California Health and Safety Code

§ 1389.4

HSC § 1389.4 Effective Jan 1, 2016Div. 2 · Ch. 2.2 · Art. 7.5

Statute text

(a)A full service health care service plan that issues, renews, or amends individual health plan contracts shall be subject to this section.

(b)A health care service plan subject to this section shall have written policies, procedures, or underwriting guidelines establishing the criteria and process whereby the plan makes its decision to provide or to deny coverage to individuals applying for coverage and sets the rate for that coverage. These guidelines, policies, or procedures shall ensure that the plan rating and underwriting criteria comply with Sections 1365.5 and 1389.1 and all other applicable provisions of state and federal law.

(c)On or before June 1, 2006, and annually thereafter, every health care service plan shall file with the department a general description of the criteria, policies, procedures, or guidelines the plan uses for rating and underwriting decisions related to individual health plan contracts, which means automatic declinable health conditions, health conditions that may lead to a coverage decline, height and weight standards, health history, health care utilization, lifestyle, or behavior that might result in a decline for coverage or severely limit the plan products for which they would be eligible. A plan may comply with this section by submitting to the department underwriting materials or resource guides provided to plan solicitors or solicitor firms, provided that those materials include the information required to be submitted by this section.

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Legislative history

Amended (as amended by Stats. 2013, 1st Ex. Sess., Ch. 2, Sec. 9) by Stats. 2015, Ch. 303, Sec. 261. (AB 731) Effective January 1, 2016. Inoperative, by its own provisions, on November 1, 2013, subject to condition for resuming operation. See later operative version, as amended by Sec. 262 of Stats. 2015, Ch. 303.