reglab/statecodes huggingface dataset:
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6 - Provider Network Access Standards for Health Insurance › Section 2240.2 - Insurance Contract Provisions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Insurance contracts containing provisions covering network
					 provider services shall contain the following:
(a) A provision for coverage on an indemnity
				  or provision of service basis at in-network cost sharing at the lowest
				  cost-sharing tier for emergency health care services rendered to covered
				  persons, consistent with the requirements of Insurance Code section
				  10112.7,
				  and any other applicable law.
(b) A
				  provision that the insurer shall give written notice to the contract holder,
				  within a reasonable period of time, of any termination or permanent breach of
				  contract by, or permanent inability to perform of, any network provider if such
				  termination, breach or inability would materially and adversely affect the
				  contract holder or covered persons or will result in the insurer's network not
				  being in compliance with this article.
(c) A provision that the contract holder
				  shall distribute to the primary covered persons the substance of any notice
				  given to the contract holder pursuant to subdivision (b) not later than 30 days
				  after its receipt.
(d) A provision
				  that, pursuant to Insurance Code Section
				  10133.56,
				  upon termination of a network provider contract, the insurer shall be liable
				  for covered services rendered by such provider to a covered person under the
				  care of such provider at the time of termination until such services are
				  completed, unless reasonable and medically appropriate arrangements for
				  assumption of such services by another network provider are made. This
				  provision need not provide that the insurer shall be liable for any services
				  rendered to a covered person after such person ceases to be eligible for
				  coverage under the insurance contract.
(e) A provision defining the service
				  area.
1. Amendment
					 of section heading, section and NOTE filed 1-8-2008; operative 2-7-2008
					 (Register 2008, No. 2).
2. Amendment of subsections (a)-(c) filed
					 3-8-2016; operative 3-8-2016 pursuant to Government Code section
					 11343.4(b)(3)
					 (Register 2016, No. 11).
Note: Authority cited: Section
						10133.5,
						Insurance Code. Reference: Sections
						10133,
						10133.5 and
						10133.56,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6 - Provider Network Access Standards for Health Insurance › Section 2240.3 - Provisions of Policies and Certificates

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Policies and certificates containing provisions covering
					 network provider services shall contain the following:
(a) A description of the coverage provided by
				  the contract for emergency health care services rendered to covered persons
				  outside the service area.
(b) A
				  description of the coverage, if any, provided by the contract for dependent
				  covered persons who both live outside the service area and away from the
				  principal residence of the primary covered person.
(c) A brief and prominent warning reflecting
				  the limitations in the contract pertaining to network provider services. Such
				  warning shall identify, by caption or number, the certificate provisions
				  required by subdivisions (d), (e) and (f), below.
(1) Where the contract provides coverage
				  outside the service area, the warning shall be in bold-face type or set off by
				  other means from the surrounding text, and shall clearly specify the
				  differences in coverage between network and non-network services in and out of
				  the service area.
(2) Where the
				  contract provides no coverage (except for emergency health care services)
				  outside the service area, the warning shall include the warning required in (1)
				  above, and shall additionally warn that no coverage is provided outside the
				  service area, except for emergency health care services. The additional warning
				  shall be in a point size at least twice that used in the body of the
				  certificate (excluding captions).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6 - Provider Network Access Standards for Health Insurance › Section 2240.4 - Contracts with Network Providers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Insurers shall establish written policies
				  and procedures for recruiting network providers, credentialing network
				  providers, contracting with network providers, and managing their
				  networks.
(b) Effective June 30,
				  2008, contracts between network providers and insurers or their agents shall:
1) be in writing and be fair and reasonable
				  as to the parties to such contracts;
2) provide that network providers shall not
				  make any additional charges for rendering network services except as provided
				  for in the contract between the insurer and the insured;
3) include all the agreements between the
				  parties pertaining to the rendering of network provider services;
4) recite that the provider's primary
				  consideration shall be the quality of the health care services rendered to
				  covered persons;
5) include
				  provisions ensuring that providers shall not discriminate against any insured
				  in the provision of contracted services on the basis of sex, marital status,
				  sexual orientation, race, color, religion, ancestry, national origin,
				  disability, health status, health insurance coverage, utilization of medical or
				  mental health or substance use disorder services or supplies, or other unlawful
				  basis including without limitation, the filing by such insured of any
				  complaint, grievance, or legal action against a provider.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6 - Provider Network Access Standards for Health Insurance › Section 2240.5 - Filing and Reporting Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For all health insurance policies that
				  include the option of utilizing contracted providers to provide health care
				  services, and specialized health insurance policies, that provide coverage for
				  the pediatric oral essential health benefit (as defined in Insurance Code
				  section
				  10112.27(a)(5)),
				  the insurer shall file a network adequacy report with the Department, with
				  accompanying documents, as follows:
(1)
				  Annually on June 1, a network adequacy report for all health insurance policies
				  providing current coverage or new health insurance policies.
(2) Upon request by the Commissioner, a
				  network adequacy report for all health insurance policies providing current
				  coverage or new health insurance policies.
(3) Whenever an insurer seeks approval from
				  the department for any policy form that relies upon or includes the option of
				  utilizing contracted network providers to deliver health care services, the
				  insurer shall at the same time file a network adequacy report for the policy
				  form for which approval is sought.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6 - Provider Network Access Standards for Health Insurance › Section 2240.6 - Notice and Information to Covered Persons

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Network provider directories shall be
				  updated pursuant to the requirements set forth in this section and shall be
				  offered to accommodate individuals with limited English proficiency or
				  disabilities.
(b) An insurer shall
				  post its current network provider directory on its internet web site and inform
				  its covered persons of the availability of the internet network provider
				  directory through its coverage materials. The network provider information
				  provided on the website shall be updated weekly. The network provider directory
				  shall be available online to both covered persons and consumers shopping for
				  coverage without requirements to log on or enter a password or a policy
				  number.
(c) An insurer shall
				  maintain accurate provider directories for its networks as to the information
				  referenced in subdivisions (g) and (h), below, as applicable, and shall
				  demonstrate the accuracy of its directories at the request of the
				  Department.
(d) In addition to
				  providing the network provider directory on its internet web site, the insurer
				  shall also inform its covered persons of the availability of a paper copy of
				  the network provider directory at no cost in its coverage material and on its
				  internet web site.
(1) The paper copy of the
				  network provider directory shall be updated quarterly during the calendar
				  year.
(2) An insurer may satisfy
				  this quarterly update requirement by providing a paper copy insert or addendum
				  to any existing paper copy network provider directory.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6 - Provider Network Access Standards for Health Insurance › Section 2240.7 - Discretionary Waiver of Network Access Standards

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) If an insurer is unable to meet the
				  network access standard(s) required by this article, the insurer may apply to
				  the Commissioner for a discretionary waiver of any network access standards and
				  offer an alternate access delivery system. A waiver application must be
				  resubmitted annually.
(b) An
				  application for waiver may only be granted for the following reasons:
(1) Absence of practicing providers located
				  within sufficient geographic proximity based upon the time or distance
				  standards of this article.
(2)
				  There are sufficient numbers or types of providers or facilities in the service
				  area to meet the standards required by this article, but the insurer
				  demonstrates, through substantial evidence, that, after good faith efforts, it
				  is unable to contract with sufficient providers or facilities to meet the
				  network access standards set forth in this article.
(3) An insurer's provider network has been
				  previously approved under this article, and a provider or facility subsequently
				  becomes unavailable within the service area.
(4) The application includes a proposal
				  regarding innovative network design, such as primary care medical homes,
				  "Centers of Excellence," or accountable care organizations, but only where the
				  innovative network design is shown to provide a benefit to
				  consumers.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 1 - Scope of Article and Definitions › Section 2241 - Policies Subject to Article

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The rules and regulations contained in this article are
						promulgated pursuant to Section
						10270.2 of
						the Insurance Code to apply to policies and forms providing the unemployment
						compensation disability benefits under voluntary plans of unemployment
						compensation disability insurance pursuant to Part 2, Division 1 of the
						California Unemployment Insurance Code. If any disability insurance other than
						the unemployment compensation disability benefits under the voluntary plan and
						other than additional benefits for loss of time is provided by the policy or
						any rider attached thereto, such policy or rider is governed, as respects such
						disability insurance, by the laws and rules and regulations applicable to such
						other disability policies.
Every policy issued by any insurer to provide
						Unemployment Compensation Disability benefits shall be issued only in
						conformity with this Article and the applicable laws of this
						State.
1. New
						Article 6.5 (§§
												2241 to
						2246) filed 12-1-47 (Register 10,
						No. 5).
2. Amended Article 6.5 (§§
												2241 through
						2246) filed 4-4-56; effective
						thirtieth day thereafter (Register 56, No. 6).
3. Amendment filed
						5-6-77 as procedural and organizational; effective upon filing (Register 77,
						No. 19).
4. 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.
Note: Authority cited: Section
						  10270.2,
						  Insurance Code. Reference: Section
						  10270.2
						  (f), Insurance
						  Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 1 - Scope of Article and Definitions › Section 2241.1 - Terms and Abbreviations Defined

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Unless the context otherwise requires, when used in this
						article the following words or abbreviations mean or include:
(a) "C. U. I. Code" means California
					 Unemployment Insurance Code.
(b)
					 "U. C. D." means California unemployment compensation disability as the words
					 are used in the C. U. I. Code.
(c)
					 "Voluntary plan" means a voluntary plan of U. C. D. benefits pursuant to Part
					 2, Division 1 of the C. U. I . Code.
(d) "Insurer" means an insurer admitted to
					 transact disability insurance in California.
(e) "Director" means the Director of the
					 Department of Employment Development.
(f) "Commissioner" means the Insurance
					 Commissioner.
(g) "Employer"
					 includes any entity or entities to which a U. C. D. policy may be
					 issued.
(h) "Employee" includes all
					 individuals, however named, who may be covered by a U. C. D. Policy.
(i) "Policy" includes any rider or
					 endorsement effecting or affecting U. C. D. benefits.
1.
						Amendment of subsection (e) filed 5-6-77 as procedural and organizational;
						effective upon filing (Register 77, No. 19).
Note: Authority cited: Sections
						  10270.2 and
						  10270.2(f),
						  Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 2 - Filing and Approval › Section 2241.3 - Filing and Approval Required

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
No U. C. D. policy shall be issued or delivered by any
						insurer until:
(a) A copy of the form
					 thereof is filed with the commissioner
(b) Either
(1) Thirty days expires without notice from
					 the commissioner after such copy is filed, or
(2) The commissioner gives the commissioner's
					 written approval thereof prior to that time.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 2 - Filing and Approval › Section 2241.5 - Filing Procedure

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
U. C. D. policies and forms shall be submitted to the
						commissioner for filing with and approval by the commissioner in conformity
						with the requirements of Article 1 of this subchapter applicable to other
						disability policies and forms, except that in the submission of final copies
						for approval, each form shall be submitted in triplicate. In addition, one copy
						should be submitted to the Department of Employment Development, Division of
						Disability and Hospital Benefits, Sacramento, California.
1.
						Amendment filed 5-6-77 as procedural and organizational; effective upon filing
						(Register 77, No. 19).
2. 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.
Note: Authority cited: Section
						  10270.2,
						  Insurance Code. Reference: Section
						  10270.2
						  (f), Insurance
						  Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 2 - Filing and Approval › Section 2241.7 - Notice of Disapproval; Contents: Withdrawal of Approval; Effect

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
If the commissioner notifies an insurer, in writing, that
						a U. C. D. form filed by it does not comply with the requirements of law or
						this article, or both, specifying the respects in which it does not so comply,
						such insurer shall not issue any U. C. D. policy in such form. If, after having
						approved a U. C. D. form, the commissioner subsequently withdraws the
						commissioner's approval pursuant to Section
						12957 of
						the Insurance Code, such insurer shall not thereafter issue any U. C. D. policy
						in such form.
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 6.5 - Unemployment Compensation Disability Policies › Subarticle 2 - Filing and Approval › Section 2241.9 - Policies Containing Misleading Provisions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
No U. C. D. policy or form will be approved by the
						commissioner for issuance or delivery if the commissioner finds that it
						contains any provision or has any title, heading, backing or other indication
						of its provisions which is likely to mislead a person to whom the policy is
						offered, delivered or issued or any employee insured or proposed to be insured
						thereunder.
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 6.5 - Unemployment Compensation Disability Policies › Subarticle 2 - Filing and Approval › Section 2242 - Individual Certificates; Forms to be Filed and Approved

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
If individual certificates setting forth a statement as
						to the insurance whom payable are to be issued to the employees insured, the
						form thereof must first be filed with and approved by the commissioner in the
						manner provided in this article for filing and approval of
						policies.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 2 - Filing and Approval › Section 2242.1 - Policies Not Conforming to C. U. I. Code or Regulations of Director

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Any U. C. D. policy or certificate which is found by the
						director not to conform to the requirements of the C. U. I. Code or the
						regulations of the director for voluntary plans, or both, will not be approved
						by the commissioner or, if previously approved by the commissioner, approval
						thereof will be withdrawn.
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 6.5 - Unemployment Compensation Disability Policies › Subarticle 2 - Filing and Approval › Section 2242.3 - Policies to State Effective and Termination Dates: Size of Type Required

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
No U. C. D. policy shall be issued or delivered by any
						insurer:
(a) Unless the times at which
					 the insurance takes effect and terminates are clearly stated in the
					 policy.
(b) Unless the policy be
					 plainly printed in lightface type of a style in general use, the size of which
					 shall be uniform and not less than 10-point with a lower-case unspaced alphabet
					 length not less than 120 points.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 2 - Filing and Approval › Section 2242.5 - Incorporated Provisions to be Set Forth in Policies

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
No U. C. D. policy shall be issued or delivered by any
						insurer if it contains any provisions purporting to make any portion of the
						charter, constitution or by-laws of the insurer a part of the policy unless
						such portion is set forth in full in the policy.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 2 - Filing and Approval › Section 2242.7 - Provisions Contradictory to Required or Optional Provisions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
No U. C. D. policy shall be issued or delivered by any
						insurer which contains any provision contradictory, in whole or in part, of any
						of the required provisions or optional provisions hereinafter set forth or
						described or which conflicts with such required and optional
						provisions.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 2 - Filing and Approval › Section 2242.9 - Foreign Insurers: What Provisions Required by State of Organization May be Included

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
U. C. D. policies issued by a foreign insurer (an insurer
						not organized under the laws of California) may contain any provision which is
						required by the law of the state or country under whose laws the insurer is
						organized if such provision is not inconsistent with the C. U. I. Code and the
						regulations of the director, and is not less favorable to the employer or any
						employee than the provisions of this article.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 2 - Filing and Approval › Section 2243 - Policies Issued Out-of-State: What Provisions May be Included

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
U. C. D. policies issued outside this State may contain
						any provision required by the laws of the state or country where issued if such
						provision is not inconsistent with the C. U. I. Code and the regulations of the
						director.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 2 - Filing and Approval › Section 2243.1 - In Lieu of Compliance Insurer May Comply with Article 2 Until January 1, 1957. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1.
						Repealer filed 5-6-77 as procedural and organizational; effective upon filing
						(Register 77, No. 19).
Note: Authority cited: Section
						  10270.2,
						  Insurance Code. Reference: Section
						  10270.2
						  (f), Insurance
						  Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 2 - Filing and Approval › Section 2243.3 - Substitutions Permitted in Required or Optional Provisions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
In respect to the forms for any of the required or
						optional provisions hereinafter set forth,
(a) Wherever the word "insurer" is used there
					 may be substituted therefor "company," "corporation," "association," "society,"
					 or such other word as may properly designate the insurer.
(b) Wherever the word "employee" is used
					 there may be substituted therefor "member" or other proper designation of the
					 individual insured.
(c) Wherever
					 the word "policy" is used there may be substituted therefor "rider,"
					 "endorsement," "contract," or other proper designation of the document
					 embodying the contract between the parties to which the provision
					 refers.
(d) Wherever the word
					 "employer" is used, there may be substituted therefor "executive officer,"
					 "trustee," or other proper designation of the person maintaining application
					 for a U.C.D. policy on behalf of an entity to whom such policy may lawfully be
					 issued.
(e) Blanks shall be
					 completed with appropriate material in conformity with any special instructions
					 relative to matter to be inserted therein.
(f) Words or phrases in parentheses may be
					 included or omitted at the option of the insurer.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 3 - Form-Required Provisions › Section 2243.7 - Issuance of Statement of Coverage or Individual Certificate

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Every U. C. D. policy shall contain a provision that the
						insurer will issue to the employer, for delivery to each employee insured,
						either a statement of coverage or an individual certificate setting forth a
						statement as to the insurance protection afforded the employee and to whom
						payable. If the policy provides for the issuance of a statement of coverage or
						an individual certificate in the alternative, but does not specify which will
						be issued, the application shall so specify.
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-40-20.0.52
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 3 - Form-Required Provisions › Section 2243.9 - Admission of All New Employees

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Every U. C. D. policy shall contain a provision that to
						the group or class thereof originally insured there shall be added from time to
						time all employees of the employer eligible to and applying for insurance in
						such group or class.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 3 - Form-Required Provisions › Section 2244 - Policy Not in Lieu of Workmen's Compensation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Every U. C. D. policy shall contain a provision in the
						following form (or in the substance thereof):
"This policy is not in lieu of and does not affect
						workmen's compensation insurance."
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 3 - Form-Required Provisions › Section 2244.1 - Entire Contract. Incorporation by Reference

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Every U. C. D. policy shall contain a provision relative
						to the contract which shall be in one of the forms set forth in (a), (b) and
						(c) hereof, appropriate to the basis upon which the policy is issued (or in the
						substance thereof), but if the policy incorporates by reference in any lawful
						manner any portion of the C. U. I. Code or the regulations of the director as a
						part thereof, the form set forth in (c) shall be used with the alternative
						language noted therein appropriate to the basis upon which the policy is
						issued:
(a) This policy and the application
						of the employer constitute the entire contract between the parties.
(b) This policy constitutes the entire
						contract between the parties.
(c)
						This policy (the application of the employer) and the provisions of the
						California Unemployment Insurance Code and the regulations of the Director of
						the Department of Employment Development which are incorporated by reference in
						this policy constitute the entire contract between the
						parties.
1.
						Amendment of subsection (c) filed 5-6-77 as procedural and organizational;
						effective upon filing (Register 77, No. 19).
Note: Authority cited: Section
						  10270.2,
						  Insurance Code. Reference: Section
						  10270.2
						  (f), Insurance
						  Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 3 - Form-Required Provisions › Section 2244.3 - Statements in Application and Changes in Policy

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Every U. C. D. policy shall contain a provision relative
						to statements in the applications and changes in the policy which shall be in
						one of the forms set forth in (a) and (b) hereof at the option of the insurer
						(or in the substance thereof):
(a) "In
					 the absence of fraud, all statements made by the employer shall be deemed
					 representations and not warranties and no such statement shall (avoid the
					 insurance or reduce the benefits under this policy or) be used in defense to a
					 claim hereunder unless it is contained in a written application.
"No agent has authority to change this policy or to waive
						any of its provisions. No change in this policy shall be valid unless approved
						by an executive officer of the insurer and such approval be enclosed
						hereon.
(b) "In the absence
					 of fraud, all statements made by the employer shall be deemed representations
					 and not warranties and no such statement shall (avoid the insurance or reduce
					 the benefits under this policy or) be used in defense to a claim hereunder
					 unless it is contained in a written application.
"No agent has authority to change this policy or to waive
						any of its provisions. No change in this policy shall be valid unless approved
						by an executive officer of the insurer and evidenced by endorsement hereon, or
						by amendment hereto signed by the employer and by an executive officer of the
						insurer."
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 4 - Form-Optional Provisions › Section 2244.7 - Examination of Insured Employee

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
At the option of the insurer, any U. C. D. policy may
						contain a provision relative to examination of the person of the insured
						employee, but any such provision shall be in the following form only or in the
						substance thereof:
"The insurer shall have the right and opportunity to
						examine the person of the insured when and so often as it may reasonably
						require during the pendency of claim hereunder except where such right is
						limited by the California Unemployment Insurance Code."
1. Change
						without regulatory effect adopting subarticle 4 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-40-20.0.52
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 4 - Form-Optional Provisions › Section 2244.9 - Time Restriction on Institution of Suit on Policy

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
At the option of the insurer, any U. C. D. policy may
						contain a provision relative to the time within which suit may be brought under
						the policy, but any such provision shall be in the following form only or in
						the substance thereof:
"No action at law or in equity shall be brought to
						recover on this policy prior to the expiration of sixty days after proof of
						loss has been filed in accordance with the requirements of this policy, nor
						shall action be brought at all unless brought within three years from the
						expiration of the time within which proof of loss is required by the policy.
						This provision does not affect inn any way any employee's right to appeal under
						the California Unemployment Insurance Code."
If the insurer elects to use the short form of
						alternative required provision relative to notice and proof of claim set forth
						in (a) of Section
						2244.5, and to omit the provision
						set forth under (b) (4) of Section
						2244.5, there shall be substituted
						for the words "from the expiration of the time within which proof of loss is
						required by the policy" contained in the provision herein above set forth in
						this section, the words "and ninety days after the termination of the period of
						disability on which the cause of action is based."
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 4 - Form-Optional Provisions › Section 2245 - Cancellation by Insurer

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
At the option of the insurer, any U. C. D. policy may
						contain provision relative to the cancellation or termination of the policy at
						the instance of the insurer, but any such provision shall
(a) Provide for notice to the employer and
					 such notice to the Department of Employment Development as the C. U. I. Code or
					 the regulations of the director require.
(b) State when the cancellation or
					 termination of the policy is to become effective.
(c) Provide for the return to the employer of
					 pro rata unearned premium if the cancellation or termination is made effective
					 at other than a premium due date.
1.
						Amendment of subsection (a) filed 5-6-77 as procedural and organizational;
						effective upon filing (Register 77, No. 19).
Note: Authority cited: Section
						  10270.2,
						  Insurance Code. Reference: Section
						  10270.2(f),
						  Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 4 - Form-Optional Provisions › Section 2245.1 - Reduction of Benefits Because of Age

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
At the option of the insurer, any U. C. D. policy may
						contain a provision relative to the reduction of benefits because of age, but
						no such provision shall reduce benefits because of age, but no such provision
						shall reduce benefits below the amount to which the individual employee insured
						would be entitled under the C. U. I. Code if he were not covered by a voluntary
						plan.
1.
						Repealer of former Section
						2245.1 and amendment to present
						Section 2245.1 (formerly Section
						2245.3) filed 5-27-50; effective
						30th day thereafter (Register 20, No. 5).
2. Amendment filed 4-4-56;
						effective thirtieth day thereafter (Register 56, No.
						6).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 4 - Form-Optional Provisions › Section 2245.3 - Benefits Limited Etc. Under C. U. I. Code

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Subject to the provisions of Sections
						2245.1 and
						2245.2, any U. C. D. policy may,
						at the option of the insurer, contain a provision which limits, reduces or
						eliminates benefits in the same manner, and to the same extent benefits are or
						may be limited, reduced or eliminated under the C. U. I. Code and the
						authorized rules and regulations adopted thereunder.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 4 - Form-Optional Provisions › Section 2245.4 - Limitation of Amount of Indemnity

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Except as provided in Sections
						2245.1,
						2245.2 and
						2245.3, no U. C. D. policy shall
						contain a provision limiting the amount of indemnity to an amount less than
						that stated in the policy and for which the premium has been paid. A provision
						in a U. C. D. policy which guarantees to all employees benefits not less than
						they would be entitled to under the C. U. I. Code if they were not covered by
						such policy or which limits the benefits payable to a specified class or
						classes of employees to the same benefits to which they would be entitled under
						the C. U. I. Code if they were not covered by such policy, shall not be
						considered to be in conflict with this section or Sections
						2245.1,
						2245.2 or
						2245.3.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 4 - Form-Optional Provisions › Section 2245.5 - Facility of Payment

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
At the option of the insurer, any U. C. D. policy may
						contain a facility of payment provisions relative to the payment of benefits to
						persons other than the individual employee insured out of whose disability the
						insurer's liability for benefit arises, but any such provision shall be in the
						following form only or in the substance thereof. In the blank space an amount
						not exceeding $1,000 shall be inserted.
"All benefits shall be paid to the insured employee,
						except that (in event the insurer determines that he is incompetent or
						incapable of executing a valid receipt, the insurer may, during his lifetime,
						unless claim has been made by a duly appointed guardian or committee, pay any
						amount otherwise payable to the insured employee to the husband or wife or
						relative by blood of the insured employee, or to any other person or
						institution determined by the insurer to be equitably entitled thereto; or) in
						case of the death of the insured employee before all amounts payable under the
						policy have been paid, the insurer may pay any such amount to an aggregate of
						$__________to any person or institution determined by the insurer to be
						equitably entitled thereto. Any payment in accordance with this provision shall
						discharge the obligation of the insurer hereunder to the extent of such
						payment."
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 5 - Issuance › Section 2245.7 - To Whom Policy May be Issued

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Policies providing U. C. D. benefits may be issued to any
						employer or association of employees that may apply for and receive approval of
						a voluntary plan pursuant to Part 2, Division 1 of the C. U. I. Code. Such
						policies may also be issued to any entity to which may be issued a group
						disability policy pursuant to the provisions of Section
						10270.5 of
						the Insurance Code, subject, however, to the obtaining of the approval of the
						director of the voluntary plan or plans which may insured thereby.
1. Change
						without regulatory effect adopting subarticle 5 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-40-20.0.52
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 5 - Issuance › Section 2245.9 - Who May be Covered

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Every U. C. D. policy may be issued to cover any person
						who may be included as an employee under a group disability policy in
						accordance with Sections
						10270.5 or
						10270.55 of
						the Insurance Code, even if not eligible for coverage under the voluntary plan
						approved by the director, if the purpose and scope of the policy is principally
						to provide U. C. D. benefits and additional benefits for loss of time on
						account of disability to eligible employees under an approved voluntary
						plan.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.5 - Unemployment Compensation Disability Policies › Subarticle 5 - Issuance › Section 2246 - Insurer to Issue Statement of Coverage or Individual Certificate for Each Employee

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Every insurer shall provide or issue to the employer for
						delivery to each employee insured under a U. C. D. Policy issued by it, either
						a statement of coverage which has been approved both as to form and substance
						by the director or an individual certificate setting forth a statement as to
						the insurance protection afforded him and to whom payable, which has been
						approved by the Commissioner.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 6.7 - Credit Life and Credit Disability Insurance Policy Forms and Administration › Section 2248 - Preamble and Authority

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Credit insurance provides important stability in financing the flow of goods
				  and services; protecting the interests of lenders and sellers by assuring
				  payment of outstanding debts, and avoiding hardship to debtors and their
				  families in the event of death or disability of the debtor prior to termination
				  of the debt.
(b) In the marketing
				  of credit insurance there have been occasions where the inferior bargaining
				  position of the debtor creates a "captive market" which, in the absence of
				  appropriate regulation, places the creditor in a position to dictate the choice
				  of coverage, the premium rate, the insurer and agent, with undesirable
				  consequences, such as: excessive coverage both as to amounts and duration;
				  excessive charges to debtors; failure to inform debtors of their insurance
				  coverage; and failure to provide debtors the protection purchased by the
				  debtor.
(c) In the absence of
				  appropriate regulations, premium rates and compensation for credit insurance
				  tend to be set at levels determined by the rate of return desired by the
				  creditor in the form of dividends, or experience-rating refunds or in the form
				  of commissions either to the creditor as a licensed agent or broker controlled
				  or owned by the creditor instead of on the basis or reasonable cost for the
				  protection provided to the consumer, the debtor. This results in "reverse
				  competition" which, unless properly controlled through the regulation of the
				  premium rates charged to the debtor and the amount of compensation received by
				  the creditor, agents and brokers results in inequitable insurance premium
				  charges to debtors which are unreasonably high and not reasonable in relation
				  to the premium charged for the insurance benefits received by debtors, and
				  constitute provisions which are unjust, inequitable and unfair.
(d) These regulations are promulgated
				  pursuant to Section
				  779.21 of
				  the Insurance Code and apply to credit life insurance and credit disability
				  insurance which is subject to the subject to the provisions of Article 5.9,
				  Chapter 1, Part 2, Division 1, of the Insurance Code.
1. Repealer
					 of article 6.7 (sections
					 2248.1-2248.25, consecutive) and
					 new article 6.7 (sections
					 2248-2248.20, consecutive) filed
					 12-29-78; designated effective 4-1-79 (Register 79, No. 2). For prior history,
					 see Registers 73, No. 22; 70, No. 18.
2. Amendment of article
					 heading filed 4-14-94; operative 5-18-94. Submitted to OAL for printing only
					 pursuant to Government Code section
					 11343(a)(1)
					 (Register 94, No. 15).
Note: Authority cited: Section
						779.41,
						California Insurance Code.