reglab/statecodes huggingface dataset:
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 7 - Workers' Compensation Policy Forms › Section 2266 - Submission of the Customized Limiting and Restricting Endorsement

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
An insurer shall file the customized limiting and
					 restricting endorsement with the rating organization in accordance with Section
					 2267, along with a detailed cover
					 letter that identifies:
(a) The policy
				  to which the endorsement will be attached upon approval, and
(b) The circumstances that justify use of the
				  endorsement.
The rating organization shall submit the endorsement to the
					 Insurance Commissioner for approval or disapproval upon receipt of all required
					 documents and shall forward copies of the endorsement and cover letter to the
					 policyholder and to the Department of Industrial Relations. An insurer shall
					 not use a limiting and restricting endorsement unless it complies with Section
					 2257(c).
1. Amendment
					 filed 10-4-60; designated effective 1-1-61 (Register 60, No. 21). (Ed. note:
					 Similar to former Section
					 2262.)
2. Amendment and
					 renumbering of Section
					 2265 filed 9-18-67; designated
					 effective with respect to all policies and endorsements with an effective date
					 falling on or after April 1, 1968 (Register 67, No. 38).
3.
					 Amendment filed 5-6-77 as procedural and organizational; effective upon filing
					 (Register 77, No. 19).
4. Amendment of section heading, repealer and
					 new section and amendment of NOTE filed 2-2-2016; operative 4-1-2016 (Register
					 2016, No. 6).
Note: Authority cited: Sections
						11657,
						11658,
						11659 and
						12921(a),
						Insurance Code. Reference: Sections
						11650,
						11651,
						11652,
						11653,
						11654,
						11655,
						11656,
						11656.7,
						11656.8,
						11656.9,
						11657,
						11658.5,
						11660,
						11661,
						11661.5,
						11661.6,
						11662,
						11663,
						11664,
						11734,
						11736 and
						11751.5,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 7 - Workers' Compensation Policy Forms › Section 2268 - Unlawful Use of Policy Forms, Endorsement Forms, or Ancillary Agreements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) An insurer
				  shall not use any policy form, endorsement form, or ancillary agreement unless
				  attached to and made a part of the policy. If an insurer attaches a policy or
				  endorsement form that restricts or limits the coverage of the policy, it shall
				  conform in all respects with these rules.
(b) An insurer shall not use a policy form,
				  endorsement form, or ancillary agreement except those filed and approved by the
				  Commissioner in accordance with these regulations.
(c) An insurer shall not use a policy form,
				  endorsement form, or ancillary agreement that does not conform to the
				  regulations set forth in this Article or Insurance Code Sections
				  11657,
				  11658 or
				  11659. An
				  insurer that fails to comply with this regulation is in violation of Insurance
				  Code Sections
				  11657,
				  11658 or
				  11659 and
				  therefore, is in violation of Section
				  700(c). Such an
				  insurer shall be subject to proceedings pursuant to Sections
				  701,
				  704(b) and
				  1065.1. Each occurrence of a
				  violation to each insured shall constitute a separate and distinct violation
				  for purposes of this regulation.
1. Amendment
					 filed 10-4-60; designated effective 1-1-61 (Register 60, No. 21). (Ed. note:
					 Same as former Section
					 2265.)
2. Renumbering
					 of Section
					 2267 filed 9-18-67; designated
					 effective with respect to all policies and endorsements with an effective date
					 falling on or after April 1, 1968 (Register 67, No. 38).
3.
					 Amendment of section heading and section and new NOTE filed 2-2-2016; operative
					 4-1-2016 (Register 2016, No. 6).
Note: Authority cited: Sections
						720,
						1065.1,
						11658,
						11752.6,
						11752.8 and
						12921(a),
						Insurance Code. Reference: Sections
						704.7,
						790.03,
						1011(e),
						11657,
						11658,
						11659,
						11752.6 and
						11752.8,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 7 - Workers' Compensation Policy Forms › Section 2269 - Policy Forms; Endorsement Forms; Ancillary Agreements; Confidentiality

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
An insurer or a rating organization may submit a written
					 request to prevent public access to a policy form, endorsement form, ancillary
					 agreement, or other related writing that has been submitted to the Insurance
					 Commissioner.
(a) The insurer or the
				  rating organization shall provide the basis upon which each document submitted
				  should be withheld from public access, along with the time period during which
				  each document should be withheld.
(b) The Insurance Commissioner shall base the
				  determination on the nature of the information including, but not limited to,
				  information that is proprietary, privileged, or contains trade
				  secrets.
(c) The Insurance
				  Commissioner shall issue a written decision and send it to the person or entity
				  submitting the request, and it shall be final.
(d) The written request and the Insurance
				  Commissioner's written determination shall be confidential and not open to
				  public inspection.
1. New
					 section filed 2-2-2016; operative 4-1-2016 (Register 2016, No.
					 6).
Note: Authority cited: Sections
						12919 and
						12921(a),
						Insurance Code. Reference: Section
						12956,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 7 - Workers' Compensation Policy Forms › Section 2269.1 - California Approved Form Endorsement NO. 1C. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 10-4-60; designated effective 1-1-61 (Register 60, No.
					 21).
2. Amendment filed 1-21-81; effective thirtieth day thereafter
					 (Register 81, No. 4).
3. Repealer filed 2-2-2016; operative 4-1-2016
					 (Register 2016, No. 6).
Note: Authority cited: Sections
						11732,
						11732.1,
						and
						11734,
						Insurance Code. Reference: Articles 2 and 3 of Chapter 3, Part 3, Division 2,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 7 - Workers' Compensation Policy Forms › Section 2269.2 - California Approved Form Endorsement NO. 2. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 10-4-60; designated effective 1-1-61 (Register 60, No.
					 21).
2. Repealer filed 9-18-67; designated effective with respect to
					 all policies and endorsements with an effective date failing on or after April
					 1, 1968 (Register 67, No. 38).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 7 - Workers' Compensation Policy Forms › Section 2269.3 - California Approved Form Endorsement NO. 3. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 10-4-60; designated effective 1-1-61 (Register 60, No.
					 21).
2. Amendment filed 9-18-67; designated effective with respect
					 to all policies and endorsements with an effective data falling on or after
					 April 1, 1968 (Register 67, No. 38).
3. Repealer filed 12-1-78 as an
					 emergency; designated effective 1-1-79. Certificate of Compliance included
					 (Register 78, No. 48).
Note: Authority cited: Sections
						11732,
						11732.1 and
						11734,
						Insurance Code. Reference: Articles 2 and 3 of Chapter 3, Part 3, Division 2,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 7 - Workers' Compensation Policy Forms › Section 2269.4 - California Approved Form Endorsements NO. 4. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. Amendment
					 filed 10-4-60; designated effective 1-1-61 (Register 60, No. 21).
2.
					 Amendment filed 9-18-67; designated effective with respect to all policies and
					 endorsements with an effective date falling on or after April 1, 1968 (Register
					 67, No. 38).
3. Amendment filed 1-21-81; effective thirtieth day
					 thereafter (Register 81, No. 4).
4. Repealer filed 2-2-2016;
					 operative 4-1-2016 (Register 2016, No. 6).
Note: Authority cited: Sections
						11732,
						11732.1,
						and
						11734,
						Insurance Code. Reference: Articles 2 and 3 of Chapter 3, Part 3, Division 2,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 7 - Workers' Compensation Policy Forms › Section 2269.7 - California Approved Form Endorsement NO. 7. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 10-4-60; designated effective 1-1-61 (Register 60, No.
					 21).
2. Amendment filed 9-18-67; designated effective with respect
					 to all policies and endorsements with an effective date falling on or after
					 April 1, 1968 (Register 67, No. 38).
3. Amendment filed 1-21-81;
					 effective thirtieth day thereafter (Register 81, No. 4).
4.
					 Amendment filed 12-30-83; designated effective 1-1-84 pursuant to Government
					 Code Section
					 11346.2(d)
					 (Register 84, No. 1).
5. Repealer filed 2-2-2016; operative 4-1-2016
					 (Register 2016, No. 6).
Note: Authority cited: Sections
						11659,
						11732,
						11732.1 and
						11734,
						Insurance Code. Reference: Sections
						11657,
						11658 and
						11659 and, Articles 2 and 3 of
						Chapter 3, Part 3, Division 2, Insurance
						Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 7 - Workers' Compensation Policy Forms › Section 2269.9 - California Approved Form Endorsement NO. 9. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 10-4-60; designated effective 1-1-61 (Register 60, No.
					 21).
2. Repealer filed 9-18-67; designated effective with respect to
					 all policies and endorsements with an effective date falling on or after April
					 1, 1968 (Register 67, No. 38).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 7 - Workers' Compensation Policy Forms › Section 2269.10 - California Approved Form Endorsement NO. 10. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 10-4-60; designated effective 1-1-61 (Register 60, No.
					 21).
2. Amendment filed 9-18-67; designated effective with respect
					 to all policies and endorsements with an effective date falling on or after
					 April 1, 1968 (Register 67, No. 38).
3. Amendment filed 1-21-81;
					 effective thirtieth day thereafter (Register 81, No. 4).
4. Repealer
					 filed 2-2-2016; operative 4-1-2016 (Register 2016, No.
					 6).
Note: Authority cited: Sections
						11732,
						11732.1,
						and
						11734,
						Insurance Code. Reference: Articles 2 and 3 of Chapter 3, Part 3, Division 2,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 7 - Workers' Compensation Policy Forms › Section 2269.11 - California Approved Form Endorsement NO. 11. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 10-4-60; designated effective 1-1-61 (Register 60, No.
					 21)
2. Amendment filed 9-18-67; designated effective with respect to
					 all policies and endorsements with an effective date falling on or after April
					 1, 1968 (Register 67, No. 38).
3. Amendment filed 1-21-81; effective
					 thirtieth day thereafter (Register 81, No. 4).
4. Repealer filed
					 2-2-2016; operative 4-1-2016 (Register 2016, No.
					 6).
Note: Authority cited: Sections
						11732,
						11732.1,
						and
						11734,
						Insurance Code. Reference: Articles 2 and 3 of Chapter 3, Part 3, Division 2,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 7 - Workers' Compensation Policy Forms › Section 2269.12 - California Approved Form Endorsement NO. 12. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 104-60; designated effective 1-1-61 (Register 60, No.
					 21).
2. Repealer filed 9-18-67; designated effective with respect to
					 all policies and endorsements with an effective date falling on or after April
					 1, 1968 (Register 67, No. 38).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 7 - Workers' Compensation Policy Forms › Section 2269.13 - California Approved Form Endorsement NO. 13. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 10-4-60; designated effective 1-1-61 (Register 60, No.
					 21).
2. Amendment filed 9-18-67; designated effective with respect
					 to all policies and endorsements with an effective date falling on or after
					 April 1, 1968 (Register 67, No. 38).
3. Amendment filed 1-21-81;
					 effective thirtieth day thereafter (Register 81, No. 4).
4. Repealer
					 filed 2-2-2016; operative 4-1-2016 (Register 2016, No.
					 6).
Note: Authority cited: Sections
						11732,
						11732.1,
						and
						11734,
						Insurance Code. Reference: Articles 2 and 3 of Chapter 3, Part 3, Division 2,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 7 - Workers' Compensation Policy Forms › Section 2269.14 - California Approved Form Endorsement NO. 14. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 10-4-60; designated effective 1-1-61 (Register 60, No.
					 21).
2. Amendment filed 9-18-67; designated effective with respect
					 to all policies and endorsements with an effective date falling on or after
					 April 1, 1968 (Register 67, No. 38).
3. Amendment filed 1-21-81;
					 effective thirtieth day thereafter (Register 81, No. 4).
4. Repealer
					 filed 2-2-2016; operative 4-1-2016 (Register 2016, No.
					 6).
Note: Authority cited: Sections
						11732,
						11732.1,
						and
						11734,
						Insurance Code. Reference: Articles 2 and 3 of Chapter 3, Part 3, Division 2,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 7 - Workers' Compensation Policy Forms › Section 2269.15 - California Approved Form Endorsement NO. 15. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 10-4-60; designated effective 1-1-61 (Register 60, No.
					 21).
2. Repealer filed 9-18-67; designated effective with respect to
					 all policies and endorsements with an effective date falling on or after April
					 1, 1968 (Register 67, No. 38).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 8 - Surety Bonds › Section 2270 - Consideration or Premium to be Stated

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
In conformity with Attorney General's Opinion No. NS-3736,
					 it is hereby ordered that all surety bonds issued by insurers in the State of
					 California on or after October 1 1941, comply with the following
					 conditions:
(a) Such bonds shall state
				  the entire consideration or premium paid therefor.
(b) Such statement of consideration, if not
				  contained in the text of the bond, shall be attached thereto by endorsement or
				  stamped thereon prior to delivery of said bond.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 9 - Extension of Covering Notes › Section 2271 - Extension of Covering Notes

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
This article governs the extension of covering notes beyond
					 90 days from the effective date of the original covering note without the
					 written approval of the Commissioner and is for the purpose of preventing the
					 violation of any provision of the Insurance Code by such extension without such
					 written approval.
1. New 2271
					 to 2274.5 inclusive, filed 4-30-48 (Register 12, No.
					 5).
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 9 - Extension of Covering Notes › Section 2272 - Effective Date of Article

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
This article shall take effect at 12.01 a.m., Pacific
					 Standard Time, on June 1, 1948.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 9 - Extension of Covering Notes › Section 2273 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
As used in this article:
(a) The term "covering note(s)," etc.
				  includes binder, binder letters, or any similar agreement which provides
				  temporary insurance, other than a policy or certificate of insurance.
(b) The terms "extension(s)" and "renewal(s)"
				  are synonymous and includes any means by which coverage granted by a covering
				  note is kept in force other than by the issuance of a policy or certificate of
				  insurance.
(c) The terms "extend"
				  and "renew" mean the act whereby the extension or renewal of a covering note is
				  accomplished.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 9 - Extension of Covering Notes › Section 2274 - Authority to Extend Beyond 90 Days

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Any insurer may extent or renew any covering note issued by
					 it beyond 90 days from the effective date of the original cover note without
					 the written approval of the commissioner, in accordance and subject to all
					 conditions set forth in Sections
					 2274.1 to
					 2274.5, and said sections pertain
					 only to such extension or renewal.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 9 - Extension of Covering Notes › Section 2274.1 - Terms of Coverage Limited to 150 Days

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The extension or renewal may be for a period or periods
					 which, when added to the original 90-day period, will not grant coverage under
					 covering notes for a period in excess of 150 days from the effective date of
					 the original covering note.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 9 - Extension of Covering Notes › Section 2274.2 - Contents of Covering Note and Insurer's Record Prescribed

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The covering note and its extension or renewal must be in
					 writing, and the insurer must maintain a permanent record of the original
					 covering note and of all renewals or extensions thereof. Such record and the
					 covering note must contain the following:
(a) Name of the insured.
(b) The property or liability
				  insured.
(c) The amount of
				  insurance.
(d) The risks insured
				  against.
(e) The commencement and
				  termination dates of the covering note.
(f) The basis or rates upon which the final
				  premium is to be determined and paid. (If the risk falls within a definite
				  schedule of rates used by the insurer, this rule may be complied with by a
				  declaration in the note and the records that the premium will be based upon
				  such a schedule.)
(g) If the
				  extension or renewal is by a separate covering note, or if the entry in the
				  records is a separate entry, such note and/or such entry must refer to and
				  identify the original note or entry.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 9 - Extension of Covering Notes › Section 2274.3 - Policy Must be Issued; Minimum Period and Risks to be Covered by Policy Prescribed

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
At or before the expiration of the extension or renewal, or
					 at the expiration of such further extensions or renewals as may be specifically
					 granted in writing by the Insurance Commissioner, a policy of insurance must be
					 issued covering the insured, the risks bound by the covering note, and
					 commencing with the effective date of the original covering note at least the
					 period of time included in all covering notes.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 9 - Extension of Covering Notes › Section 2274.4 - Earned Premium Must be Charged: Rate May Not be Unfairly Discriminatory; when Separate Charge Need Not be Made

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
An earned premium must be charged for the insurance bound
					 by covering notes. Such earned premium shall not be unfairly discriminatory,
					 but shall be consistent with the premium rates usually used by the insurer for
					 risks of the nature of that bound by the covering note. When the policy issued
					 pursuant to Section
					 2274.3 covers not only the period
					 of time included in all of the covering notes but extends beyond the
					 termination of the last one thereof, then the earned premium may be included in
					 the premium charged under the policy and need not be charged separately
					 therefrom.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 9 - Extension of Covering Notes › Section 2274.5 - Risks Eligible for Automatic Extension Defined

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The risk to be bound under the covering note to be extended
					 or renewed must be one for which, by reason of the unavailability of an average
					 rate, the in ability to determine the value of the property, or the physical
					 inability to make a survey or inspection of the hazards, it is impossible to
					 issue an insurance policy in the ordinary course of business within 90 days. A
					 covering note binding a risk which does not fall within on of the following
					 categories shall not be eligible for automatic extension. A risk which does
					 fall within one of the following categories shall be prima facie deemed to have
					 met the requirements of this section.
(a) The property insured is in five or more
				  separate locations.
(b) The premium
				  which it is estimated the risk will develop will be:
(1) $400 or more per annum in the case of
				  fire insurance.
(2) $250 or more
				  per annum in the case of insurance other than fire.
(3) If the parties contemplate the issuance
				  of a policy with a term other than one year, then the estimated premium must be
				  at least in an amount which is either in the same ratio to the $400 or $250,
				  respectively, as the term of the policy is to one year, or, if the insurer
				  calculates its premiums for such a policy on a multiple or fraction of the
				  one-year premium, equal to such multiple or fraction of the $400 or $250,
				  respectively.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 10 - Commissioner's Review of Complaints of Unlawful Cancellation, Rescission or Nonrenewal of Health Insurance Policies › Section 2274.51 - The Request for Review

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  A request for review by the commissioner is any communication received from a
				  policyholder, certificate holder or other insured by the Department of
				  Insurance (the "Department") regarding an actual or impending nonrenewal,
				  cancellation or rescission of health insurance coverage in connection with
				  which communication the policyholder, certificate holder or other insured
				  asserts that the termination of coverage was or would be wrongful.
(b) The date of the request for review is the
				  date the Department first receives the communication in writing, which for
				  purposes of this Section
				  2274.51 shall include
				  communications received via email. The preceding sentence notwithstanding, in
				  the event the Department first receives the communication orally, the date of
				  the request for review shall be the date of that oral communication, provided
				  that the Department receives written confirmation of the request for review,
				  which may include confirmation by email, from the policyholder, certificate
				  holder or other insured, no later than thirty days after the date of the oral
				  communication. However, in the event that the policyholder, certificate holder
				  or other insured mistakenly directs his or her request for review by the
				  commissioner to the Department of Managed Healthcare (DMHC), the date of the
				  request for review shall be the date upon which, according to DMHC, the request
				  for review was received by DMHC, provided that the Department receives written
				  confirmation of the request for review, which may include confirmation by
				  email, from the policyholder, certificate holder or other insured.
1. New
					 section filed 11-20-2013; operative 1-1-2014 (Register 2013, No.
					 47).
Note: Authority cited: Sections
						10273.7 and
						12926,
						Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989) and 20th
						Century Ins. Co. v. Garamendi, 8 Cal. 4th 216 (1994). Reference: Sections
						10273.4,
						10273.6,
						10273.7,
						10384,
						10384.17
						and
						10713,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 10 - Commissioner's Review of Complaints of Unlawful Cancellation, Rescission or Nonrenewal of Health Insurance Policies › Section 2274.52 - The Proper Complaint

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Subject to the additional requirements applicable to the complaint that are set
				  forth in subdivisions (c) and (e) of this Section
				  2274.52, a request for review
				  received by the commissioner from a policyholder, certificate holder or other
				  insured constitutes a proper complaint for purposes of subdivision (b) of
				  Insurance Code section
				  10273.7 if
				  the complainant asserts, with or without prompting by the Department, all of
				  the following:
(1) The insurance product in
				  question constitutes health insurance that is within the jurisdiction of the
				  Department of Insurance;
(2) The
				  complainant has not voluntarily terminated the policy or coverage;
				  and
(3) The complainant has been
				  notified in writing, or has otherwise learned, that its policy, certificate or
				  coverage has been or will be canceled, rescinded or nonrenewed by the
				  insurer.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 10 - Commissioner's Review of Complaints of Unlawful Cancellation, Rescission or Nonrenewal of Health Insurance Policies › Section 2274.53 - Grace Period

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
For purposes of Insurance Code sections
					 10273.4,
					 10273.6 and
					 10713:
(a) The minimum 30-day grace period shall end
				  no sooner than the thirtieth day following the last day of coverage for which
				  the insurer has received payment.
(b) In order for a policyholder, certificate
				  holder or other insured to have been "duly notified," the insurer must have
				  sent to the policyholder, certificate holder or other insured a notice of
				  intent to nonrenew due to nonpayment:
(1)
				  After a sufficient interval of time has passed since the sending of the initial
				  premium billing statement to make it possible, in the ordinary course, for:
(A) The policyholder, certificate holder or
				  other insured to receive the billing statement,
(B) The policyholder, certificate holder or
				  other insured to send the required premium payment to the insurer,
				  and
(C) The insurer to receive the
				  premium payment; but
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 10 - Commissioner's Review of Complaints of Unlawful Cancellation, Rescission or Nonrenewal of Health Insurance Policies › Section 2274.54 - Reinstatement and Continuation of Coverage

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For purposes of this article and
				  Insurance Code section
				  10273.7,
				  whenever an insurer is required to continue to provide coverage, to reinstate
				  coverage or to reinstate a policyholder, certificate holder or other insured,
				  the insurer must process and pay claims, and provide any required prior
				  authorization of covered services, with respect to that coverage, policyholder,
				  certificate holder or other insured, all in accordance with the terms of the
				  policy or certificate as in the ordinary course of business.
(b) The insurer shall provide coverage to the
				  policyholder, certificate holder, or other insured pursuant to subdivision (d)
				  of Insurance Code section
				  10273.7 if,
				  on the date of the request for review by the commissioner, any of the following
				  are true:
(1) The policyholder's, certificate
				  holder's or other insured's coverage is in effect;
(2) No more than 30 days have passed since
				  the date the insurer sent to the policyholder, certificate holder or other
				  insured the notice of the right to request a review required by Section
				  2274.50; or
(3) The insurer has not sent to the
				  policyholder, certificate holder or other insured the notice of the right to
				  request a review required by Section
				  2274.50.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 10 - Commissioner's Review of Complaints of Unlawful Cancellation, Rescission or Nonrenewal of Health Insurance Policies › Section 2274.55 - Submittal of Information by Insurers for Use in Determination by the Commissioner that a Cancellation, Rescission or Failure to Renew is or is Not Contrary to Existing Law

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) After
				  the commissioner determines that a proper complaint exists pursuant to Section
				  2274.52 and prior to any
				  determination by the commissioner that a cancellation, rescission or failure to
				  renew is or is not contrary to existing law, the insurer shall submit any
				  written information required by this article to the commissioner at the
				  following address:
LEGAL DIVISION, HEALTH ENFORCEMENT BUREAU
CALIFORNIA DEPARTMENT OF INSURANCE
1901 HARRISON STREET, 3RD FLOOR MAILROOM
OAKLAND, CA 94612
(b) The insurer shall specify a responsible
				  person whom Department staff may contact with questions or requests for further
				  information. After the insurer has sent the information required by this
				  article to the address specified in subdivision (a) of this Section
				  2274.55, Department staff may,
				  under conditions consented to by the insurer's designated responsible person,
				  agree to receive further information from the insurer by specified alternate
				  means of delivery. Nothing in this section shall be interpreted to bar informal
				  communication during the time period referenced in subdivision (a) of this
				  section between Department staff and the insurer's responsible person,
				  including by telephone, provided Department staff agrees beforehand to such
				  informal communication.
(c) No
				  later than 15 days after receiving from the Department a notice of a proper
				  complaint pursuant to subdivision (d) of Section
				  2274.52, the insurer shall either:
(1) Request a hearing pursuant to subdivision
				  (b) of Insurance Code Section
				  10273.7 by
				  submitting to the Department its evidence that the insurer's rescission,
				  cancellation or failure to renew was lawful, including but not limited to any
				  and all of the information called for by Section
				  2274.56, Section
				  2274.57 or Section
				  2274.60 that is applicable;
				  or
(2) Reinstate the policyholder,
				  certificate holder or other insured.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 10 - Commissioner's Review of Complaints of Unlawful Cancellation, Rescission or Nonrenewal of Health Insurance Policies › Section 2274.57 - Miscellaneous Factual Showings Required of Insurers

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
In addition to any other evidence required to be submitted
					 pursuant to this article, the insurer shall submit:
(a) Its evidence demonstrating that it has
				  timely delivered to the policyholder, certificate holder or other insured any
				  notice required under this article, Section
				  2274.78, or Insurance Code section
				  10273.4,
				  10273.6,
				  10273.7,
				  10384.17 or
				  10713, and
				  that the form of any such notices complied with all applicable legal
				  requirements; and
(b) Its evidence
				  in support of any legal theory the insurer relies on for the proposition that
				  its rescission, cancellation or failure to renew was lawful.
1. New
					 section filed 11-20-2013; operative 1-1-2014 (Register 2013, No.
					 47).
Note: Authority cited: Sections
						10273.7 and
						12926,
						Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989) and 20th
						Century Ins. Co. v. Garamendi, 8 Cal. 4th 216 (1994). Reference: Sections
						10273.4,
						10273.6,
						10273.7,
						10384,
						10384.17
						and
						10713,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 10 - Commissioner's Review of Complaints of Unlawful Cancellation, Rescission or Nonrenewal of Health Insurance Policies › Section 2274.58 - The Request for a Hearing Pursuant to Insurance Code Section 10273.7(b); Role of Department Staff

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Department staff evaluating the insurer's request for a hearing under
				  subdivision (b) of Insurance Code section
				  10273.7
				  shall have discretion to obtain from the policyholder, certificate holder or
				  other insured, or from any other source, such additional evidence as in the
				  opinion of staff may assist in the determination of whether the rescission,
				  cancellation or nonrenewal is or is not contrary to existing law. Department
				  staff shall make any such evidence reasonably available to the insurer and
				  shall provide the insurer a reasonable opportunity to submit a response to that
				  evidence.
(b) Department staff
				  evaluating the insurer's request for a hearing under subdivision (b) of
				  Insurance Code section
				  10273.7
				  shall in each case determine whether the evidence is or is not sufficient to
				  establish that the insurer has satisfied all legal requirements pertaining to
				  the cancellation, rescission or nonrenewal.
(c) In the event Department staff determines
				  that the cancellation, rescission or nonrenewal is contrary to existing law,
				  the order to reinstate the policyholder, certificate holder or other insured
				  shall:
(1) Identify each provision of law
				  which the staff determines was not satisfied, and
(2) Cite the factual basis for each such
				  determination.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 10 - Commissioner's Review of Complaints of Unlawful Cancellation, Rescission or Nonrenewal of Health Insurance Policies › Section 2274.59 - The Request for a Hearing Pursuant to Insurance Code Section 10273.7(c); Hearing Procedure

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Within 15 days after receipt of an order by the commissioner to reinstate a
				  policyholder, certificate holder or other insured, the insurer shall either
				  reinstate the policyholder, certificate holder or other insured, or request a
				  hearing pursuant to subdivision (c) of Insurance Code section
				  10273.7. In
				  order to request a hearing pursuant to subdivision (c) of Insurance Code
				  section
				  10273.7,
				  the insurer shall submit any and all of the evidence required to be submitted
				  pursuant to Sections
				  2274.56,
				  2274.57 or
				  2274.60 that is applicable, but
				  for purposes of this Section
				  2274.59 the information shall be
				  submitted to the commissioner at the following address:
ADMINISTRATIVE HEARING BUREAU
CALIFORNIA DEPARTMENT OF INSURANCE
1901 HARRISON STREET, 3RD FLOOR MAILROOM
OAKLAND, CA 94612
(b) Simultaneously with the submittal
				  described in subdivision (a) of this section, the insurer shall:
(1) Send one copy of the submittal to the
				  address specified in subdivision (a) of Section
				  2274.55; and
(2) Send one copy of the submittal to the
				  policyholder, certificate holder or other insured who requested review of the
				  insurer's rescission, cancellation or failure to renew.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 10 - Commissioner's Review of Complaints of Unlawful Cancellation, Rescission or Nonrenewal of Health Insurance Policies › Section 2274.60 - Affirmative Defense

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A
				  policyholder, certificate holder or other insured shall be barred from
				  requesting a review by the commissioner if the date of his or her request for
				  review is more than 180 calendar days after the date the insurer sent the
				  notice required by Section
				  2274.50, or the date coverage was
				  terminated (if coverage was terminated), whichever is later in time. The
				  running of this 180-day period shall be tolled, however, during such period as
				  the policyholder, certificate holder or other insured is unable, due to
				  substantial health reasons or other incapacity, to understand or appreciate the
				  significance of such notice, or termination of coverage, and act upon
				  it.
(b) The insurer shall have the
				  burden to establish that the 180-day period had run, and had not been tolled,
				  at the time of the policyholder's, certificate holder's or other insured's
				  request for review by the commissioner. The insurer must assert the affirmative
				  defense described in this Section
				  2274.60, and include all evidence
				  available to the insurer in support of that assertion, in the submittal
				  required pursuant to Paragraph (c)(1) of Section
				  2274.55 and in any submittal
				  required pursuant to subdivision (a) of Section
				  2274.59. In the event the insurer
				  has not sent the notice required by Section
				  2274.50, the affirmative defense
				  described in this section shall not obtain.
1. New
					 section filed 11-20-2013; operative 1-1-2014 (Register 2013, No.
					 47).
Note: Authority cited: Sections
						10273.7 and
						12926,
						Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989) and 20th
						Century Ins. Co. v. Garamendi, 8 Cal. 4th 216 (1994). Reference: Sections
						10273.4,
						10273.6,
						10273.7,
						10384,
						10384.17
						and
						10713,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 11 - Standards for Health History Questionnaires in Health Insurance Applications, Pre-Issuance Medical Underwriting and Rescission of Health Insurance Policies › Section 2274.70 - Purpose

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The purpose of this article is to:
(a) Clarify and make specific the application
				  of the following statutes to the medical underwriting process and the
				  permissibility of rescission by insurers: Insurance Code sections
				  10113,
				  10119.3,
				  10380,
				  10381.5 and
				  10384 and
				  related insurance policy provisions;
(b) Set forth standards for determining
				  whether questions used to ascertain the health condition or history of an
				  applicant for health insurance coverage are clear and unambiguous pursuant to
				  Insurance Code section
				  10291.5(c)(1);
(c) Identify bases on which the Commissioner
				  may find that provisions in a health insurance policy containing a health
				  history questionnaire which the insurer makes part of the contract between the
				  insurer and the insured are unintelligible, uncertain, ambiguous, abstruse or
				  likely to mislead an applicant pursuant to Insurance Code section
				  10291.5(b)(1);
(d) Set forth standards for determining
				  whether questions on a health history questionnaire, supplemental questionnaire
				  or script used during pre-issuance underwriting are reasonable and necessary
				  for medical underwriting purposes as required by Insurance Code section
				  10291.5(c)(2);
(e) Set forth requirements for the
				  pre-issuance medical underwriting process pursuant to Insurance Code section
				  10384;
(f) Set forth attestation requirements for
				  agents assisting insureds in the submission of health insurance applications;
				  and
(g) Set forth requirements for
				  the conduct of post-issuance rescission investigations where a claim has been
				  submitted or the insurer has received notice of a claim.
1. New
					 article 11 (sections
					 2274.70-2274.78) and section filed
					 7-19-2010; operative 8-18-2010 (Register 2010, No. 30).
2. Change
					 without regulatory effect amending NOTE filed 9-23-2010 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2010, No. 39).
Note: Authority cited: Sections
						790.10,
						10291.5,
						10384,
						12921 and
						12926,
						Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989); and 20th
						Century Ins. Co. v. Garamendi, 8 Cal. 4th 216 (1994). Reference: Sections
						106,
						380,
						730,
						733,
						734,
						790.03,
						796.04,
						10113,
						10291.5,
						10380,
						10381.5 and
						10384,
						Insurance Code.
California Code of Regulations › Title 10 - Investment › Chapter 5 - Insurance Commissioner › Subchapter 2 - Policy Forms and Other Documents › Article 11 - Standards for Health History Questionnaires in Health Insurance Applications, Pre-Issuance Medical Underwriting and Rescission of Health Insurance Policies › Section 2274.71 - Scope

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) This article
				  shall apply to all health insurance policies as defined in Insurance Code
				  section
				  106(b)
				  and all certificates issued under such policies where the insurer applies
				  medical underwriting guidelines and where guaranteed issue requirements do not
				  apply.
(b) This article is not
				  intended to set forth an exhaustive list of all rights and responsibilities of
				  insureds or insurers with respect to applicable statutes governing medical
				  underwriting and rescissions of health insurance policies and related issues.
				  This article does not preclude the insurer's use of new underwriting methods or
				  techniques.
(c) Any provision of
				  this article shall be inapplicable to the extent it conflicts with any
				  provision of the Patient Protection and Affordable Care Act of 2010, 111
				  Pub. L. No.
				  148, 124 Stat. 119 (2010), as amended, or any
				  federal regulations at any time implementing it, as amended (collectively, the
				  "Act"), provided the provision of the Act has gone into effect and is
				  operative. However, any provision of this article to which the preceding
				  sentence applies shall yield to the applicable provision of the Act only to the
				  extent necessary to avoid the conflict and otherwise shall remain in force to
				  the fullest extent possible.
1. New
					 section filed 7-19-2010; operative 8-18-2010 (Register 2010, No.
					 30).
2. Change without regulatory effect amending NOTE filed
					 9-23-2010 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2010, No. 39).
Note: Authority cited: Sections
						790.10,
						10291.5,
						10384,
						12921 and
						12926,
						Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989); and 20th
						Century Ins. Co. v. Garamendi, 8 Cal. 4th 216 (1994). Reference: Sections
						106,
						380,
						730,
						733,
						734,
						790.03,
						796.04,
						10113,
						10291.5,
						10380,
						10381.5 and
						10384,
						Insurance Code.