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California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 12.9 - Life Settlements › Section 2548.21 - Notification/License Terms

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A
				  life producer who has complied with the procedure in Section
				  2548.20 herein will be granted a
				  two-year life settlement broker notification which will coincide with the terms
				  of his or her two-year life producer license. The license renewal date for the
				  life settlement broker notification is the same date as that of the
				  individual's life producer license;
(b) A life settlement broker who has complied
				  with the procedure in Section
				  2548.18 herein will have a
				  one-year license term. The license renewal date for this license is the last
				  day of the month in the year following the year of the license's
				  issuance.
(c) A life settlement
				  broker or a life producer who has notified the Commissioner that he or she is
				  brokering life settlements, who has not renewed on or before the applicable
				  renewal date expires, must discontinue transacting life settlements. To resume
				  brokering life settlements, such individuals must either re-apply or re-notify
				  the Commissioner as applicable per Section
				  2548.9.
1. New
					 section filed 7-29-2010 as an emergency; operative 7-29-2010. Emergency
					 regulation shall remain in effect, not to be repealed by the Office of
					 Administrative Law, unless repealed by the Department of Insurance pursuant to
					 Insurance Code section
					 10113.35
					 (Register 2010, No. 31).
2. Change without regulatory effect
					 amending NOTE filed 1-24-2012 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2012, No. 4).
3. Change without regulatory
					 effect amending subsections (a)-(d) and NOTE filed 7-3-2013 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2013, No. 27).
4. Change without regulatory
					 effect amending subsections (a)-(d) filed 8-14-2014 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2014, No. 33).
5. Renumbering of former
					 section 2548.21 to section
					 2548.22 and renumbering and
					 amendment of former section
					 2548.20 to new section
					 2548.21 filed 11-25-2014;
					 operative 1-1-2015 (Register 2014, No. 48).
Note: Authority cited: Section
						10113.35,
						Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989); 20th
						Century Ins. Co. v. Garamendi, 8 Cal. 4th 216 (1994). Reference: Section
						10113.2,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 12.9 - Life Settlements › Section 2548.22 - Fees

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An individual
				  or business entity applying for the life settlement broker license shall pay a
				  one-year license fee of $155.
(b)
				  An individual or business entity licensed as life insurance producer who
				  notifies the Commissioner that he or she is brokering life settlements shall
				  pay a two-year notification fee of $154.
(c) An individual or business entity licensed
				  as a life settlement broker shall pay a one-year renewal fee of $155.
(d) An individual or business entity licensed
				  as a life insurance producer who notifies the Commissioner that he or she is
				  brokering life settlements shall pay a two-year renewal fee of $154.
(e) No license application or notification
				  for which the Commissioner does not receive payment of the appropriate fee or
				  fees as specified in Section
				  2548.22 shall under any
				  circumstances be accepted for filing.
(f) An individual applying for the life
				  settlement broker license is responsible for paying to the Live Scan vendor
				  including the vendor's rolling fee and the criminal history processing fees
				  collected by the California Department of Justice and the Federal Bureau of
				  Investigation.
1. New
					 section filed 7-29-2010 as an emergency; operative 7-29-2010. Emergency
					 regulation shall remain in effect, not to be repealed by the Office of
					 Administrative Law, unless repealed by the Department of Insurance pursuant to
					 Insurance Code section
					 10113.35
					 (Register 2010, No. 31).
2. Change without regulatory effect
					 amending NOTE filed 1-24-2012 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2012, No. 4).
3. Renumbering of former section
					 2548.22 to section
					 2548.23 and renumbering and
					 amendment of former section
					 2548.21 to new section
					 2548.22 filed 11-25-2014;
					 operative 1-1-2015 (Register 2014, No. 48).
Note: Authority cited: Sections
						10113.35
						and
						12978,
						Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989); 20th
						Century Ins. Co. v. Garamendi, 8 Cal. 4th 216 (1994). Reference: Section
						10113.2,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 12.9 - Life Settlements › Section 2548.23 - Business Entity Application

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Any business entity acting as a life
				  settlement broker in California pursuant to Insurance Code section
				  10113.2(b)(1)
				  or
				  10113.2(b)(1)(D)(ii)
				  shall submit to the California Insurance Commissioner an application for a
				  license, by submitting the form referenced at Section
				  2548.24 herein. The Commissioner
				  shall have the authority to require an applicant to fully disclose the
				  identification of all stockholders who hold more than 10 percent of the shares
				  of the company, as well as all partners, directors, members, officers,
				  managers, controlling persons, or designated employees. The Commissioner may
				  refuse to issue a license to the business entity if the Commissioner is not
				  satisfied that any stockholder, partner, director, member, officer, manager,
				  controlling person, or designated employee meets the standards of Insurance
				  Code sections
				  10113.2(b)(1)
				  and
				  10113.2(b)(2).
(b) Business entities shall submit to the
				  Commissioner the form referenced at section
				  2548.25 ("Business Entity
				  Endorsement") that permits individually licensed life settlement brokers to
				  exercise the brokerage powers of the business entity. Upon the termination of
				  employment of any life settlement broker, business entities shall submit to the
				  Commissioner a notice that terminates these individuals' authority to exercise
				  the brokerage powers of the business entity on the form referenced at section
				  2548.26 herein ("Business Entity
				  Endorsement Termination").
1. New
					 section filed 7-29-2010 as an emergency; operative 7-29-2010. Emergency
					 regulation shall remain in effect, not to be repealed by the Office of
					 Administrative Law, unless repealed by the Department of Insurance pursuant to
					 Insurance Code section
					 10113.35
					 (Register 2010, No. 31).
2. Change without regulatory effect
					 amending NOTE filed 1-24-2012 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2012, No. 4).
3. Renumbering of former section
					 2548.23 to section
					 2548.24 and renumbering and
					 amendment of former section
					 2548.22 to new section
					 2548.23 filed 11-25-2014;
					 operative 1-1-2015 (Register 2014, No. 48).
Note: Authority cited: Section
						10113.35,
						Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989); 20th
						Century Ins. Co. v. Garamendi, 8 Cal. 4th 216 (1994). Reference: Sections
						10113.1 and
						10113.2,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 12.9 - Life Settlements › Section 2548.24 - Business Entity Application Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
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1. New
					 section filed 7-29-2010 as an emergency; operative 7-29-2010. Emergency
					 regulation shall remain in effect, not to be repealed by the Office of
					 Administrative Law, unless repealed by the Department of Insurance pursuant to
					 Insurance Code section
					 10113.35
					 (Register 2010, No. 31).
2. Change without regulatory effect
					 amending NOTE filed 1-24-2012 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2012, No. 4).
3. Change without regulatory
					 effect amending form and NOTE filed 7-3-2013 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2013, No. 27).
4. Change without regulatory
					 effect amending form filed 8-14-2014 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2014, No. 33).
5. Renumbering of former
					 section 2548.24 to section
					 2548.25 and renumbering and
					 amendment of former section
					 2548.23 to new section
					 2548.24 filed 11-25-2014;
					 operative 1-1-2015 (Register 2014, No. 48).
Note: Authority cited: Section
						10113.35,
						Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989); 20th
						Century Ins. Co. v. Garamendi, 8 Cal.4th 216 (1994). Reference: Sections
						10113.1 and
						10113.2,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 12.9 - Life Settlements › Section 2548.27 - Life Settlement Licensee Form Filings

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
State of California
Life Settlement Form Filing Cover Sheet California
					 Insurance Code, Section
					 10113.2(c)
Name of
					 Licensee:
______________________________
Provide the Following (choose all that
					 apply):
CA# or NAIC #
______________________________
License Number:
______________________________
FEIN Number:
______________________________
Application No.:
______________________________
Licensee is a:
[]
Life Settlement Provider
[]
Life Settlement Broker
[]
Life Producer Transacting Life Settlement
					 Business
___________________________
Description of Form(s) and any Identifying Form
					 Number(s):
___________________________
________________________________________________________________
Approximate Date Licensee will Commence Using
					 Form(s):
______________________________
Form Submitted by On Behalf of Licensee
______________________________
Name
______________________________
Title
______________________________
Phone Number
1. New
					 section filed 7-29-2010 as an emergency; operative 7-29-2010. Emergency
					 regulation shall remain in effect, not to be repealed by the Office of
					 Administrative Law, unless repealed by the Department of Insurance pursuant to
					 Insurance Code section
					 10113.35
					 (Register 2010, No. 31).
2. Change without regulatory effect
					 amending NOTE filed 1-24-2012 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2012, No. 4).
3. Renumbering of former section
					 2548.27 to section
					 2548.28 and renumbering of former
					 section 2548.26 to new section
					 2548.27 filed 11-25-2014;
					 operative 1-1-2015 (Register 2014, No. 48).
Note: Authority cited: Section
						10113.35,
						Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989); 20th
						Century Ins. Co. v. Garamendi, 8 Cal.4th 216 (1994). Reference: Section
						10113.2,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 12.9 - Life Settlements › Section 2548.30 - Life Settlement Provider Disclosure to Owner

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
State of California Department of Insurance Life
					 Settlement Provider Disclosure to Owner (To be provided prior to the execution
					 of the life settlement contract)
IMPORTANT: READ THIS DISCLOSURE FORM BEFORE SIGNING
					 ANY LIFE SETTLEMENT CONTRACT.
The Commissioner may consider any failure to provide
					 the disclosures in this form as a basis for suspending or revoking a provider's
					 license. You should carefully read all of the following points and seek
					 financial, insurance, tax and other advice where appropriate.
1. The name, business address, and telephone
				  number of the life settlement broker are as follows:
Broker's (printed) name:
					 ______________________________
Address: ______________________________
Telephone: ______________________________
2. Pursuant to California law, the policy
				  owner is entitled to the disclosure of the gross purchase price the life
				  settlement provider is paying for the policy, the amount of the purchase price
				  to be paid to the owner's life settlement broker, and the net amount of the
				  purchase price to be paid to the owner of the policy.
a. The
gross purchase price
(the
				  total amount or value paid by the provider for the purchase of the life
				  insurance policy, including all commissions and fees) paid by the life
				  settlement provider for the policy is $ __________.
b. The amount of the purchase price to be
				  paid to the owner's
life settlement broker
is: $
				  __________
c. The net amount of the
				  purchase price to be paid to the
owner
is: $ __________.
LIFE INSURANCE POLICY OWNER'S ACKNOWLEDGMENT: I have
					 read and fully understand this disclosure form and have received a copy to keep
					 for my records.
LIFE INSURANCE POLICY
							 OWNER
LIFE SETTLEMENT PROVIDER
By:
___________________________
By:
___________________________
Printed
							 Name:
___________________________
Printed
							 Name:
___________________________
Date:
___________________________
Date:
___________________________
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 13 - Exemption from Limitations on Cancellation and Nonrenewal of Coverage › Section 2550 - Exemptions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Insurance in
				  respect to any risk or class of risks described in (b) and (c) is exempt from
				  those provisions of Chapter 11, Part 1, Division 1, of the Insurance Code
				  (commencing with Section
				  675) other than Section
				  679.6.
(b) The exemption granted in (a) shall apply
				  to insurance (whether on an all-risks basis or a named perils basis) against
				  loss of or damage to personal property under scheduled or blanket personal
				  property floaters whether written separately or as a supplemental contract or
				  endorsement when the aggregate amount of insurance on the schedule or policy
				  exceeds $25,000 or when a single risk exceeds $5,000.
(c) The exemption granted in (a) shall apply
				  to all animal mortality policies.
1. New
					 Article 13 (Section
					 2550) filed 7-19-72; effective
					 thirtieth day thereafter (Register 72, No. 30).
Note: Authority cited: Section
						679.6,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 14 - Title Insurance › Section 2555 - Authority. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 Article 14 (Sections
					 2555-2556.2, not consecutive)
					 filed 3-29-74; designated effective 5-1-74 (Register 74, No. 13).
2.
					 Repealer of article 14 and repealer of section filed 7-26-2007; operative
					 11-23-2007 pursuant to Government Code section
					 11343.4(b)
					 (Register 2007, No. 30).
Note: Authority cited: Section
						12389,
						12401.5 and
						12414.21,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 14 - Title Insurance › Section 2555.1 - Purpose. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Repealer
					 filed 7-26-2007; operative 11-23-2007 pursuant to Government Code section
					 11343.4(b)
					 (Register 2007, No. 30).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 14 - Title Insurance › Section 2556 - Maintenance of Records. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Repealer
					 filed 7-26-2007; operative 11-23-2007 pursuant to Government Code section
					 11343.4(b)
					 (Register 2007, No. 30).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 14 - Title Insurance › Section 2556.1 - Filing of Rates and Reporting of Statistics. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Repealer
					 filed 7-26-2007; operative 11-23-2007 pursuant to Government Code section
					 11343.4(b)
					 (Register 2007, No. 30).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 14 - Title Insurance › Section 2556.2 - Rating Examinations. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Repealer
					 filed 7-26-2007; operative 11-23-2007 pursuant to Government Code section
					 11343.4(b)
					 (Register 2007, No. 30).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 15 - Discrimination on Account of Sex and/or Marital Status › Section 2560 - Authority

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
This Article is promulgated pursuant to the authority
					 granted to the Insurance Commissioner under the provisions of Section
					 790.10 of
					 the Insurance Code.
1. New
					 Article 15 (Sections
					 2560,
					 2560.1-2560.6) filed 12-2-75;
					 designated effective 1-1-75 (Register 75, No.
					 49).
Note: Authority cited: Section
						790.10,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 15 - Discrimination on Account of Sex and/or Marital Status › Section 2560.1 - Purpose

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The purpose of this Article is to eliminate unfair
					 discrimination based upon sex, marital status or sexual orientation in the
					 terms and conditions of insurance contracts and in the underwriting criteria of
					 insurance carriers.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 15 - Discrimination on Account of Sex and/or Marital Status › Section 2560.2 - Definition of Contract

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
For the purpose of this Article, the term "contract"
					 includes any insurance policy, plan, certificate, subscriber agreement,
					 statement of coverage, binder, rider or endorsement offered by any person or
					 entity engaged in the business of insurance in this State.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 15 - Discrimination on Account of Sex and/or Marital Status › Section 2560.4 - Remedy for Past Discriminations

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Any person who, prior to the effective date of this
					 Article, has been denied insurance coverage on the basis of sex, marital status
					 or sexual orientation may submit to the Commissioner, within one year following
					 the effective date of this Article, a complaint setting forth the details of
					 such denial to the best of such person's knowledge and belief. The Commissioner
					 shall investigate the facts set forth in such complaint and shall take such
					 action as he deems appropriate.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 15 - Discrimination on Account of Sex and/or Marital Status › Section 2560.5 - Severability Provision

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
If any provision of this Article or the application thereof
					 to any person or circumstance is for any reason held invalid, the remainder of
					 this Article and the application of such provision to any other persons or
					 circumstances shall not be affected thereby.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 15 - Discrimination on Account of Sex and/or Marital Status › Section 2560.6 - Effective Date

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
This Article shall be effective on January 1, 1976.
					 Provisions which are contained in group contracts in force on the effective
					 date of this Article and which are not in compliance with this Article may
					 continue in effect until no later than the renewal anniversaries of such
					 contracts next following the effective date of this Article.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 15.1 - Gender Nondiscrimination in Health Insurance › Section 2561.1 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The following terms have the following meanings as used in
					 this article.
(a) "Actual gender
				  identity" means a person's internal sense of being:
(1) male,
(2) female,
(3) a gender different from the gender
				  assigned to the person at birth,
(4) a transgender person, or
(5) neither male nor
				  female.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 15.1 - Gender Nondiscrimination in Health Insurance › Section 2561.2 - Discrimination on the Basis of Actual or Perceived Gender Identity

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An admitted
				  insurer shall not, in connection with health insurance as defined in
				  subdivision (b) of Insurance Code section
				  106,
				  discriminate on the basis of an insured's or prospective insured's actual or
				  perceived gender identity, or on the basis that the insured or prospective
				  insured is a transgender person. The discrimination prohibited by this Section
				  2561.2 includes any of the
				  following:
(1) Denying, cancelling, limiting
				  or refusing to issue or renew an insurance policy on the basis of an insured's
				  or prospective insured's actual or perceived gender identity, or for the reason
				  that the insured or prospective insured is a transgender person;
(2) Demanding or requiring a payment or
				  premium that is based in whole or in part on an insured's or prospective
				  insured's actual or perceived gender identity, or for the reason that the
				  insured or prospective insured is a transgender person;
(3) Designating an insured's or prospective
				  insured's actual or perceived gender identity, or the fact that an insured or
				  prospective insured is a transgender person, as a preexisting condition for
				  which coverage will be denied or limited; or
(4) Denying or limiting coverage, or denying
				  a claim, for services including but not limited to the following, due to an
				  insured's actual or perceived gender identity or for the reason that the
				  insured is a transgender person:
(A) Health
				  care services related to gender transition if coverage is available for those
				  services under the policy when the services are not related to gender
				  transition, including but not limited to hormone therapy, hysterectomy,
				  mastectomy, and vocal training; or
(B) Any health care services that are
				  ordinarily or exclusively available to individuals of one sex when the denial
				  or limitation is due only to the fact that the insured is enrolled as belonging
				  to the other sex or has undergone, or is in the process of undergoing, gender
				  transition.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 15.2 - Mental Health Parity › Section 2562.1 - Scope of Article; Definition

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) This article shall apply only to coverage
				  for services or treatments rendered for pervasive developmental disorder or
				  autism under a policy of health insurance as defined in Insurance Code section
				  106.
(b) This article shall not apply to a policy
				  described in subdivision (g) of Insurance Code section
				  10144.5.
(c) As used in this article, the term
				  "behavioral health treatment" has the meaning set forth in subdivision (c)(1)
				  of Insurance Code section
				  10144.51.
1. New
					 article 15.2 (sections
					 2562.1-2562.4) and section filed
					 3-11-2013 as an emergency; operative 3-11-2013 (Register 2013, No. 11). A
					 Certificate of Compliance must be transmitted to OAL by 9-9-2013 or emergency
					 language will be repealed by operation of law on the following
					 day.
2. New article 15.2 (sections
					 2562.1-2562.4) and section refiled
					 9-9-2013 as an emergency; operative 9-9-2013 (Register 2013, No. 37). A
					 Certificate of Compliance must be transmitted to OAL by 12-9-2013 or emergency
					 language will be repealed by operation of law on the following
					 day.
3. New article 15.2 (sections
					 2562.1-2562.4) and section filed
					 11-20-2013 as an emergency; operative 12-9-2013 pursuant to Government Code
					 section
					 11346.1(d)
					 (Register 2013, No. 47). A Certificate of Compliance must be transmitted to OAL
					 by 3-10-2014 or emergency language will be repealed by operation of law on the
					 following day.
4. Certificate of Compliance as to 11-20-2013 order
					 transmitted to OAL 3-7-2014 and filed 4-10-2014 (Register 2014, No.
					 15).
Note: Authority cited: Sections
						10144.5,
						10144.51,
						12921 and
						12926,
						Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989); 20th
						Century Ins. Co. v. Garamendi, 8 Cal.4th 216 (1994). Reference: Sections
						10144.5 and
						10144.51,
						Insurance Code; Harlick v. Blue Shield of California, 686 F.3d 699
						(2012).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 15.2 - Mental Health Parity › Section 2562.2 - Medical Necessity; Case Management and Utilization Review

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Nothing in this
				  article shall be construed to mandate coverage of services that are not
				  medically necessary.
(b) Nothing in
				  this article shall be construed to preclude an insurer from utilizing the
				  following in accordance with the provisions of this article and Insurance Code
				  sections
				  10144.5 and
				  10144.51:
(1) Case management;
(2) Managed care;
(3) Network providers;
(4) Utilization review techniques;
(5) Prior authorization;
(6) Copayments; or
(7) Other cost sharing.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 15.2 - Mental Health Parity › Section 2562.3 - Prohibited Limitations on Coverage

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
For purposes of Insurance Code section
					 10144.5,
(a) If treatment or services are
(1) Medically necessary,
(2) Rendered to an individual diagnosed with
				  a health condition indicated in subdivision (d)(7) of Insurance Code section
				  10144.5,
				  and
(3) Rendered for the purpose of
				  treating that condition;
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 15.2 - Mental Health Parity › Section 2562.4 - Behavioral Health Treatment for Pervasive Developmental Disorder or Autism

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Scope of
				  Section. In addition to the limitations on scope set forth in section
				  2562.1 of this article, the scope
				  of this section
				  2562.4 shall be further limited by
				  the following sentence: This section does not apply to a policy or plan
				  described in subdivision (d) of Insurance Code section
				  10144.51.
(b) In cases where behavioral health
				  treatment is medically necessary, an insurer shall not deny or unreasonably
				  delay coverage for behavioral health treatment:
(1) Based on an asserted need for cognitive,
				  developmental or intelligence quotient (IQ) testing,
(2) On the grounds that behavioral health
				  treatment is experimental, investigational, or educational,
(3) On the grounds that behavioral health
				  treatment is not being, will not be, or was not, provided or supervised by a
				  licensed person, entity or group when the provider or supervisor in question is
				  certified by a national entity, such as the Behavior Analyst Certification
				  Board, that is accredited by the National Commission for Certifying
				  Agencies,
(4) On the grounds that
				  behavioral health treatment has been, is being, should be or will be provided
				  by a Regional Center contracting with the Department of Developmental
				  Services,
(5) On the grounds that
				  an annual visit limit has been reached or exceeded, or
(6) For any other reason, provided, however,
				  that the insurer may apply a deductible or other financial term or limit when
				  the same term or limit is equally applicable to all benefits under the
				  policy.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 15.3 - Independent Medical Review Assessment › Section 2563 - Independent Medical Review System Fee Assessment

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For purposes of this section, the
				  following definitions shall apply:
(1)
				  "Application For Independent Medical Review" means a request for an independent
				  medical review received by the Department from an insured, covered person, or
				  other person.
(2) "Direct
				  Department Independent Medical Review System Costs" means the costs borne by
				  the Department for staff time and overhead in administering the Independent
				  Medical Review System. This administration includes the Department's activities
				  in processing Applications For Independent Medical Review submitted to the
				  Department and the Department's activities ensuring compliance with article 3.5
				  of division 2, part 2, chapter 1 commencing with section
				  10169 of
				  the Insurance Code when Health Requests For Assistance are received by the
				  Department.
(3) "Health Request For
				  Assistance" means a request for assistance received by the department from an
				  insured, covered person, or other person regarding an insurance policy which
				  provides coverage for hospital, medical, or surgical benefits.
(4) "Independent Medical Review Organization
				  Review Costs" means the fees charged by the independent medical review
				  organization for its medical reviews, as discussed in Insurance Code section
				  10169.5(a).
(5) "Independent Medical Review System" means
				  the system for reviewing insurance disputes described in Insurance Code section
				  10169.
(6) "Insurer" means every person holding a
				  certificate of authority and writing insurance subject to the Independent
				  Medical Review System described in Insurance Code section
				  10169.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 16 - Home Protection Companies › Section 2570 - Authority

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
This Article is promulgated pursuant to the authority
					 granted to the Commissioner under the provisions of Part 7, Division 2 of the
					 Insurance Code.
1. New
					 Article 16 (Sections
					 2570-2570.09,
					 not consecutive) filed 3-8-79; effective thirtieth day thereafter (Register 79,
					 No. 10).
2. New Article 16 (Sections
					 2570-2570.09, not consecutive)
					 refiled 3-16-79 as an emergency; effective upon filing (Register 79, No.
					 10).
Note: Authority cited: Section
						2570, California Insurance Code.
						Reference: Sections
						771.1,
						831.1,
						881.1,
						882.5,
						988,
						1215.13 1/2, 1634, 1635, Part 7
						commencing with Section
						12740 of Division 2, Insurance
						Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 16 - Home Protection Companies › Section 2570.01 - Purpose

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The purpose of this Article is to implement the provisions
					 of Part 7 (commencing with Section
					 12740) to Division 2 of the
					 Insurance Code, relating to home protection companies. This law was added to
					 the Insurance Code effective September 26, 1978, as an urgency statute to give
					 the Commissioner regulatory authority over home protection companies conducting
					 a home protection business in this State.
Note: Authority cited: Section
						2570,
						California Insurance Code. Reference: Sections
						771.1,
						831.1,
						881.1,
						882.5,
						988,
						1215.13 1/2, 1634, 1635, Part 7
						commencing with Section
						12740 of Division 2, Insurance
						Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 16 - Home Protection Companies › Section 2570.02 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) "Unearned home
				  protection contract fees" as used in Section
				  2570.06(g)(2)
				  (B)7 and the reserves contemplated in Section
				  985 of the
				  Insurance Code as required by Section
				  12751 of
				  the Insurance Code means that a home protection company must make provision for
				  reinsurance of the outstanding risk on policies which provide that premiums are
				  fully earned at inception and on policies which for any other reason do not
				  provide for a return premium to the insured on cancellation prior to
				  expiration.
Standards for reasonably estimating the amount required to
					 reinsure under Sections
					 980 through
					 988 of the
					 Insurance Code to provide adequate safeguards for the contract holders,
					 creditors and the public will be provided from time to time by the Commissioner
					 after giving consideration to the developing experience of the home protection
					 business.
(b) "Service
				  claims adjusted and unpaid or in the process of adjustment" as used in Section
				  2570.06(g)(2)
				  (B)1 means a reserve estimated in the
				  aggregate to provide for the payment of all service claims for which a home
				  protection company may be liable and to provide for the expense of adjustment
				  or settlement of all service claims. This includes the cost to purchase home
				  appliances, systems or components and to pay for installation and service.
"Service claim" as used herein means a claim by the holder
					 of a home protection contract for the provision of service for the replacement
					 or repair of a covered appliance, system or component pursuant to a home
					 protection contract.
Note: Authority cited: Section
						2570,
						California Insurance Code. Reference: Sections
						771.831.1,
						881.1,
						882.5,
						988,
						1215.13 1/2, 1634, 1635, Part 7
						commencing with Section
						12740 of Division 2, Insurance
						Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 16 - Home Protection Companies › Section 2570.03 - Home Protection Company License Requirement

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
No person shall issue or offer to issue home protection
					 contracts in this state unless such person (1) holds a valid home protection
					 company license issued by the Commissioner, or (2) holds a valid Certificate of
					 Authority to transact miscellaneous insurance under Insurance Code Section
					 120.
Note: Authority cited: Section
						2570,
						California Insurance Code. Reference: Sections
						771.1,
						831.1,
						881.1,
						882.5,
						988,
						1215.13 1/2, 1634, 1635, Part 7
						commencing with Section
						12740 of Division 2, Insurance
						Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 16 - Home Protection Companies › Section 2570.04 - Application Procedure for Home Protection Companies

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A domestic home protection company
				  incorporated and capitalized prior to January 1, 1979 or a foreign home
				  protection company incorporated, capitalized and conducting a home protection
				  company business in California prior to January 1, 1979 shall file with the
				  Commissioner an application on the form furnished by the Commissioner and
				  submit the exhibits specified in Section
				  2570.06 on or before March 31,
				  1979.
(b) A domestic home
				  protection company not incorporated and capitalized prior to January 1, 1979
				  shall comply with the following procedures prior to the commencement of
				  business:
(1) Apply for a corporate name
				  approval from the Commissioner pursuant to Insurance Code Section
				  880 et
				  seq.;
(2) Incorporate under the
				  California General Corporations Law;
(3) File an application for a security permit
				  with the Commissioner pursuant to Section
				  2570.08;
(4) Capitalize in accordance with the terms
				  and conditions of the security permit issued;
(5) Correct any deficiencies found during
				  field examination conducted by the Commissioner; and
(6) File an application on a form furnished
				  by the Commissioner for a license pursuant to Section
				  2570.06 and obtain a license from
				  the Commissioner to conduct a home protection company
				  business.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 16 - Home Protection Companies › Section 2570.06 - Exhibits to be Submitted by Applicant

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
An applicant for a license to conduct a home protection
					 company business shall submit the following exhibits with its
					 application.
(a) Fees.
(1) Application fee.
(2) Name(s) of marketing representatives
				  (Make check payable to the California Department of
				  Insurance.)
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 16 - Home Protection Companies › Section 2570.07 - Additional Requirements for Foreign Applicants

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A foreign applicant shall also file the following
					 exhibits.
(a) Notice of appointment of
				  agent for service of process.
(b)
				  Latest annual and quarterly statements to date certified by applicant's home
				  state regulatory official to be true and correct copies.
(c) Latest examination report certified by
				  applicant's home estate regulatory official to be a true and correct
				  copy.
Note: Authority cited: Section
						2570,
						California Insurance Code. Reference: Sections
						771.1,
						831.1,
						881.1,
						882.5,
						988,
						1215.13 1/2, 1634, 1635, Part 7
						commencing with Section
						12740 of Division 2, Insurance
						Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 16 - Home Protection Companies › Section 2570.08 - Exhibits to be Submitted in Support of a Security Permit Application

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A home protection company applying for a security permit
					 shall submit the following:
(a)
				  Security permit application fee.
(b) A voided specimen of any share
				  certificate or other security which applicant proposes to issue.
(c) If the sale is by subscription, a list of
				  all proposed share purchasers, the amount of shares to be purchased by each
				  subscriber, the aggregate consideration to be paid by each subscriber and
				  identification of the promoters by means of an asterisk.
(d) Prospectus or offering circular, or a
				  statement why it should not be required. No prospectus or offering circular is
				  required if the entire issue will be made to three or less subscribers, all of
				  whom are promoters.
(e) Copy of any
				  letter to stockholders, offering letter or other solicitation
				  material.
(f) Stock subscription
				  agreement.
(g) Agreement
				  restricting transfer of shares.
(h)
				  Impound agent instructions and letters of consent to act as escrow
				  agent.
(i) Underwriter's agreement
				  concerning the issue or providing for sale or disposition of applicant's
				  shares.
(j) Names of all persons
				  who will solicit the sale of these securities and their addresses,
				  relationships to the applicant, production and securities licenses held and
				  compensation for the sale of these securities, if any.
(k) The plan of operation as specified in
				  Section 2570.06
				  (f).
(l) A two-year financial
				  projection.
Note: Authority cited: Section
						2570,
						California Insurance Code. Reference: Sections
						771.1,
						831.1,
						881.1,
						882.5,
						988,
						1215.13 1/2, 1634, 1635, Part 7
						commencing with Section
						12740 of Division 2, Insurance
						Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 16 - Home Protection Companies › Section 2570.09 - Filing Instructions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  All applications for a home protection company license shall be filed with the
				  Corporate Affairs Bureau, Legal Division, Oakland Office.
(b) Submit an original and one copy of the
				  application, index of exhibits and all exhibits.
(c) The applications and exhibits must comply
				  with the following requirements:
(1) The
				  documents should be arranged as follows:
Application
Index of Exhibits
Exhibits (lower right hand side of the exhibits should
					 indicate the number or description corresponding to the
					 index).
(2) In the event
				  that an exhibit is not submitted with the application, please so
				  indicate.
(3) Supplements or
				  amendments to exhibits should be submitted and marked in the same manner as
				  original exhibits. Each supplement or amendment should consist of a whole
				  document or complete pages of a document paginated to correspond to existing
				  exhibits so that the new material can be readily inserted into the existing
				  file.
(4) Every application will be
				  assigned a file number. Applicants will be notified on the file number and
				  filing date, and all subsequent correspondence shall bear the file
				  number.
(5) The application,
				  amendments and supplements shall be verified as required by the Code of Civil
				  Procedures Sections
				  446 and
				  2015.5.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 17 - Actuarial Opinion and Memorandum Regulation › Section 2580.1 - Purpose

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The purpose of this regulation is to prescribe:
(a) Requirements for statements of actuarial
				  opinion that are to be submitted in accordance with Section
				  10489.15 of
				  the Insurance Code, and for memoranda in support thereof;
(b) Rules applicable to the appointment of an
				  appointed actuary; and
(c) Guidance
				  as to the meaning of "adequacy of reserves."
1. New
					 article and section filed 12-6-94; operative 1-5-95 (Register 94, No.
					 49).
2. Amendment filed 12-27-2004; operative 1-1-2005 pursuant to
					 Government Code section
					 11343.4
					 (Register 2004, No. 53).
Note: Authority cited: Section
						10489.15,
						Insurance Code. Reference: Section
						10489.15,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 17 - Actuarial Opinion and Memorandum Regulation › Section 2580.2 - Scope

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
This regulation shall apply to all life insurance companies
					 and fraternal benefit societies doing business in this State and to all life
					 insurance companies and fraternal benefit societies that are authorized to
					 reinsure life insurance, annuities or accident and health insurance business in
					 this State. This regulation shall be applied in a manner that allows the
					 Appointed Actuary to utilize his or her professional judgment in performing the
					 Asset Adequacy Analysis and developing the Actuarial Opinion and supporting
					 memoranda, consistent with relevant actuarial standards of practice. However,
					 the Commissioner shall have the authority to specify specific methods of
					 actuarial analysis and actuarial assumptions when, in the Commissioner's
					 judgment, these specifications are necessary for an acceptable opinion to be
					 rendered relating to the adequacy of reserves and related items.
This regulation shall be applicable to all annual
					 statements filed with the office of the Commissioner after the effective date
					 of this regulation. A statement of opinion on the adequacy of the reserves and
					 related actuarial items based on an Asset Adequacy Analysis in accordance with
					 Section 2580.5 of this regulation, and a
					 memorandum in support thereof in accordance with Section
					 2580.6 of this regulation, shall
					 be required each year.
1. New
					 section filed 12-6-94; operative 1-5-95 (Register 94, No. 49).
2.
					 Amendment filed 12-27-2004; operative 1-1-2005 pursuant to Government Code
					 section
					 11343.4
					 (Register 2004, No. 53).
Note: Authority cited: Section
						10489.15,
						Insurance Code. Reference: Section
						10489.15,
						Insurance Code.