California,
				  where the submitting insurer has not been:
(A) admitted to transact the relevant classes
				  of business in California, and
(B)
				  actively transacting the type of insurance in question in California for three
				  years prior to the date of the submission, unless and until such prior
				  substantive review is expressly waived by the Commissioner in
				  writing.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.2 - Prescription Drug Prior Authorization or Step Therapy Exception Requests › Section 2218.30 - Prescription Drug Prior Authorization or Step Therapy Exception Requests; Form and Procedure

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Definitions. The following definitions shall apply to this section:
(1) "Request Form" means the Prescription
				  Drug Prior Authorization or Step Therapy Exception Request Form set forth in
				  subdivision (k) of this section or an electronic prior authorization system
				  utilizing the standard form described in subdivision (c).
(2) "Material information" means information
				  that is:
(A) related to the patient's clinical
				  condition sufficient to enable an individual with the appropriate training and
				  experience to determine whether the prescription authorization or step therapy
				  exception request should be approved or disapproved; or
(B) required by state or federal law for
				  dispensing restricted prescription drugs.
(3) "Exigent circumstances" exist when an
				  enrollee is suffering from a health condition that may seriously jeopardize the
				  enrollee's life, health, or ability to regain maximum function or when an
				  enrollee is undergoing a current course of treatment using a nonformulary
				  drug.
(4) "Step therapy exception"
				  is the exception to the step therapy process and the determination of whether
				  the exception shall be granted, taking into consideration the enrollee's needs
				  and medical circumstances, along with the professional judgment of the
				  enrollee's provider.
(5)
				  "Electronic I.D. Verification" is a unique identification number that clearly
				  identifies the prescribing provider on the Prescription Drug Prior
				  Authorization or Step Therapy Exception Request Form to allow verification of
				  the prescriber by the health plan or pharmacy benefit
				  manager.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.3 - Mandated Benefits Analysis Regulations › Section 2218.60 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The term
				  "health insurer" means any disability insurer that issues a policy of "health
				  insurance" as defined in California Insurance Code Section
				  106.
(b) The term "number of covered lives" means
				  the sum of all named insureds and all covered dependents insured by a health
				  insurer.
(c) The term "percent to
				  total ratio" means the total number of covered lives insured by a health
				  insurer in the state of California divided by the total number of covered lives
				  insured by all health insurers in the state of California.
(d) The term "total need" means the dollar
				  amount the Department of Insurance has determined that it is responsible for
				  and has stipulated in order to fund the University of California study of
				  mandated benefits required by California Health and Safety Code Section
				  127760.
				  The dollar amount of the "total need" shall be calculated in the manner
				  described in 2218.61(b).
1. New
					 article 1.3 (sections
					 2218.60-2218.63) and section filed
					 4-1-2005; operative 5-1-2005 (Register 2005, No.
					 13).
Note: Authority cited: Sections
						127662
						and
						127664,
						Health and Safety Code; and Sections
						12921 and
						12926,
						Insurance Code. Reference: Section
						106,
						Insurance Code; and Sections
						127660,
						127661,
						127662,
						127663
						and
						127664,
						Health and Safety Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.3 - Mandated Benefits Analysis Regulations › Section 2218.61 - Assessment of Fee

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each
				  health insurer shall be assessed, and shall pay, a fee in an amount determined
				  by the formula set forth in Section
				  2218.62 for each policy written in
				  California for insurance or group disability insurance that provides coverage
				  for hospital, medical, or surgical benefits; however, health insurance
				  described in Health & Safety Code Section
				  127662(c)(4)
				  shall not be subject to any assessment by the Commissioner.
(b) The dollar amount of total need shall be
				  determined by the Department of Insurance and the Department of Managed Care in
				  consultation with the University of California and shall be limited to the
				  amount necessary to fund the actual and necessary expenses of the university
				  and its work in implementing Health and Safety Code Section
				  127660.
				  The total amount of assessment on health insurers and health care service plans
				  when combined together shall not exceed two million dollars ($2,000,000.00)
				  annually. The total annual assessment of health insurers shall not exceed 12.4%
				  of the total annual assessment of health insurers and health care services
				  plans combined.
(c) The
				  Commissioner shall calculate and levy an assessment of all health insurers
				  equal to the appropriation contained in the State Budget for the administrative
				  and operational costs arising from the provisions of Chapter 7 (commencing with
				  Section 127660), Part 2 of Division 107 of
				  the Health and Safety Code plus or minus such amounts as the Commissioner deems
				  necessary as a contingency against unanticipated fluctuations in expenditures
				  and revenues and plus or minus such amounts as the Commissioner deems necessary
				  to correct for over-collections or under-collections in prior years.
(d) The Commissioner may adjust the amount
				  set forth in (b) above as necessary to minimize costs by excluding assessment
				  amounts that are too small to justify the cost of such assessment and
				  collection or if such assessment or collection is impractical.
1. New
					 section filed 4-1-2005; operative 5-1-2005 (Register 2005, No.
					 13).
Note: Authority cited: Sections
						127662
						and
						127664,
						Health and Safety Code; and Sections
						12921 and
						12926,
						Insurance Code. Reference: Section
						106,
						Insurance Code; and Sections
						127660,
						127661,
						127662,
						127663
						and
						127664,
						Health and Safety Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.3 - Mandated Benefits Analysis Regulations › Section 2218.62 - Formula for Calculating Fee

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The formula for calculating the fee
				  assessed from each health insurer set forth pursuant to 2218.61 shall be based
				  on the number of covered lives insured by a health insurer in the calendar year
				  preceding the first day of the fiscal year in which the assessment is made,
				  calculated by annual statement line of insurance.
(b) The formula for calculating the fee as
				  described in Section
				  2218.61 is as follows: The
				  aggregate of all covered lives insured by an insurer will be used to determine
				  a percent-to-total ratio for each insurer. This ratio will be multiplied by the
				  total need as defined in Section
				  2218.60(d) to
				  calculate the amount of the fee to be assessed to each insurer.
1. New
					 section filed 4-1-2005; operative 5-1-2005 (Register 2005, No.
					 13).
Note: Authority cited: Sections
						127662
						and
						127664,
						Health and Safety Code; and Sections
						12921 and
						12926,
						Insurance Code. Reference: Section
						106,
						Insurance Code; and Sections
						127660,
						127661,
						127662,
						127663
						and
						127664,
						Health and Safety Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.3 - Mandated Benefits Analysis Regulations › Section 2218.63 - Issuance of Invoice and Disposition of Assessment Proceeds

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Department of Insurance shall issue
				  an invoice to each health insurer setting forth the amount of the assessment
				  owed. The invoice shall be issued no later than the fifteenth day of June for
				  any assessment.
(b) The invoice
				  described in Section
				  2218.63(a) shall
				  assess a fee calculated in the manner described in 2218.62 from each health
				  insurer for the Fiscal Years 2006-07, 2007-08, 2008-09 and 2009-10.
(c) Any amount set forth in the invoice
				  described in 2218.63(a) shall be due and payable upon receipt and shall be
				  considered delinquent if the total amount invoiced is not received within 45
				  days of the date that the invoice is issued.
(d) Fees assessed and collected pursuant to
				  this section shall be deposited in the Health Care Benefits Fund for the sole
				  purpose of collecting and disbursing funds for the administrative and
				  operational costs arising from the provisions of Chapter 7 (commencing with
				  Section 127660), Part 2 of Division 107 of
				  the Health and Safety Code.
1. New
					 section filed 4-1-2005; operative 5-1-2005 (Register 2005, No.
					 13).
2. Amendment of subsection (b) filed 10-10-2007; operative
					 11-9-2007 (Register 2007, No. 41).
Note: Authority cited: Sections
						127662
						and
						127664,
						Health and Safety Code; and Sections
						12921 and
						12926,
						Insurance Code. Reference: Section
						106,
						Insurance Code; and Sections
						127660,
						127661,
						127662,
						127663
						and
						127664,
						Health and Safety Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.4 - Standard Prescription Drug Formulary Template › Section 2218.80 - Scope of Article

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Pursuant to section
					 10123.192
					 of the Insurance Code, this article applies to a health insurer that provides
					 prescription drug benefits and maintains one or more prescription drug
					 formularies. This article establishes minimum standards for a prescription drug
					 formulary that is maintained by a health insurer. A health insurer may
					 implement additional provisions in a prescription drug formulary that exceed
					 these standards.
1. New
					 article 1.4 (sections
					 2218.80-2218.83) and section filed
					 8-31-2018; operative 10-1-2018 (Register 2018, No. 35).
2. Change
					 without regulatory effect amending NOTE filed 8-18-2023 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2023, No. 33).
Note: Authority cited: Section
						10123.192,
						Insurance Code. Reference: Sections
						10123.192,
						10123.193,
						10123.1932
						and
						10123.201,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.4 - Standard Prescription Drug Formulary Template › Section 2218.82 - Standard Prescription Drug Formulary Template

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Structure and content. A formulary shall
				  be maintained in a format that is text searchable and shall include all of the
				  following sections in the order listed:
(1)
				  Title page.
(2) Table of
				  contents.
(3) Informational
				  section.
(4) Categorical list of
				  prescription drugs.
(5)
				  Alphabetical index of prescription drugs.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.4 - Standard Prescription Drug Formulary Template › Section 2218.83 - Review by the Commissioner

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
No later than six months following the date this article is
					 adopted, a health insurer that maintains prescription drug formularies shall
					 submit all prescription drug formularies for health insurance products in which
					 it has covered lives enrolled in the state of California to the commissioner
					 for review for compliance with this article. Following review, a health insurer
					 shall not implement any provisions in its prescription drug formularies that
					 the commissioner has determined are inconsistent with this article or other
					 applicable law.
1. New
					 section filed 8-31-2018; operative 10-1-2018 (Register 2018, No.
					 35).
Note: Authority cited: Sections
						10123.192
						and
						10123.201,
						Insurance Code. Reference: Section
						10123.192,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code › Section 2219 - Purpose and Scope

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Insurance Code Section
					 10290
					 requires all individual disability policy forms must be submitted to the
					 Insurance Commissioner for approval. The provisions of this Article, as
					 specified, are applicable to all such disability policy forms submitted to the
					 Insurance Commissioner for approval on and after January 1, 1973. Subdivision
					 (c) of Section
					 10291.6,
					 Insurance Code, provides that the Insurance Commissioner may promulgate rules
					 establishing certain standards, conforming to the provisions of Subdivision (b)
					 of said Section
					 10291.5, by
					 which individual disability policies will be disapproved or approval thereof
					 withdrawn, other than as provided in Subdivision (j) of Insurance Code Section
					 10291.5. This Article contains
					 some standards of that nature, but such standards herein are limited to
					 standards conforming to the provisions of Paragraph (7) of said Subdivision (b)
					 by which such policies will be disapproved or approval thereof withdrawn. Such
					 standards cannot anticipate all insurance benefits which may be contained in
					 policies hereafter submitted for approval. Promulgation of these rules does not
					 limit the responsibility of the Commissioner, imposed upon the Commissioner by
					 law, in respect to all such policy forms, to approve, disapprove or withdraw
					 approval of policy forms in accordance with all applicable statutes and
					 regulations.
Filing deadline specified in Government Code section
					 11349.3(a)
					 extended 60 calendar days pursuant to Executive Order
					 N-40-20.
1. New
					 Article 1.5 (2219, 2220, 2220.1 to 2220.26, inclusive) filed 10-25-50;
					 effective thirtieth day thereafter (Register 22, No. 2).
2. Repealer
					 of Article 1.5 and new Article 1.5 (2219, 2220, 2220.1 through 2220.31 filed
					 11-3-72; effective thirtieth day thereafter (Register 72, No.
					 45).
3. Change without regulatory effect amending section filed
					 7-14-2021 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2021, No. 29).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code › Subarticle 1 - Definitions › Section 2220 - Terms Defined

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
As used in this article the words and phrases defined in
						Sections 2220.1 to
						2220.6 have the meanings set forth
						therein.
1. Change
						without regulatory effect adopting subarticle 1 heading and removing subject
						heading filed 7-14-2021 pursuant to section
						100, title 1, California Code of
						Regulations (Register 2021, No. 29). Filing deadline specified in Government
						Code section
						11349.3(a)
						extended 60 calendar days pursuant to Executive Order
						N-40-20.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code › Subarticle 1 - Definitions › Section 2220.1 - Policy

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) "Disability
					 policy" or "policy" or "policy form" includes all of the following except when
					 issued to:
(1) supplement Medicare (Health
					 Insurance for the Aged Act, Social Security Amendments of 1965, as amended)
					 other than to the extent specified in this Article; or
(2) to supplement other governmental
					 programs; or
(3) when issued as
					 credit disability insurance written in accordance with the provisions of
					 Article 5.9, Division 1, Part 2 of the Insurance Code; or
(4) when issued as mortgage disability
					 insurance; or
(5) when issued as a
					 conversion policy when group coverage (either insured or noninsured) is
					 terminated, or when issued in accordance with a conversion privilege specified
					 in any in-force individual policy:
(1) A
					 policy of disability insurance insuring only one person;
(2) A policy of family disability insurance
					 as defines in either Insurance Code Section
					 10270.7 or
					 10320(c);
(3) A policy of disability insurance issued
					 on a selected group basis pursuant to Insurance Code Section
					 10270.97;
					 and
(4) Any rider or other document
					 or endorsement attached or to be attached, as a part thereof, to any policy
					 described in (1), (2) or (3) above.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code › Subarticle 1 - Definitions › Section 2220.2 - Industrial Insurance

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Industrial Insurance" means that form of disability
						insurance embodied in a disability policy which is issued on an industrial
						debit basis and which provides, at issue, either:
(a) that premiums are payable weekly,
					 or
(b) that premiums are payable
					 monthly at a rate not greater than $15.00 per person insured per month.
It shall be presumed for the purposes of this Article
						that a policy will not be issued on an industrial debit basis unless:
(1) The words "Industrial Policy" are printed
					 upon the policy as a part of the descriptive matter, or
(2) When submitted to the Commissioner, it is
					 accompanied by a written certificate, over the signature of an executive
					 officer of the company, to the effect that such policy will be issued on such
					 basis only.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code › Subarticle 1 - Definitions › Section 2220.3 - Waiting Period

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Waiting period" means the period of time specified in a
						policy which must follow the issue, or reinstatement, date of the policy in
						respect to a particular insured person before the coverage or coverages of the
						policy become effective as to such insured person.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code › Subarticle 1 - Definitions › Section 2220.4 - Elimination Period

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Elimination period" means the initial period of time,
						during the continuance of a continuance insured against and specified in
						respect to a particular benefit, for which such benefit will not be
						paid.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code › Subarticle 1 - Definitions › Section 2220.5 - Dismemberments

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Double dismemberment" means dismemberment described and
						defined in Insurance Code Section
						10291.5 (b) (8)
						(i); and "single dismemberment" means loss of
						one only of any of the members described in such Code
						Section.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code › Subarticle 1 - Definitions › Section 2220.6 - Time and Amount Equivalents

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Periods of time or dollar amounts defining standards in
						this Article may also be expressed in rounded equivalents. For example, the
						following, respectively illustrate equivalent periods of time:
(1) One month, four weeks and thirty
					 days.
(2) Three months, thirteen
					 weeks and ninety days.
(3) Twelve
					 months, one year and three hundred sixty days.The following, respectively,
					 illustrate equivalent dollar amounts:
(1)
					 "$100 per month" and "$25 per week."
(2) "$300 (or $280) per month" and "$70 per
					 week" and "$10 per day."
A benefit payable as long as the insured shall live and
						remain disabled shall be deemed to be payable for a period of time not less
						than any period of time specified in the standards contained in this
						Article.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code › Subarticle 2 - Standards › Section 2220.7 - Effect of Standards

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Any policy containing a type of coverage which, under the
						provisions of Sections
						2220.8 to
						2220.30, inclusive, shall be
						deemed not sufficient to be of real economic value to insureds shall be
						disapproved by the Commissioner unless it is specifically demonstrated to the
						Commissioner in writing to the Commissioner's satisfaction that such coverage
						will be of real economic value to insureds under the special circumstances of
						issuance, in which case the Commissioner shall approve issuance of such
						policies only in such special circumstances. This section shall be liberally
						construed to permit experimentation and adaptation to economic or social
						changes, which the Commissioner hereby declares to be in the public
						interest.
1. Change
						without regulatory effect adopting subarticle 2 heading, removing subject
						heading and amending section filed 7-14-2021 pursuant to section
						100, title 1, California Code of
						Regulations (Register 2021, No. 29). Filing deadline specified in Government
						Code section
						11349.3(a)
						extended 60 calendar days pursuant to Executive Order
						N-40-20.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code › Subarticle 2 - Standards › Section 2220.9 - Authority of Insurance Commissioner to Approve Other Exceptions, Limitations and Reductions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The provisions of Section
						2220.8 shall not be deemed to
						prohibit the Insurance Commissioner from approving the subject matter of other
						exceptions, limitations and reductions under the procedure specified in Section
						2220.7 when the insurer
						demonstrates to the satisfaction of the Commissioner the need and the
						reasonable scope of the exception, limitation or reduction in writing to the
						Commissioner.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code › Subarticle 2 - Standards › Section 2220.10 - Waiting Periods

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A sickness benefit shall be deemed not sufficient to be
						of real economic value to a covered person if one or more coverages become
						effective more than 30 days after the effective date of the policy or rider or
						is subject to a waiting period greater than:
(a) Ten months for pregnancy, childbirth or
					 miscarriage; or when the waiting period is expressed in terms of the inception
					 of the pregnancy, 30 days after the effective date of the policy or rider;
					 or
(b) Six months for hernia;
					 disorder of the reproductive organs; tuberculosis; cancer; tumors; varicose
					 veins; adenoids; appendix; tonsils; gallbladder; rectum; thyroid gland, and
					 diseases of the heart; and
(c)
					 Twelve months for organ transplant, cosmetic surgery or dental
					 insurance.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code › Subarticle 2 - Standards › Section 2220.11 - Loss-of-Time Generally

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A loss-of-time benefit provided by a policy shall be
						deemed not sufficient to be of real economic value to the insured if:
(a) Its amount is less than:
(1) $100 per month payable at ages up to 62
					 and $50 per month payable at ages after 62; except
(2) In the case of industrial insurance or
					 insurance issued to cover persons not gainfully employed, if its amount is less
					 than $60 per month payable at ages up to 62 and $30 per month payable after age
					 62; or
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code › Subarticle 2 - Standards › Section 2220.12 - Partial Disability

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Section
						2220.11 shall not be applicable to
						a loss-of-time benefit for partial disability which complies with Subsections
						(b) (2) and (3) of Insurance Code Section
						10291.5,
						irrespective of the amount of the partial disability benefit or the length of
						time for which is payable, when contained in a policy providing loss-of-time
						coverage otherwise complying with Section
						2220.11.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code › Subarticle 3 - Dismemberment and Accidental Death Benefits › Section 2220.13 - Accidental Death Amounts

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A benefit for accidental death shall be deemed not
						sufficient to be of real economic value to the insured if its amount is less
						than $1000.
1. Change
						without regulatory effect adopting subarticle 3 heading and removing subject
						heading filed 7-14-2021 pursuant to section
						100, title 1, California Code of
						Regulations (Register 2021, No. 29). Filing deadline specified in Government
						Code section
						11349.3(a)
						extended 60 calendar days pursuant to Executive Order
						N-40-20.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code › Subarticle 3 - Dismemberment and Accidental Death Benefits › Section 2220.14 - Dismemberment Amounts

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A benefit for dismemberment regardless of whether
						resulting from accident or sickness [excluding any such benefit for which an
						amount is determined in accordance with the provisions of Insurance Code
						Section
						10291.5 (b)
						(8)] shall be deemed not sufficient to be of
						real economic value to the insured if:
(a) When a double dismemberment, its amount
					 is less than $1000; and
(b) When a
					 single dismemberment, its amount is less than $500.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code › Subarticle 4 - Basic Medical Benefits › Section 2220.15 - Basic Hospital Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A
					 hospital benefit, other than a benefit described in Sections
					 2220.17 or
					 2226.20, shall be deemed not
					 sufficient to be of real economic value to the insured if:
(1) The amount of the daily hospital benefit
					 for each covered confined person (provided on either an expense incurred basis
					 or on other than an expense incurred basis) is less than $30.00 per day
					 provided, however, that a policy may provide benefits on an expense incurred
					 basis up to that amount; or
(2) The
					 period the benefit is payable is less than 60 days; or
(3) The amount of the daily hospital benefit
					 for each covered confined person is less than $40.00 per day for the next 53
					 days; or
(4) The elimination
					 period, if any more than three days for sickness benefits and three days for
					 accident benefits.