California Insurance Code

§ 10112.25

INS § 10112.25 Effective Jan 1, 2019Div. 2 · Part 2 · Ch. 1 · Art. 1

Statute text

(a)A health insurer that issues, sells, renews, or offers health insurance policies for health care coverage in this state, including a grandfathered health plan, but not including specialized health insurance policies that provide only dental or vision services, shall provide an annual rebate to each insured under that coverage, on a pro rata basis, if the ratio of the amount of premium revenue expended by the health insurer on the costs for reimbursement for clinical services provided to insureds under that coverage and for activities that improve health care quality to the total amount of premium revenue, excluding federal and state taxes and licensing or regulatory fees and after accounting for payments or receipts for risk adjustment, risk corridors, and reinsurance, is less than the following:

(1)With respect to a health insurer offering coverage in the large group market, 85 percent.

(2)With respect to a health insurer offering coverage in the small group market or in the individual market, 80 percent.

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Legislative history

Amended by Stats. 2018, Ch. 678, Sec. 2. (AB 2499) Effective January 1, 2019.