reglab/statecodes huggingface dataset:
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 20 - Standards Applicable to Workers' Compensation Claims Adjusters and Medical Billing Entities and Certification of those Standards by Insurers › Section 2592.09 - Insurer Annual Certification Form-Medical Bill Reviewers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
ANNUAL CERTIFICATION OF MEDICAL BILL
					 REVIEWERS
To the Insurance Commissioner of the State of California
					 Pursuant to California Insurance Code Section
					 11761 and
					 California
Code of Regulations, Title 10, Sections
					 2592.04 and
					 2592.07
As the person or officer responsible for the claims
					 operation of:
______________________________
(Name of Insurer)
[] Insurance Company
[] Self-Insured
								Employer
[] Third-Party
								Administrator
(Check One)
I hereby certify the following regarding California
					 workers' compensation claims:
1. The total number of medical bill reviewers
				  reviewing medical bills on this insurer's behalf is: __________.
2. The total number of experienced or trained
				  medical bill reviewers reviewing medical bills on this insurer's behalf is:
				  __________.
3. The percentage of
				  experienced or trained medical bill reviewers reviewing medical bills on this
				  insurer's behalf is: __________%
4.
				  All persons reviewing medical bills on behalf of this insurer are designated to
				  do so or are in training.
5. The
				  course of instruction provided for training of all medical bill reviewers of
				  this insurer and of medical billing entities used by this insurer meets all
				  requirements set forth in Article 20 (commencing with section
				  2592) of Subchapter 3, Chapter 5,
				  Title 10, California Code of Regulations, and that all medical bill reviewers
				  of this insurer and of medical billing entities used by this insurer have
				  attended training for the required number of hours to be qualified to perform
				  medical bill review.
I certify under the penalty of perjury under the laws
					 of the State of California that the foregoing is true and
					 correct:
___________________________
___________________________
(Date and Place)
(Signature)
Name of person certifying (print or type):
Title of person certifying:
Business address:
1. New
					 section filed 1-23-2006; operative 2-22-2006 (Register 2006, No.
					 4).
Note: Authority cited: Section
						11761,
						Insurance Code. Reference: Section
						11761,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 20 - Standards Applicable to Workers' Compensation Claims Adjusters and Medical Billing Entities and Certification of those Standards by Insurers › Section 2592.10 - Designation-Claims Adjuster and Medical-Only Claims Adjuster

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
CLAIMS ADJUSTER or MEDICAL-ONLY CLAIMS ADJUSTER
					 DESIGNATION
This Designation is awarded to
______________________________
(Adjuster's Name)
for:
[]
Claims
								Adjuster
[]
Medical-Only Claims Adjuster
(Check Only One)
as a result of successfully completing the required
					 hours for workers' compensation training pursuant to California Insurance Code
					 Section
					 11761 and
					 California Code of Regulations, Title 10, Sections
					 2592.02 and
					 2592.03
Total Hours of Training Completed:
__________
Designation Given By:
______________________________
(Name of Insurance Company, Self-Insured Employer, or
					 Third-Party Administrator)
___________________________
___________________________
(Date)
(Signature)
Name of person awarding designation (print or type):
Title of person awarding designation:
Business address:
1. New
					 section filed 1-23-2006; operative 2-22-2006 (Register 2006, No.
					 4).
Note: Authority cited: Section
						11761,
						Insurance Code. Reference: Section
						11761,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 20 - Standards Applicable to Workers' Compensation Claims Adjusters and Medical Billing Entities and Certification of those Standards by Insurers › Section 2592.11 - Designation-Medical Bill Reviewer

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
MEDICAL BILL REVIEWER DESIGNATION
This Designation is awarded to
______________________________
(Medical Bill Reviewer's Name)
for Medical Bill Reviewer Training
as a result of successfully completing the required
					 hours for workers' compensation training pursuant to California Insurance Code
					 Section
					 11761 and
					 California Code of Regulations, Title 10, Section
					 2592.04
Total Hours of Training Completed:
____________
Designation Given By:
______________________________
(Name of Insurer or Medical Billing Entity)
___________________________
___________________________
(Date)
(Signature)
Name of person awarding designation (print or type):
Title of person awarding designation:
Business address:
1. New
					 section filed 1-23-2006; operative 2-22-2006 (Register 2006, No.
					 4).
Note: Authority cited: Section
						11761,
						Insurance Code. Reference: Section
						11761,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 20 - Standards Applicable to Workers' Compensation Claims Adjusters and Medical Billing Entities and Certification of those Standards by Insurers › Section 2592.12 - Designation-Experienced Claims Adjuster and Medical-Only Claims Adjuster

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
EXPERIENCED CLAIMS ADJUSTER OR EXPERIENCED
					 MEDICAL-ONLY CLAIMS ADJUSTER DESIGNATION
This Designation is awarded to
______________________________
(Adjuster's Name)
for:
[]
Experienced Claims
					 Adjuster
[]
Experienced Medical-Only Claims
					 Adjuster
(Check Only One)
as a result of meeting the experience requirements
					 for workers' compensation claims experience pursuant to California Insurance
					 Code Section
					 11761 and
					 California Code of Regulations, Title 10, Sections
					 2592.01 and
					 2592.05
Total Years of California Experience At Time of
					 Designation:
____________
and/or Date Completed Examination
					 Pursuant to Title 8, CCR Section
					 15452:
____________
Designation Given By:
______________________________
(Name of Insurance Company, Self-Insured Employer, or
					 Third-Party Administrator)
___________________________
___________________________
(Date)
(Signature)
Name of person awarding designation (print or type):
Title of person awarding designation:
Business address:
1. New
					 section filed 1-23-2006; operative 2-22-2006 (Register 2006, No.
					 4).
Note: Authority cited: Section
						11761,
						Insurance Code. Reference: Section
						11761,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 20 - Standards Applicable to Workers' Compensation Claims Adjusters and Medical Billing Entities and Certification of those Standards by Insurers › Section 2592.13 - Designation-Experienced Medical Bill Reviewer

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
EXPERIENCED MEDICAL BILL REVIEWER
					 DESIGNATION
This Designation is awarded to
______________________________
(Medical Bill Reviewer's Name)
for Experienced Medical Bill Reviewer
as a result of meeting the requirements for workers'
					 compensation medical bill reviewing experience pursuant to California Insurance
					 Code Section
					 11761 and
					 California Code of Regulations, Title 10, Sections
					 2592.01 and
					 2592.05
Total Years of California Experience At Time of
					 Designation: ____________
Designation Given By:
______________________________
(Name of Insurer or Medical Billing Entity)
___________________________
___________________________
(Date)
(Signature)
Name of person awarding designation (print or type):
Title of person awarding designation:
Business address:
1. New
					 section filed 1-23-2006; operative 2-22-2006 (Register 2006, No.
					 4).
Note: Authority cited: Section
						11761,
						Insurance Code. Reference: Section
						11761,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 20 - Standards Applicable to Workers' Compensation Claims Adjusters and Medical Billing Entities and Certification of those Standards by Insurers › Section 2592.14 - Post-Designation Training Form

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
POST-DESIGNATION TRAINING FORM
______________________________
(Adjuster's or Medical Bill Reviewer's Name)
[]
Claims Adjuster
[]
Medical-Only
					 Claims Adjuster
[]
Medical Bill Reviewer
(Check Only One)
has successfully completed the post-designation
					 workers' compensation training and hours noted below pursuant to California
					 Insurance Code Section
					 11761 and
					 California Code of Regulations, Title 10, Sections
					 2592.02,
					 2592.03,
					 2592.04, and
					 2592.05
Name and Topic of Post-Designation Training Taken:
______________________________
Total Hours of Post-Designation Training Completed:
					 ____________
Date of Post-Designation Training: _______________
Post-Designation Training Verified By:
______________________________
(Name of Insurer or Medical Billing Entity)
___________________________
___________________________
(Date)
(Signature)
Name of person awarding designation (print or type):
Title of person awarding designation:
Business address:
1. New
					 section filed 1-23-2006; operative 2-22-2006 (Register 2006, No.
					 4).
Note: Authority cited: Section
						11761,
						Insurance Code. Reference: Section
						11761,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 21 - Workers' Compensation Rating Organization Internet Web Sites › Section 2593 - Authority and Purpose

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The regulations set forth in this article are required to
					 carry out the provisions of Section
					 11752.75 of Article 3 of Chapter 3
					 of Part 3 of Division 2 of the Insurance Code. The purpose of these regulations
					 is to provide the standards required to allow a person to submit a query on a
					 rating organization's Internet Web site for workers' compensation insurance
					 coverage information concerning a specified employer on a specified date and to
					 allow for employers to dispute with the rating organization or the employer's
					 insurance company incorrect information displayed on the Internet Web
					 site.
1. New
					 article 21 (sections
					 2593-2593.7) and section filed
					 2-10-2011; operative 3-12-2011 (Register 2011, No.
					 6).
Note: Authority cited: Section
						11752.75,
						Insurance Code. Reference: Section
						11752.75,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 21 - Workers' Compensation Rating Organization Internet Web Sites › Section 2593.1 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
For purposes of this Article:
(a) "Coverage Information" means the name of
				  the employer, the employer's address or other identifying information, the date
				  specified in the query for coverage information, and the name of the insurer on
				  the date specified in the query for the coverage information.
(b) "Employer" means the person or entity
				  that is a named insured on the workers' compensation insurance policy for which
				  a query regarding coverage information is being made.
(c) "FEIN" means Federal employer
				  identification number.
(d)
				  "Insurer" means a California admitted workers' compensation insurance company
				  that provided workers' compensation coverage to the specified employer on the
				  specified date.
(e) "Policy" means
				  a workers' compensation insurance policy issued by a California admitted
				  workers' compensation insurance company.
(f) "Policy Information" means workers'
				  compensation insurance policy data reported by a California admitted insurance
				  company to a rating organization.
(g) "Query" means an inquiry on the rating
				  organization's insurance coverage Internet Web site regarding workers'
				  compensation coverage information for a specified employer on a specified
				  date.
1. New
					 section filed 2-10-2011; operative 3-12-2011 (Register 2011, No.
					 6).
Note: Authority cited: Section
						11752.75,
						Insurance Code. Reference: Section
						11752.75,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 21 - Workers' Compensation Rating Organization Internet Web Sites › Section 2593.2 - Employer Query Identifying Information

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A query shall allow for, but is not limited to, the
					 following identifying information on an employer to inquire about the
					 employer's coverage information on a specified date: Name of the employer; Name
					 of the employer and a full or partial address of the employer, including, but
					 not limited to, street name, city, and state; or FEIN.
1. New
					 section filed 2-10-2011; operative 3-12-2011 (Register 2011, No.
					 6).
Note: Authority cited: Section
						11752.75,
						Insurance Code. Reference: Section
						11752.75,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 21 - Workers' Compensation Rating Organization Internet Web Sites › Section 2593.3 - Web Site Access Restrictions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  A rating organization may establish protocols, rules, or other limitations and
				  restrictions on its coverage Internet Web site to limit access to information
				  concerning employer workers' compensation insurance coverage so as to allow for
				  only queries for a specified employer on a specified date.
(b) The coverage Internet Web site shall
				  prohibit the automated retrieval of information and shall give clear notice on
				  the Internet Web site of this prohibition.
(c) The rating organization shall limit a
				  person's use of the coverage Internet Web site to prevent unlimited or multiple
				  queries of the information that could be used to determine policy inception or
				  expiration dates or policy numbers or used for other purposes for which it was
				  not intended by employing reasonable security or authentication measures to
				  prevent multiple or automated retrieval of employer coverage information while
				  not hindering the public's access to it. Such measures may include limiting the
				  amount of time a person may use the Web site, limiting the number of queries in
				  a single session, employing a challenge-response system, or any other criteria
				  that meets generally accepted industry practices for limiting access to
				  information on a Web site.
(d) The
				  rating organization shall limit query results to identify as best as possible
				  the specified employer being sought and to avoid query results that may list
				  employers related by other criteria, such as employer safety groups or clients
				  of labor contractors and professional employer organizations.
(1) When an employer is being queried for by
				  using the employer's name, only employers with similar names or a portion of
				  that name may be displayed as a result of the query.
(2) When an employer is being queried for by
				  FEIN, only the employer associated with that FEIN may be displayed as a result
				  of the query.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 21 - Workers' Compensation Rating Organization Internet Web Sites › Section 2593.4 - Disclaimers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The rating
				  organization may provide disclaimers in its coverage Internet Web site
				  regarding the limitations or deficiencies of the coverage information available
				  on the Internet Web site or the policy information it collects from
				  insurers.
(b) In addition to the
				  disclaimers required pursuant to Insurance Code Section
				  11752.75,
				  the rating organization shall also provide disclaimers regarding the following:
(1) The result of a query is not evidence or
				  verification of workers' compensation insurance coverage, which should be
				  obtained from or verified by the insurer directly.
(2) The results of a query should be
				  confirmed both with the employer and the insurer before it is used for any
				  purpose.
(3) Coverage information
				  may not be available or complete for all employers due to limitations with the
				  policy information, such as similar or duplicate employer names, multiple or
				  alternate locations and addresses for employers, or more than one named insured
				  employer on an insurance policy.
(4) The coverage Internet Web site may only
				  provide coverage information for five years prior to the date of the
				  query.
(5) If employer coverage
				  information is not found on the coverage Internet Web site it may be due to the
				  employer being self-insured, and inquiries concerning self-insured employers
				  should be directed to the California Office of Self Insurance
				  Plans.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 21 - Workers' Compensation Rating Organization Internet Web Sites › Section 2593.5 - Updating Coverage Information

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The rating organization shall post, update, or correct
					 coverage information for an employer on its coverage Internet Web site in a
					 timely manner following the submission of the policy information by insurers.
					 The time to post, update, or correct the information on the web site shall not
					 be more than thirty (30) days from the time the information is received from
					 the insurer.
1. New
					 section filed 2-10-2011; operative 3-12-2011 (Register 2011, No.
					 6).
Note: Authority cited: Section
						11752.75,
						Insurance Code. Reference: Section
						11752.75,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 21 - Workers' Compensation Rating Organization Internet Web Sites › Section 2593.6 - Disputes

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An employer may
				  dispute the accuracy of its coverage information displayed on a rating
				  organization's Internet Web site by either contacting the insurer who provided
				  the policy information for the coverage period or contacting the rating
				  organization.
(b) If the insurer is
				  contacted by an employer regarding the accuracy of its coverage information
				  displayed on the rating organization's coverage Internet Web site, the insurer
				  shall have thirty (30) days from the date it receives the employer's dispute to
				  review and respond to the employer in writing and, if applicable, to provide
				  corrected policy information to the rating organization. The response to the
				  employer shall include the following:
(1)
				  Whether or not the coverage information is accurate and, if applicable, any
				  corrections that are being made.
(2) The name and contact information of the
				  representative of the insurer who handled the dispute.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 21 - Workers' Compensation Rating Organization Internet Web Sites › Section 2593.7 - Statistics to be Maintained by the Rating Organization

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The rating organization shall maintain statistics on usage,
					 user complaints, and employer complaints or disputes to the rating organization
					 or insurers concerning coverage information, along with any resulting
					 correction of the policy or coverage information by the insurer or the rating
					 organization for the coverage Internet Web site, to provide the necessary
					 information to the insurance commissioner to monitor, evaluate, and report on
					 whether the coverage Internet Web site is achieving its intended
					 purpose.
1. New
					 section filed 2-10-2011; operative 3-12-2011 (Register 2011, No.
					 6).
Note: Authority cited: Section
						11750.3,
						11751.1 and
						11752.75,
						Insurance Code. Reference: Section
						11752.75,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 22 - Essential Health Benefits › Section 2594.1 - Scope of Article

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  This article shall apply to the following:
(1)
				  An individual or small group health insurance policy which is issued, amended,
				  or renewed on or after January 1, 2017, regardless of whether the health
				  insurance policy is sold on the Exchange or outside of the Exchange.
(2) To the extent applicable, an individual
				  or small group specialized health insurance policy that covers the pediatric
				  oral essential health benefit which is issued, amended, or renewed on or after
				  January 1, 2017, regardless of whether it is an excepted benefit policy under
				  subdivision (b)(2) of this section.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 22 - Essential Health Benefits › Section 2594.2 - Mandatory Coverage and Standards

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An individual or small group health
				  insurance policy shall, at a minimum, provide coverage for essential health
				  benefits, as defined in subdivision (a) of Insurance Code section
				  10112.27
				  and section
				  2594.3 of this article.
(b) An individual or small group health
				  insurance policy shall, at a minimum, provide coverage for essential health
				  benefits that is substantially equal to the health benefits covered by the
				  base-benchmark plan, the Medi-Cal Dental Program for pediatric oral care, and
				  the Federal Employees Dental and Vision Insurance Program plan for pediatric
				  vision care.
(c) An individual or
				  small group health insurance policy shall not impose treatment limitations on
				  essential health benefits greater than the treatment limitations imposed by the
				  base-benchmark plan, the Medi-Cal Dental Program for pediatric oral care, and
				  the Federal Employees Dental and Vision Insurance Program plan for pediatric
				  vision care. Treatment limitations in a health insurance policy subject to
				  section
				  10112.27 of
				  the Insurance Code shall comply with all other applicable laws and regulations,
				  including, but not limited to, article 15.2 of this subchapter, commencing with
				  section 2562.1.
(d) An individual or small group health
				  insurance policy shall not exclude an individual from coverage for essential
				  health benefits except that an individual who does not satisfy the eligibility
				  age for pediatric services may be excluded from the pediatric services
				  category.
(e) An individual or
				  small group health insurance policy shall not substitute benefits within
				  essential health benefit categories.
(f) An individual or small group health
				  insurance policy shall cover habilitative services and devices as follows:
(1) All habilitative services and devices
				  covered by the base-benchmark plan shall be covered.
(2) Services and devices covered by the
				  base-benchmark plan for the purpose of rehabilitation shall also be covered for
				  the purpose of habilitation.
(3)
				  The same terms and conditions applied to coverage for rehabilitative services
				  and devices shall be applied to coverage for habilitative services and
				  devices.
(4) Habilitative services
				  and devices in addition to those covered by the base-benchmark plan shall be
				  covered consistent with the definition in section
				  10112.27 of
				  the Insurance Code.
(5) Treatment
				  limitations on habilitative and rehabilitative services and devices shall not
				  be combined.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 22 - Essential Health Benefits › Section 2594.4 - Prescription Drug Coverage

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An individual or small group health
				  insurance policy shall provide coverage for prescription drugs that complies
				  with all of the following:
(1) The sections
				  of the Health and Safety Code enumerated in subdivisions (a)(2)(A)(ii) and
				  (a)(2)(A)(iv) of section
				  10112.27 of
				  the Insurance Code that apply to prescription drugs.
(2) Section
				  1300.67.24 of Title 28 of the
				  California Code of Regulations.
(3)
				  Subsection (a)(1) of section
				  156.122 of Title 45 of the Code of
				  Federal Regulations.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 22 - Essential Health Benefits › Section 2594.5 - Disclosure of Levels of Coverage for Essential Health Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
An individual or small group health insurance policy,
					 including a specialized health insurance policy that covers the pediatric oral
					 essential health benefit, shall prominently disclose the level of coverage it
					 provides.
1. New
					 section filed 6-13-2013 as an emergency; operative 6-13-2013 (Register 2013,
					 No. 24). A Certificate of Compliance must be transmitted to OAL by 12-10-2013
					 or emergency language will be repealed by operation of law on the following
					 day.
2. New section refiled 12-9-2013 as an emergency; operative
					 12-9-2013 (Register 2013, No. 50). Pursuant to Insurance Code section
					 10112.27(o)(2)
					 a Certificate of Compliance must be transmitted to OAL by 6-9-2014 or emergency
					 language will be repealed by operation of law on the following
					 day.
3. Certificate of Compliance as to 12-9-2013 order, including
					 repealer of former section
					 2594.5 and renumbering and
					 amendment of former section
					 2594.6 to section
					 2594.5, transmitted to OAL
					 1-15-2014 and filed 2-24-2014; amendments effective 2-24-2014 pursuant to
					 Government Code section
					 11343.4(b)(3)
					 (Register 2014, No. 9).
Note: Authority cited: Sections
						10112.27,
						10112.295,
						10112.297,
						12921 and
						12926,
						Insurance Code. Reference: Sections
						10112.27,
						10112.295
						and
						10112.297,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 22 - Essential Health Benefits › Section 2594.6 - Demonstration of Actuarial Value for Essential Health Benefits

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Pursuant to
				  section
				  10290 of
				  the Insurance Code, a health insurer shall submit all of the following to the
				  Commissioner together with a health insurance policy form:
(1) Either of the following:
(A) A statement of variables specifying the
				  cost sharing values for all essential health benefits subject to cost sharing
				  for each plan submitted.
(B) A
				  schedule of benefits or similar document specifying the cost sharing values for
				  all essential health benefits subject to cost sharing for each plan
				  submitted.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 22 - Essential Health Benefits › Section 2594.7 - Demonstration of Actuarial Value for the Pediatric Oral Essential Health Benefit

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Pursuant to section
				  10290 of
				  the Insurance Code, a health insurer shall submit all of the following to the
				  Commissioner together with a specialized health insurance policy form that
				  covers the pediatric oral essential health benefit:
(1) Either of the following:
(A) A statement of variables specifying the
				  cost sharing values for all pediatric oral essential health benefits subject to
				  cost sharing for each plan submitted.
(B) A schedule of benefits or similar
				  document specifying the cost sharing values for all pediatric oral essential
				  health benefits subject to cost sharing for each plan
				  submitted.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 23 - Hazardous Financial Conditions; Corrective Actions › Section 2598.1 - Purpose

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The purpose of these regulations is to set forth the
					 standards that the commissioner may use for identifying insurers found to be in
					 such condition which may render the continuance of their business hazardous to
					 their policyholders, creditors or the general public.
These regulations shall not be interpreted to limit the
					 powers granted the commissioner by any laws or parts of laws of this state, nor
					 shall this regulation be interpreted to supersede any laws or parts of laws of
					 this state.
1. New
					 article 22 (sections
					 2598.1-2598.6) and section filed
					 11-26-2013; operative 1-1-2014 pursuant to Government Code section
					 11343.4(a)
					 (Register 2013, No. 48).
2. Editorial correction renumbering article
					 22 to article 23 (Register 2014, No. 3).
Note: Authority cited: Sections
						720,
						700(c)
						and
						717,
						Insurance Code. Reference: Sections
						700(c),
						923.5,
						925.3 and
						12920,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 23 - Hazardous Financial Conditions; Corrective Actions › Section 2598.3 - Adjustments; Corrective Actions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For the purposes of making a
				  determination of an insurer's financial condition under these regulations, the
				  commissioner may:
(1) Disregard any credit or
				  amount receivable resulting from transactions with a reinsurer that is
				  insolvent, impaired or otherwise subject to a delinquency proceeding;
(2) Make appropriate adjustments including
				  disallowance to asset values attributable to investments in or transactions
				  with parents, subsidiaries or affiliates consistent with the NAIC Accounting
				  Practices And Procedures Manual, state laws and regulations;
(3) Refuse to recognize the stated value of
				  accounts receivable if the ability to collect receivables is highly speculative
				  in view of the age of the account or the financial condition of the
				  debtor;
(4) Increase the insurer's
				  liability in an amount equal to any contingent liability, pledge, or guarantee
				  not otherwise included if there is a substantial risk that the insurer will be
				  called upon to meet the obligation undertaken within the next twelve-month
				  period.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 23 - Hazardous Financial Conditions; Corrective Actions › Section 2598.4 - Power of the Commissioner

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Nothing herein shall be construed as limiting the
					 commissioner's exercise of any power or remedy vested in the commissioner under
					 the Insurance Code.
1. New
					 section filed 11-26-2013; operative 1-1-2014 pursuant to Government Code
					 section
					 11343.4(a)
					 (Register 2013, No. 48).
Note: Authority cited: Section
						720,
						Insurance Code. Reference: Section
						720,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 23 - Hazardous Financial Conditions; Corrective Actions › Section 2598.5 - Judicial Review

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Any order or decision of the commissioner shall be subject
					 to review in accordance with Section
					 12940 of
					 the Insurance Code.
1. New
					 section filed 11-26-2013; operative 1-1-2014 pursuant to Government Code
					 section
					 11343.4(a)
					 (Register 2013, No. 48).
Note: Authority cited: Sections
						720 and
						12940,
						Insurance Code. Reference: Section
						12940,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 3 - Insurers › Article 23 - Hazardous Financial Conditions; Corrective Actions › Section 2598.6 - Severability

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
If any provisions of this regulation be held invalid, the
					 remainder shall not be affected.
1. New
					 section filed 11-26-2013; operative 1-1-2014 pursuant to Government Code
					 section
					 11343.4(a)
					 (Register 2013, No. 48).
Note: Authority cited: Section
						720,
						Insurance Code. Reference: Section
						720,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 4 - Insurer Securities Permits › Article 1 - General Provisions › Section 2600 - Authority for Regulations

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
These regulations are promulgated pursuant to the
					 rule-making power conferred upon the Insurance Commissioner by the Legislature
					 in Section
					 843 of the
					 Insurance Code (formerly Political Code Section
					 594 c; Chapter 730, page 1355,
					 Stats. 1929). Any express statutory basis for each regulation is cited either
					 at the end of each section hereof or after that portion of a section to which
					 it particularly relates, whichever is more appropriate. All statutory
					 references herein are to the California Insurance Code unless otherwise
					 stated.
1. Repealer
					 of former Subchapter 4 (Sections
					 2600 through
					 2680) and new Subchapter 4 (2600,
					 2601, 2601-2601.04, 2602.01-2602.09, 2603.01-2603.21, 2604.01-2604.07,
					 2605.01-2605.06, 2606.01-2606.03, 2607.01-2607.06, 2608.01-2608.08,
					 2609.01-2609.08, 2610.01-2610.03, 2611.01-2611.03, 2612.01-2612.05,
					 2613.01-2613.08) filed 12-1-66; effective thirtieth day thereafter (Register
					 66, No. 42). For history of former Subchapter 4, see Registers 58, No. 17, and
					 59, Nos. 2 and 3.
Note: Authority cited for new Subchapter 4: Section
						843,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 4 - Insurer Securities Permits › Article 1 - General Provisions › Section 2601 - Citation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
These regulations may be referred to and cited as the
					 Insurer Securities Permit Regulations; the abbreviated citation is
					 ISPR.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 4 - Insurer Securities Permits › Article 1 - General Provisions › Section 2601.01 - Purpose

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The object of these regulations is to provide in a readily
					 accessible form for the guidance and assistance of all who are subject to,
					 practice under or administer the Insurance Securities Law the principal
					 requirements of substance and procedure governing applications for and the
					 granting of insurer securities permits.
It is impossible to foresee every contingency and provide a
					 regulation in anticipation thereof. These regulations are designed to be
					 applied to the situations most frequently arising under that portion of the
					 Insurance Securities Law governing applications for and issuance of insurer
					 securities permits. They shall not contravene or curtail any statute.
					 Furthermore, the duties and discretion of the Insurance Commissioner conferred
					 upon the Insurance Commissioner by statute in administering the Insurance
					 Securities Law are not and cannot be exhausted by these regulations. Each
					 application will continue to be analyzed individually and judged on its own
					 merits, in the lawful discretion of the Commissioner, after application of the
					 provisions of the Insurance Securities Law.
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 4 - Insurer Securities Permits › Article 1 - General Provisions › Section 2601.02 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A. "Commissioner"
				  means the Insurance Commissioner of the State of California (Section
				  20)
B. "Department" means the Insurance
				  Department of the State of California as constituted by statute. (Sections
				  21 and
				  12906)
C. "Insurer" for the purpose of these rules
				  includes every organization organized for the purpose of assuming the risk of
				  loss under contracts of insurance or reinsurance, and also includes any of the
				  following organizations:
1. An admitted
				  insurer;
2. A nonadmitted domestic
				  insurer;
3. A nonadmitted foreign
				  insurer;
4. A nonadmitted alien
				  insurer;
5. An underwritten title
				  company, or an organization organized for the purpose of doing an underwritten
				  title business, whether licensed or not;
6. An attorney-in-fact of a reciprocal or
				  interinsurance exchange, whether it be admitted or not, or an organization
				  organized for the purpose of acting as the attorney-in-fact of a reciprocal or
				  interinsurance exchange, whether the same be admitted or not;
				  and
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 4 - Insurer Securities Permits › Article 1 - General Provisions › Section 2601.03 - Terminology in General

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Unless the context otherwise requires, the terminology and
					 nomenclature used throughout these rules are the same as in the Insurance Code
					 of the State of California. See especially Sections
					 1 to
					 42, inclusive, ib. containing
					 definitions; also Sections
					 101 to
					 123 ib. defining classes of
					 insurance. Words of art are used with the meaning currently attributable to
					 them in the insurance industry.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 4 - Insurer Securities Permits › Article 1 - General Provisions › Section 2601.04 - Offices

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Insurance Code Section
					 12905
					 specifies that "The commissioner shall maintain offices in Sacramento, Los
					 Angeles, San Diego, and the San Francisco Bay area." Office addresses of the
					 Department are:
1901 HARRISON STREET, 3RD FLOOR MAILROOM
OAKLAND, CA 94612
300 SOUTH SPRING STREET, SOUTH TOWER
LOS ANGELES, CALIFORNIA 90013
300 CAPITOL MALL, SUITE 1700
SACRAMENTO, CALIFORNIA 95814
10021 WILLOW CREEK ROAD, SUITE 100
SAN DIEGO, CALIFORNIA 92131
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 8-27-2020 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2020, No. 35).
Note: Authority cited: Section
						843,
						Insurance Code. Reference: Sections
						820-
						860,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 4 - Insurer Securities Permits › Article 2 - The Insurance Securities Law (Insurance Code Sections 820-860) › Section 2602.01 - Stock Permit Jurisdiction

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The insurance Securities Law applies to the original issue
					 of their own securities anywhere (including sale of treasury stock) by domestic
					 insurers. It applies to foreign and alien admitted and nonadmitted insurers
					 alike wherever acts concerning the original issue of their own securities to
					 which jurisdiction of this sovereign state attaches are performed within the
					 state. It also forbids certain secondary sales as hereinafter explained. Except
					 as provided by Insurance Code Sections
					 845,
					 12393 and
					 12395, and
					 Financial Code Sections
					 350-
					 407
					 (especially Sec.
					 402) with respect to a title
					 insurer doing or preparing to do a trust business, there is not an overlapping
					 or dual jurisdiction with any other agency. If the applicant is an "insurer"
					 and if it is to "offer for sale, negotiate for the sale of, or take
					 subscriptions for any security of its own issue" (except upon a sale pursuant
					 to Sections
					 2700 et seq., Corporations Code,
					 for delinquent assessment) within the meaning of Section
					 827, the Corporate Securities Law
					 does not apply. See Corporations Code Section
					 25100(h).
					 Underwritten title companies, attorneys-in-fact for reciprocals, and exclusive
					 management corporations for domestic insurers are included in the definition of
					 "insurer." Refer to Insurance Code Section
					 826 and to
					 Section 2601.02 C, supra, for definition.
					 Choice of the wrong agency for issuance of insurer security permits will
					 apparently result in issue of void securities, according to statute (Sections
					 826,
					 827,
					 831 and Corporations Code Section
					 25100(h)),
					 unless and until such issue is subsequently validated by legislative
					 act.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 4 - Insurer Securities Permits › Article 2 - The Insurance Securities Law (Insurance Code Sections 820-860) › Section 2602.02 - Secondary Sales of Securities

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Section
					 845 of the
					 Insurance Code prohibits sale or resale of any security of a domestic, foreign,
					 or alien insurer (as "insurer" is defined by Section
					 826 ib.; compare Paragraph C of
					 Section 2601.02 of these regulations) as
					 an agent of an insurer, as a broker or an agent of a broker, except under the
					 authority therein specified; and it describes the conditions under which resale
					 by a bona fide owner is valid.
The statute provides:
845.
(a) No person
				  may sell or resell any security of a domestic, foreign, or alien insurer:
(1) As an insurer with respect to securities
				  of its own issue without securing the permit of the Commissioner as provided in
				  this article.
(2) As an agent of
				  such insurer except under authority of a certificate issued by the Commissioner
				  under this code.
(3) As a broker or
				  as an agent for a broker except under authority of a certificate or license
				  issued by the Commissioner of Corporations under the provisions of the
				  Corporations Code and in full conformity with all provisions of the
				  Corporations Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 4 - Insurer Securities Permits › Article 2 - The Insurance Securities Law (Insurance Code Sections 820-860) › Section 2602.03 - Secondary Sales by Person Acting as an Agent, Broker, or Agent of a Broker. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Repealer
					 filed 12-20-67; effective thirtieth day thereafter (Register 67. No.
					 51).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 4 - Insurer Securities Permits › Article 2 - The Insurance Securities Law (Insurance Code Sections 820-860) › Section 2602.04 - Where Applicable

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Insurance Securities Law (Insurance Code Sections
					 820-
					 860)
					 literally applies and requires the Commissioner's permit for any of the
					 following to be done in this State: solicitation, sale or issuance of its
					 securities by any insurer when such sale is an original issue not a secondary
					 sale. Refer to Code Sections
					 821.5,
					 822,
					 827, and Opinion of California
					 Attorney General No. 50/70, June 22, 1951, 17 Opinions California Attorney
					 General 217, the cases cited therein and any subsequent decisions bearing on
					 the subject. In addition, the matter of "commercial domicile" of a foreign
					 corporation in this State may be determinative. See
Western Air
					 Lines
vs.
Sobieski
(2nd District Court of
					 Appeals--4/20/61), 12 Cal. Rptr. 719, 191 Cal. App. 2d 399.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 4 - Insurer Securities Permits › Article 2 - The Insurance Securities Law (Insurance Code Sections 820-860) › Section 2602.05 - When Permit Required-in General

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A permit is necessary for the sale by an insurer in this
					 state of its treasury shares. A permit is required of domestic insurers, but is
					 not normally required of foreign insurers, for stock splits, stock dividends,
					 and amending articles of incorporation so as to change the rights, preferences
					 and privileges or restrictions on outstanding securities. (There is no
					 provision in the Insurance Securities Law comparable to subparagraphs (a)
					 through (d) of Corporations Code Section
					 25500.)
					 Insurers are further advised that in the opinion of this Department a permit is
					 required where any of the following to be done by or on behalf of an insurer in
					 connection with the original issue of its own securities will take place within
					 the state: solicitation of the sale and purchase of a security; any act
					 essential to sale or issuance of a security. Reference is suggested to the
					 relevant court decisions, including
Western Air Lines
vs.
Sobieski
, 12 Cal. Rptr. 719, 191 Cal. App. 2d 399. (Secs.
					 821.5,
					 822,
					 827,
					 17 Ops. Cal. Atty. Gen.
					 217.)