Bill Text: CA AB1515 | 2015-2016 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Insurance.
Spectrum: Moderate Partisan Bill (Democrat 9-1)
Status: (Passed) 2015-09-28 - Chaptered by Secretary of State - Chapter 348, Statutes of 2015. [AB1515 Detail]
Download: California-2015-AB1515-Introduced.html
Bill Title: Insurance.
Spectrum: Moderate Partisan Bill (Democrat 9-1)
Status: (Passed) 2015-09-28 - Chaptered by Secretary of State - Chapter 348, Statutes of 2015. [AB1515 Detail]
Download: California-2015-AB1515-Introduced.html
BILL NUMBER: AB 1515 INTRODUCED
BILL TEXT
INTRODUCED BY Committee on Insurance (Daly (Chair), Calderon,
Cooley, Cooper, Dababneh, Frazier, Gatto, Gonzalez, Mayes, and
Rodriguez)
MARCH 5, 2015
An act to amend Sections 481, 510, 739.3, 742.34, 790.034, 1725.5,
1729.2, 1764.1, 1861.02, 1861.025, 10111.2, 10127.13, 10169,
10192.18, 10232.3, 10233.5, 10235.35, 12418.4, 12820, and 12921 of,
and to repeal Section 10233.9 of, the Insurance Code, and to amend
Section 1299.04 of the Penal Code, relating to insurance.
LEGISLATIVE COUNSEL'S DIGEST
AB 1515, as introduced, Committee on Insurance. Insurance.
(1) Existing law requires any insurance policy that includes a
provision to refund premium other than on a pro rata basis, including
the assessment of cancellation fees, to disclose that fact in
writing, including the actual or maximum fees or penalties to be
applied, which may be stated in the form of percentages of the
premium. The disclosure is required to be provided prior to, or
concurrent with, the application and prior to each renewal to which
the policy provision applies.
This bill would require the disclosure to be on the first page of
a policy and in a specified font size.
(2) Existing law requires certain insurance disclosures in various
circumstances, including, but not limited to, when a life or
disability insurance policy or certificate of coverage is first
issued or delivered to a new insured or policyholder, when an
employer obtains coverage from a multiple employer welfare
arrangement, and when a claim is up for settlement.
This bill would require those disclosures to also include the
Department of Insurance's Internet Web site.
(3) Existing law defines the term "Adjusted RBC Report" as a
Risk-Based Capital (RBC) report that has been adjusted by the
Insurance Commissioner in accordance with specified provisions
governing the determination of a property and casualty insurer's RBC.
Existing law requires the filing of an RBC report by a life or
health insurer if the insurer has a Total Adjusted Capital that is
greater than or equal to its Company Action Level RBC but the Total
Adjusted Capital is less than the product of its Authorized Control
Level RBC and 2.5.
This bill would require the RBC report if the Total Adjusted
Capital is less than the product of its Authorized Control Level RBC
and 3.0.
(4) Existing law provides requirements for various written
insurance-related documents, including, among other things, the
requirement on a licensee to include certain information on a
business card, the requirement on all individual life insurance
policies and individual annuity contracts to be in certain font, and
an outline of coverage for long-term care insurance policies.
This bill would modify the requirements with respect to those
written documents, as specified.
(5) Existing law requires an applicant or licensee to update his
or her application if background information that was provided in the
application for a license changes.
This bill would expand the definition of a license to include,
among others, title insurance.
(6) This bill would make technical, nonsubstantive changes to
correct obsolete cross-references and would delete obsolete
provisions.
(7) Existing law, governing life and disability insurance,
provides, among other things, that the only measure of insurer
liability and damage is the sum payable to the insured in the manner
and at the times as provided in the policy. Existing law requires, in
addition, if any insurer fails to pay any benefits under a policy of
disability income insurance, as defined, within 30 calendar days
after the insurer has received all information needed to determine
liability and has determined that liability exists, any delayed
payment to bear interest, as specified.
This bill would specify that the above requirement to pay interest
does not apply to health insurance, as defined.
(8) Existing law requires an outline of coverage to be delivered
to a prospective applicant for long-term care insurance at the time
of initial solicitation. Existing law specifies the form for the
outline of coverage and requires the form to state that the policy
provides coverage for insureds diagnosed with Alzheimer's disease,
organic disorders, or related degenerative and dementing illnesses.
This bill would require the form to state that the policy provides
coverage for insureds for all mental illnesses.
(9) Existing law provides that any insurer offering long-term care
insurance shall provide to the Department of Insurance a copy of the
specimen individual policy form or group master policy and
certificate forms, corresponding outline of coverage, and
representative advertising materials to be used in the state.
This bill would eliminate that requirement.
(10) Existing law provides various procedural rights for, and
requirements of, a title insurance representative applicant.
This bill would add the requirement to immediately notify the
commissioner, using an approved method, of any change in email, other
personal information, or other background information.
(11) Existing law requires the Insurance Commissioner to perform
all duties imposed upon him or her by the Insurance Code and other
laws regulating the business of insurance in this state and to
enforce the execution of those provisions and laws. In an
administrative action to enforce the Insurance Code and other laws
regulating the business of insurance in this state, any settlement is
subject to various requirements, including that the commissioner may
delegate the power to negotiate the terms and conditions of a
settlement, but shall not delegate the power to approve the
settlement.
This bill would authorize the commissioner to delegate the power
to approve settlements that do not involve an insurer, a managing
general agent or production agent that manages the business of an
insurer, a title company, a home protection company, an insurance
adjuster whose claims practices are at issue, and an insurance agent
or broker, or an insurance agent or broker applicant, who has
allegedly engaged in theft, fraud, or the misappropriation of premium
or other funds in an amount that exceeds $50,000.
(12) Existing law requires a licensed bail agent, bail permittee,
or bail solicitor who engages, in the arrest of a defendant to
satisfy specified requirements, including, among other things, the
completion of 20 hours of classroom education pertinent to the duties
and responsibilities of a bail licensee.
This bill would require a bail fugitive recovery person licensed
after December 31, 2012, to have at least 20 hours of classroom
prelicensing education, and a bail fugitive recovery person licensed
between January 1, 1994, and December 31, 2012, to have at least 12
hours of classroom prelicensing education. The bill would provide
that a person licensed prior to January 1, 1994, has no prelicensing
education requirement.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 481 of the Insurance Code is amended to read:
481. (a) Unless the insurance contract otherwise provides, a
person insured is entitled to a return of his or her premium if the
policy is canceled, rejected, surrendered, or rescinded, as follows:
(1) To the whole premium, if the insurer has not been exposed to
any risk of loss.
(2) Where When the insurance is made
for a definite period of time and the insured surrenders his or her
policy, to such that proportion of the
premium as corresponds with the unexpired time, after deducting from
the whole premium any claim for loss or damage under the policy
which that has previously accrued. The
provisions of Section 482 apply only to the expired time.
(b) No contract for individual motor vehicle liability or
homeowners' multiple-peril insurance may contain a provision
which that mandates that the premium for the
policy shall be fully earned upon the happening of any contingency
except the expiration of the policy itself. This subdivision shall
not apply to policy fees or membership fees.
(c) (1) Any insurance policy that includes a provision to refund
premium other than on a pro rata basis, including the assessment of
cancellation fees, shall disclose that fact in writing, including the
actual or maximum fees or penalties to be applied, which may be
stated in the form of percentages of the premium. The disclosure
shall be provided prior to, or concurrent with, the application and
prior to each renewal to which the policy provision applies. The
disclosure shall be in at least 11-point font. For personal lines
new business, the disclosure shall be included on the first page of
the application. For commercial lines new business, the disclosure
shall be included on the first page of the application or as a
separate stand-alone page in the application. For renewals,
the disclosure shall be included in the actual notice and
displayed on the first page of the declaration pages. For
purposes of this subdivision, an insurer offering workers'
compensation insurance, as defined in Section 109, may provide the
disclosure with the quote offering insurance to the consumer prior to
the consumer accepting the quote in lieu of disclosure prior to or
concurrent with the application. Disclosure shall not be required if
the policy provision permits, but does not require, the insurer to
refund premium other than on a pro rata basis, and the insurer
refunds premium on a pro rata basis.
(2) If an application is made by telephone, the disclosure shall
be mailed to the applicant or insured within five business days.
(3) The disclosure may be made electronically pursuant to Section
38.5 in lieu of being mailed.
(4) This section does not apply to cancellations that are
calculated subject to paragraph (2) of subdivision (g) of Section
673.
(d) This section shall not apply to policies of ocean marine
insurance. For purposes of this section, "ocean marine insurance"
means insurance of vessels or crafts, their cargos, marine builders'
risks, marine protection and indemnity, or other risks commonly
insured under marine insurance governed by the provisions of Chapter
1 (commencing with Section 1880) of Part 1 of Division 2, and as
distinguished from inland marine insurance policies.
(e) The disclosure requirements of subdivision (c) shall be
prospective and shall apply only to policies issued or renewed on or
after January 1, 2012. 2016.
(f) Nothing in this section shall require any additional
disclosure of a fee or penalty for early cancellation if that
disclosure is required by any other provision of law.
SEC. 2. Section 510 of the Insurance Code is amended to read:
510. Whenever a policy of insurance specified in Section 660 or
675, a policy of life insurance as defined in Section 101, a policy
of disability insurance as defined in Section 106, or a certificate
of coverage as defined in Section 10270.6, is first issued to or
delivered to a new insured or a new policyholder in this state, the
insurer shall include a written disclosure containing the name,
address, and toll-free telephone number
number, and Internet Web site of the unit within
the Department of Insurance that deals with consumer affairs. The
telephone number shall be the same as that provided to consumers
under Section 12921.1. The disclosure shall be printed in large,
boldface type.
The disclosure shall also contain the address and customer service
telephone number of the insurer, or the address and customer service
telephone number of the agent or broker of record, or all of those
addresses and telephone numbers. All addresses and telephone numbers
for the insurer or the agent or broker of record shall be prominently
displayed, in boldfaced type. The disclosure shall also contain a
statement that the Department of Insurance should be contacted only
after discussions with the insurer, or its agent or other
representative, or both, have failed to produce a satisfactory
resolution to the problem. If the policy or certificate was issued or
delivered by an agent or broker, the disclosure shall specifically
advise the insured to contact his or her agent or broker for
assistance.
SEC. 3. Section 739.3 of the Insurance Code is amended to read:
739.3. (a) "Company Action Level Event" means any of the
following events:
(1) The filing of an RBC Report by an insurer that indicates any
of the following:
(A) The insurer's Total Adjusted Capital is greater than or equal
to its Regulatory Action Level RBC but less than its Company Action
Level RBC.
(B) If a life or health insurer, the insurer has Total Adjusted
Capital that is greater than or equal to its Company Action Level RBC
but less than the product of its Authorized Control Level RBC and
2.5, 3.0, and has a negative trend.
(C) If a property and casualty insurer, the insurer has Total
Adjusted Capital that is greater than or equal to its Company Action
Level RBC but less than the product of its Authorized Control Level
RBC and 3.0, and triggers the trend test determined in accordance
with the trend test calculation included in the Property and Casualty
RBC instructions.
(2) The notification by the commissioner to the insurer of an
Adjusted RBC Report that indicates the event in paragraph (1),
provided that the insurer does not challenge the Adjusted RBC Report
under Section 739.7.
(3) If the insurer challenges, under Section 739.7, an Adjusted
RBC Report that indicates the event in paragraph (1), the
notification by the commissioner to the insurer that the commissioner
has, after a hearing, rejected the insurer's challenge.
(b) In the event of a Company Action Level Event, the insurer
shall prepare and submit to the commissioner a comprehensive
financial plan that shall do all of the following:
(1) Identify the conditions in the insurer that contribute to the
Company Action Level Event.
(2) Contain proposals of corrective actions that the insurer
intends to take and would be expected to result in the elimination of
the Company Action Level Event.
(3) Provide projections of the insurer's financial results in the
current year and at least the four succeeding years, both in the
absence of proposed corrective actions and giving effect to the
proposed corrective actions, including projections of statutory
operating income, net income, capital, or surplus, or a combination.
The projections for both new and renewal business may include
separate projections for each major line of business and separately
identify each significant income, expense, and benefit component.
(4) Identify the key assumptions impacting the insurer's
projections and the sensitivity of the projections to the
assumptions.
(5) Identify the quality of, and problems associated with, the
insurer's business, including, but not limited to, its assets,
anticipated business growth and associated surplus strain,
extraordinary exposure to risk, mix of business, and use of
reinsurance in each case, if any.
(c) The RBC Plan shall be submitted as follows:
(1) Within 45 days of the Company Action Level Event.
(2) If the insurer challenges an Adjusted RBC Report pursuant to
Section 739.7, within 45 days after notification to the insurer that
the commissioner has, after a hearing, rejected the insurer's
challenge.
(d) Within 60 days after the submission by an insurer of an RBC
Plan to the commissioner, the commissioner shall notify the insurer
whether the RBC Plan shall be implemented or is, in the judgment of
the commissioner, unsatisfactory. If the commissioner determines that
the RBC Plan is unsatisfactory, the notification to the insurer
shall set forth the reasons for the determination, and may set forth
proposed revisions that will render the RBC Plan satisfactory, in the
judgment of the commissioner. Upon notification from the
commissioner, the insurer shall prepare a Revised RBC Plan, which may
incorporate by reference revisions proposed by the commissioner, and
shall submit the Revised RBC Plan to the commissioner as follows:
(1) Within 45 days after the notification from the commissioner.
(2) If the insurer challenges the notification from the
commissioner under Section 739.7, within 45 days after a notification
to the insurer that the commissioner has, after a hearing, rejected
the insurer's challenge.
(e) In the event of a notification by the commissioner to an
insurer that the insurer's RBC Plan or Revised RBC Plan is
unsatisfactory, the commissioner may, at his or her discretion,
subject to the insurer's right to a hearing under Section 739.7,
specify in the notification that the notification constitutes a
Regulatory Action Level Event.
(f) Every domestic insurer that files an RBC Plan or Revised RBC
Plan with the commissioner shall file a copy of the RBC Plan or
Revised RBC Plan with the insurance commissioner in any state in
which the insurer is authorized to do business if both of the
following apply:
(1) That state has an RBC provision substantially similar to
subdivision (a) of Section 739.8.
(2) The insurance commissioner of that state has notified the
insurer of its request for the filing in writing, in which case the
insurer shall file a copy of the RBC Plan or Revised RBC Plan in that
state no later than the later of:
(A) Fifteen days after the receipt of notice to file a copy of its
RBC Plan or Revised RBC Plan with the state.
(B) The date on which the RBC Plan or Revised RBC Plan is filed
under subdivision (c) of Section 739.7.
SEC. 4. Section 742.34 of the Insurance Code is amended to read:
742.34. (a) The following notice shall be provided to employers
and employees who obtain coverage from a multiple employer welfare
arrangement:
NOTICE
(A) THE MULTIPLE EMPLOYER WELFARE ARRANGEMENT IS NOT AN INSURANCE
COMPANY AND DOES NOT PARTICIPATE IN ANY OF THE GUARANTEE FUNDS
CREATED BY CALIFORNIA LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR
CLAIMS OR PROTECT YOUR ASSETS IF A MULTIPLE EMPLOYER WELFARE
ARRANGEMENT BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS
PROMISED.
(B) THE HEALTH CARE BENEFITS THAT YOU HAVE PURCHASED OR ARE
APPLYING TO PURCHASE ARE BEING ISSUED BY A MULTIPLE EMPLOYER WELFARE
ARRANGEMENT THAT IS LICENSED BY THE STATE OF CALIFORNIA.
(C) FOR ADDITIONAL INFORMATION ABOUT THE MULTIPLE EMPLOYER WELFARE
ARRANGEMENT YOU SHOULD ASK QUESTIONS OF YOUR TRUST ADMINISTRATOR OR
YOU MAY CONTACT THE CALIFORNIA DEPARTMENT OF INSURANCE AT ________.
(b) Each multiple employer welfare arrangement should include the
department's current "800" consumer service telephone number and
Internet Web site address in the blank provided in paragraph
(C) of this notice.
SEC. 5. Section 790.034 of the Insurance Code is amended to read:
790.034. (a) Regulations adopted by the commissioner pursuant to
this article that relate to the settlement of claims shall take into
consideration settlement practices by classes of insurers.
(b) (1) Upon receiving notice of a claim, every insurer shall
immediately, but no more than 15 calendar days after receipt of the
claim, provide the insured with a legible reproduction of
subdivisions (h) and (i) of Section 790.03 along with a written
notice containing the following language in at least 10-point type:
"In addition to Section 790.03 of the Insurance Code, Fair Claims
Settlement Practices Regulations govern how insurance claims must be
processed in this state. These regulations are available at the
Department of Insurance Internet Web site,
www.insurance.ca.gov. www.insurance.ca.gov, or by
calling the department's consumer information line at 1-800-927-HELP
(4357). You may also obtain a copy of this law and these
regulations free of charge from this insurer." qzq
(2) Every insurer shall provide, when requested orally or in
writing by an insured, a legible reproduction of Section 790.03 of
the Insurance Code and copies of Sections 2695.5, 2695.7, 2695.8, and
2695.9 of Subchapter 7.5 of Chapter 5 of Title 10 of the California
Code of Regulations, unless the regulations are inapplicable to that
class of insurer. This law and these regulations shall be provided to
the insured within 15 calendar days of request.
(3) The provisions of this subdivision shall apply to all insurers
except for those that are licensed pursuant to Chapter 1 (commencing
with Section 12340) of Part 6 of Division 2, with respect to
policies and endorsements described in Section 790.031.
SEC. 6. Section 1725.5 of the Insurance Code is amended to read:
1725.5. (a) For purposes of Sections 32.5, 1625, 1626, 1724.5,
1758.1, 1765, 1800, 14020, 14021, and 15006, every licensee shall
prominently affix, type, or cause to be printed on business cards,
written price quotations for insurance products, and print
advertisements distributed exclusively in this state for insurance
products its license number in type the same size as any indicated
telephone number, address, or fax number. If the licensee maintains
more than one organization license, one of the organization license
numbers is sufficient for compliance with this section.
(b) Effective January 1, 2005, for purposes of Sections 32.5,
1625, 1626, 1724.5, 1758.1, 1765, 1800, 14020,
14021, and 15006, every licensee shall prominently affix, type, or
cause to be printed on business cards, written price quotations for
insurance products, and print advertisements, distributed in this
state for insurance products, the word "Insurance" in type size
no smaller than the largest indicated telephone number.
that is at least as large as the smallest telephone
number or 12-point font, whichever is larger.
(c) In the case of transactors, or agent and broker licensees, who
are classified for licensing purposes as solicitors, working as
exclusive employees of motor clubs, organizational licensee numbers
shall be used.
(d) Any person in violation of this section shall be subject to a
fine levied by the commissioner in the amount of two hundred dollars
($200) for the first offense, five hundred dollars ($500) for the
second offense, and one thousand dollars ($1,000) for the third and
subsequent offenses. The penalty shall not exceed one thousand
dollars ($1,000) for any one offense. These fines shall be deposited
into the Insurance Fund.
(e) A separate penalty shall not be imposed upon each piece of
printed material that fails to conform to the requirements of this
section.
(f) If the commissioner finds that the failure of a licensee to
comply with the provisions of subdivision (a) or (b) is due to
reasonable cause or circumstance beyond the licensee's control, and
occurred notwithstanding the exercise of ordinary care and in the
absence of willful neglect, the licensee may be relieved of the
penalty in subdivision (d).
(g) A licensee seeking to be relieved of the penalty in
subdivision (d) shall file with the department a statement with
supporting documents setting forth the facts upon which the licensee
bases its claims for relief.
(h) This section does not apply to any person or entity that is
not currently required to be licensed by the department or that is
exempted from licensure.
(i) This section does not apply to general advertisements of motor
clubs that merely list insurance products as one of several services
offered by the motor club, and do not provide any details of the
insurance products.
(j) This section does not apply to life insurance policy
illustrations required by Chapter 5.5 (commencing with Section
10509.950) of Part 2 of Division 2 or to life insurance cost indexes
required by Chapter 5.6 (commencing with Section 10509.970) of Part 2
of Division 2.
(k) This section shall become operative January 1, 1997.
SEC. 7. Section 1729.2 of the Insurance Code is amended to read:
1729.2. (a) An applicant or licensee shall notify the
commissioner when any of the background information set forth in this
section changes after the application has been submitted or the
license has been issued. If the licensee is listed as an endorsee on
any business entity license, the licensee shall also provide this
notice to any officer, director, or partner listed on that business
entity license.
(b) A business entity licensee, upon learning of a change in
background information pertaining to any unlicensed person listed on
its business entity license or application therefor, shall notify the
commissioner of that change. The changes subject to this requirement
include changes pertaining to any unlicensed officer, director,
partner, member, or controlling person, or any other natural person
named under the business entity license or in an application
therefor.
(c) The following definitions apply for the purposes of this
section:
(1) "License" includes all types of licenses issued by the
commissioner pursuant to Chapter 5 (commencing with Section 1621),
Chapter 5A (commencing with Section 1759), Chapter 6 (commencing with
Section 1760), Chapter 6.5 (commencing with Section 1781.1), Chapter
7 (commencing with Section 1800), and Chapter 8 (commencing with
Section 1831) of Part 2 of Division 1, Chapter 1 (commencing
with Section 10110) of Part 2 of Division 2, Chapter 4
(commencing with Section 12280) of Part 5 of Division 2, Article
8 (commencing with Section 12418) of Chapter 1 of Part 6 of Division
2, and Chapter 1 (commencing with Section 14000) and Chapter 2
(commencing with Section 15000) of Division 5.
(2) "Background information" means any of the following: a
misdemeanor or felony conviction; a filing of felony criminal charges
in state or federal court; an administrative action regarding a
professional or occupational license; any licensee's discharge or
attempt to discharge, in a personal or organizational bankruptcy
proceeding, an obligation regarding any insurance premiums or
fiduciary funds owed to any company, including a premium finance
company, or managing general agent; and any admission, or judicial
finding or determination, of fraud, misappropriation or conversion of
funds, misrepresentation, or breach of fiduciary duty.
(3) "Applicant" and "licensee" include individual and organization
applicants and licensees, and officers, directors, partners,
members, and controlling persons (as defined in subdivision (b) of
Section 1668.5) of an organization.
(d) Notification to the commissioner shall be in writing and shall
be sent within 30 days of the date the applicant or licensee learns
of the change in background information.
(e) The commissioner may adopt regulations necessary or desirable
to implement this section.
SEC. 8. Section 1764.1 of the Insurance Code is amended to read:
1764.1. (a) (1) Every nonadmitted insurer, in the case of
insurance to be purchased by a home state insured pursuant to Section
1760, and surplus line broker, in the case of any insurance with a
nonadmitted carrier for a home state insured to be transacted by the
surplus line broker, shall be responsible to ensure that, at the time
of accepting an application for an insurance policy, other than a
renewal of that policy, issued by a nonadmitted insurer, the
signature of the applicant on the disclosure statement set forth in
subdivision (b) is obtained. In fulfillment of this responsibility,
the nonadmitted insurer and the surplus line broker may rely, if it
is reasonable under all the circumstances to do so, on the disclosure
statement received from a licensee involved in the transaction as
prima facie evidence that the disclosure statement and appropriate
signature from the applicant have been obtained. The surplus line
broker shall maintain a copy of the signed disclosure statement in
his or her records for a period of at least five years. These records
shall be made available to the commissioner and the insured upon
request. This disclosure shall be signed by the applicant, and is not
subject to a limited power of attorney agreement between the
applicant and an agent or broker or a surplus line broker. The
disclosure statement shall be in boldface 16-point type on a
freestanding document. In addition, every policy issued by a
nonadmitted insurer and every certificate evidencing the placement of
insurance shall contain, or have affixed to it by the insurer or
surplus line broker, the disclosure statement set forth in
subdivision (b) in boldface 16-point type on the front page of the
policy.
(2) In a case in which the applicant has not received and
completed the signed disclosure form required by this section, he or
she may cancel the insurance so placed. The cancellation shall be on
a pro rata basis as to premium, and the applicant shall be entitled
to the return of any broker's fees charged for the placement.
(b) The following notice shall be provided to home state insureds
and home state insured applicants for insurance as provided by
subdivision (a), and shall be printed in English and in the language
principally used by the surplus line broker and nonadmitted insurer
to advertise, solicit, or negotiate the sale and purchase of surplus
line insurance. The surplus line broker and nonadmitted insurer shall
use the appropriate bracketed language for application and issued
policy disclosures:
"NOTICE:
1. THE INSURANCE POLICY THAT YOU HAVE PURCHASED] ARE APPLYING
TO PURCHASE] IS BEING ISSUED BY AN INSURER THAT IS NOT LICENSED BY
THE STATE OF CALIFORNIA. THESE COMPANIES ARE CALLED "NONADMITTED" OR
"SURPLUS LINE" INSURERS.
2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY REGULATION
AND ENFORCEMENT THAT APPLY TO CALIFORNIA LICENSED INSURERS.
3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE
GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE, THESE FUNDS
WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER
BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS PROMISED.
4. THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN INSURER IN
ANOTHER STATE IN THE UNITED STATES OR AS A NON-UNITED STATES (ALIEN)
INSURER. YOU SHOULD ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER, OR
"SURPLUS LINE" BROKER OR CONTACT THE CALIFORNIA DEPARTMENT OF
INSURANCE AT THE FOLLOWING TOLL-FREE TELEPHONE NUMBER ____ OR
INTERNET WEB SITE WWW.INSURANCE.CA.GOV . ASK WHETHER OR NOT THE
INSURER IS LICENSED AS A FOREIGN OR NON-UNITED STATES (ALIEN)
INSURER AND FOR ADDITIONAL INFORMATION ABOUT THE INSURER. YOU MAY
ALSO CONTACT THE NAIC'S INTERNET WEB SITE AT WWW.NAIC.ORG.
5. FOREIGN INSURERS SHOULD BE LICENSED BY A STATE IN THE UNITED
STATES AND YOU MAY CONTACT THAT STATE'S DEPARTMENT OF INSURANCE TO
OBTAIN MORE INFORMATION ABOUT THAT INSURER.
6. FOR NON-UNITED STATES (ALIEN) INSURERS, THE INSURER SHOULD BE
LICENSED BY A COUNTRY OUTSIDE OF THE UNITED STATES AND SHOULD BE ON
THE NAIC'S INTERNATIONAL INSURERS DEPARTMENT (IID) LISTING OF
APPROVED NONADMITTED NON-UNITED STATES INSURERS. ASK YOUR AGENT,
BROKER, OR "SURPLUS LINE" BROKER TO OBTAIN MORE INFORMATION ABOUT
THAT INSURER.
7. CALIFORNIA MAINTAINS A LIST OF APPROVED SURPLUS LINE INSURERS.
ASK YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST, OR VIEW THAT
LIST AT THE INTERNET WEB SITE OF THE CALIFORNIA DEPARTMENT OF
INSURANCE: WWW.INSURANCE.CA.GOV.
8. IF YOU, AS THE APPLICANT, REQUIRED THAT THE INSURANCE POLICY
YOU HAVE PURCHASED BE BOUND IMMEDIATELY, EITHER BECAUSE EXISTING
COVERAGE WAS GOING TO LAPSE WITHIN TWO BUSINESS DAYS OR BECAUSE YOU
WERE REQUIRED TO HAVE COVERAGE WITHIN TWO BUSINESS DAYS, AND YOU DID
NOT RECEIVE THIS DISCLOSURE FORM AND A REQUEST FOR YOUR SIGNATURE
UNTIL AFTER COVERAGE BECAME EFFECTIVE, YOU HAVE THE RIGHT TO CANCEL
THIS POLICY WITHIN FIVE DAYS OF RECEIVING THIS DISCLOSURE. IF YOU
CANCEL COVERAGE, THE PREMIUM WILL BE PRORATED AND ANY BROKER'S FEE
CHARGED FOR THIS INSURANCE WILL BE RETURNED TO YOU."
(c) When a contract is issued to an industrial insured, neither
the nonadmitted insurer nor the surplus line broker is required to
provide the notice required in this section except on the
confirmation of insurance, the certificate of placement, or the
policy, whichever is first provided to the insured, nor is the
insurer or surplus line broker required to obtain the insured's
signature. The producer shall ensure that the notice affixed to the
confirmation of insurance, certificate of placement, or the policy is
provided to the insured. The producer shall insert the current
toll-free telephone number of the Department of Insurance as provided
in paragraph 4 of the notice.
(1) An industrial insured is an insured that does both of the
following:
(A) Employs at least 25 employees on average during the prior 12
months.
(B) Has aggregate annual premiums for insurance for all risks
other than workers' compensation and health coverage totaling no less
than twenty-five thousand dollars ($25,000) or obtains insurance
through the services of a full-time employee acting as an insurance
manager or a continuously retained insurance consultant. A
"continuously retained insurance consultant" does not include: (i) an
agent or broker through whom the insurance is being placed, (ii) a
subagent or subproducer involved in the transaction, or (iii) an
agent or broker that is a business organization employing or
contracting with a person mentioned in clauses (i) and (ii).
(2) The surplus line broker shall be responsible for ensuring that
the applicant is an industrial insured. A surplus line broker who
reasonably relies on information provided in good faith by the
applicant, whether directly or through the producer, shall be deemed
to be in compliance with this requirement.
(d) For purposes of compliance with the requirement
of subdivision (a) that the signature of the applicant be obtained,
the following shall apply:
(1) If the insurance transaction is not conducted at an in-person,
face-to-face meeting, the applicant's signature on the disclosure
form may be transmitted by the applicant to the agent or broker via
facsimile or comparable electronic transmittal.
(2) In the case of commercial lines coverage, or personal
insurance coverage subject to Section 675 and any umbrella coverage
associated therewith, where an applicant requires that insurance
coverage be bound immediately, either because existing coverage will
lapse within two business days of the time the insurance is bound or
because the applicant is required to have coverage in place within
two business days, and the applicant cannot meet in person with the
agent or broker to sign the disclosure form, the agent or broker may
obtain the signature of the applicant within five days of binding
coverage, provided that the applicant may cancel the insurance so
placed within five days of receiving the disclosure form from the
agent or broker. The cancellation shall be on a pro rata basis, and
the applicant shall be entitled to the rescission or return of any
broker's fees charged for the placement. When a policy is canceled,
the broker shall inform the applicant that the broker's fee must be
returned and that the premium must be prorated.
(e) Notwithstanding subdivision (a), this section shall not apply
to insurance issued or delivered in this state by a nonadmitted
Mexican insurer by and through a surplus line broker affording
coverage exclusively in the Republic of Mexico on property located
temporarily or permanently in, or operations conducted temporarily or
permanently within, the Republic of Mexico.
SEC. 9. Section 1861.02 of the Insurance Code is amended to read:
1861.02. (a) Rates and premiums for an automobile insurance
policy, as described in subdivision (a) of Section 660, shall be
determined by application of the following factors in decreasing
order of importance:
(1) The insured's driving safety record.
(2) The number of miles he or she drives annually.
(3) The number of years of driving experience the insured has had.
(4) Those other factors that the commissioner may adopt by
regulation and that have a substantial relationship to the risk of
loss. The regulations shall set forth the respective weight to be
given each factor in determining automobile rates and premiums.
Notwithstanding any other provision of law, the use of any criterion
without approval shall constitute unfair discrimination.
(b) (1) Every person who meets the criteria of Section 1861.025
shall be qualified to purchase a Good Driver Discount policy from the
insurer of his or her choice. An insurer shall not refuse to offer
and sell a Good Driver Discount policy to any person who meets the
standards of this subdivision.
(2) The rate charged for a Good Driver Discount policy shall
comply with subdivision (a) and shall be at least 20%
20 percent below the rate the insured would
otherwise have been charged for the same coverage. Rates for Good
Driver Discount policies shall be approved pursuant to this article.
(3) (A) This subdivision shall not prevent a reciprocal insurer,
organized prior to November 8, 1988, by a motor club holding a
certificate of authority under Chapter 2 (commencing with Section
12160) of Part 5 of Division 2, and which
that requires membership in the motor club as a condition
precedent to applying for insurance from requiring membership in the
motor club as a condition precedent to obtaining insurance described
in this subdivision.
(B) This subdivision shall not prevent an insurer which
that requires membership in a specified
voluntary, nonprofit organization, which was in existence prior to
November 8, 1988, as a condition precedent to applying for insurance
issued to or through those membership groups, including franchise
groups, from requiring such that
membership as a condition to applying for the coverage offered to
members of the group, provided that it or an affiliate also offers
and sells coverage to those who are not members of those membership
groups.
(C) However, all of the following conditions shall be applicable
to the insurance authorized by subparagraphs (A) and (B):
(i) Membership, if conditioned, is conditioned only on timely
payment of membership dues and other bona fide criteria not based
upon driving record or insurance, provided that membership in a motor
club may not be based on residence in any area within the state.
(ii) Membership dues are paid solely for and in consideration of
the membership and membership benefits and bear a reasonable
relationship to the benefits provided. The amount of the dues shall
not depend on whether the member purchases insurance offered by the
membership organization. None of those membership dues or any portion
thereof shall be transferred by the membership organization to the
insurer, or any affiliate of the insurer, attorney-in-fact,
subsidiary, or holding company thereof, provided that this provision
shall not prevent any bona fide transaction between the membership
organization and those entities.
(iii) Membership provides bona fide services or benefits in
addition to the right to apply for insurance. Those services shall be
reasonably available to all members within each class of membership.
Any insurer that violates clause (i), (ii), or (iii) shall be
subject to the penalties set forth in Section 1861.14.
(c) The absence of prior automobile insurance coverage, in and of
itself, shall not be a criterion for determining eligibility for a
Good Driver Discount policy, or generally for automobile rates,
premiums, or insurability. However, notwithstanding
subdivision (a), an insurer may use persistency of automobile
insurance coverage with the insurer, an affiliate, or another insurer
as an optional rating factor. The Legislature hereby finds and
declares that it furthers the purpose of Proposition 103 to encourage
competition among carriers so that coverage overall will be priced
competitively. The Legislature further finds and declares that
competition is furthered when insureds are able to claim a discount
for regular purchases of insurance from any carrier offering this
discount irrespective of whether or not the insured has previously
purchased from a given carrier offering the discount. Persistency of
coverage may be demonstrated by coverage under the low-cost
automobile insurance program pursuant to Article 5.5 (commencing with
Section 11629.7) and Article 5.6 (commencing with Section 11629.9)
of Chapter 1 of Part 3 of Division 2, or by coverage under the
assigned risk plans pursuant to Article 4 (commencing with Section
11620) of Chapter 1 of Part 3 of Division 2. Persistency shall be
deemed to exist even if there is a lapse of coverage of up to two
years due to an insured's absence from the state while in military
service, and up to 90 days in the last five years for any other
reason.
(d) An insurer may refuse to sell a Good Driver Discount policy
insuring a motorcycle unless all named insureds have been licensed to
drive a motorcycle for the previous three years.
(e) This section shall become operative on November 8, 1989. The
commissioner shall adopt regulations implementing this section and
insurers may submit applications pursuant to this article which
comply with those regulations prior to that date, provided that no
such application shall be approved prior to that date.
SEC. 10. Section 1861.025 of the Insurance Code is amended to
read:
1861.025. A person is qualified to purchase a Good Driver
Discount policy if he or she meets all of the following criteria:
(a) He or she has been licensed to drive a motor vehicle for the
previous three years.
(b) During the previous three years, he or she has not done any of
the following:
(1) Had more than one violation point count determined as provided
by subdivision (a), (b), (c), (d), (e), (g), or (h)
(f), or (j) of, or paragraph (1) of subdivision (i)
of, of Section 12810 of the Vehicle Code, but subject to the
following modifications:
(A) For the purposes of this section, the driver of a motor
vehicle involved in an accident for which he or she was principally
at fault that resulted only in damage to property shall receive one
violation point count, in addition to any other violation points that
may be imposed for this accident.
(B) If, under Section 488 or 488.5, an insurer is prohibited from
increasing the premium on a policy on account of a violation, that
violation shall not be included in determining the point count of the
person.
(C) If a violation is required to be reported under Section 1816
of the Vehicle Code, or under Section 784 of the Welfare and
Institutions Code, or any other provision requiring the reporting of
a violation by a minor, the violation shall be included for the
purposes of this section in determining the point count in the same
manner as is applicable to adult violations.
(2) Had more than one dismissal pursuant to Section 1803.5 of the
Vehicle Code that was not made confidential pursuant to Section
1808.7 of the Vehicle Code, in the 36-month period for violations
that would have resulted in the imposition of more than one violation
point count under paragraph (1) if the complaint had not been
dismissed.
(3) Was the driver of a motor vehicle involved in an accident that
resulted in bodily injury or in the death of any person and was
principally at fault. The commissioner shall adopt regulations
setting guidelines to be used by insurers for the determination of
fault for the purposes of this paragraph and paragraph (1).
(c) During the period commencing on January 1, 1999, or the date
10 years prior to the date of application for the issuance or renewal
of the Good Driver Discount policy, whichever is later, and ending
on the date of the application for the issuance or renewal of the
Good Driver Discount policy, he or she has not been convicted of a
violation of Section 23140, 23152, or 23153 of the Vehicle Code, a
felony violation of Section 23550 or 23566, or former Section 23175
or, as those sections read on January 1, 1999, of the Vehicle Code,
or a violation of Section 191.5 or subdivision (a) of Section 192.5
of the Penal Code.
(d) Any person who claims that he or she meets the criteria of
subdivisions (a), (b), and (c) based entirely or partially on a
driver's license and driving experience acquired anywhere other than
in the United States or Canada is rebuttably presumed to be qualified
to purchase a Good Driver Discount policy if he or she has been
licensed to drive in the United States or Canada for at least the
previous 18 months and meets the criteria of subdivisions (a), (b),
and (c) for that period.
SEC. 11. Section 10111.2 of the Insurance Code is amended to read:
10111.2. (a) Under a policy of disability insurance
other than health insurance, as defined in Section 106,
including a policy of disability income insurance, as defined
in subdivision (i) of Section 799.01, payment of benefits to the
insured shall be made within 30 calendar days after the insurer has
received all information needed to determine liability for a claim.
However, the 30-calendar-day period shall not include any time during
which the insurer is doing any of the following:
(1) Awaiting a response for relevant medical information from a
health care provider.
(2) Awaiting a response from the claimant to a request for
additional relevant information.
(3) Investigating possible fraud that has been reported to the
department's Fraud Division in compliance with subdivision (a) of
Section 1872.4.
(b) If the insurer has not received all information needed to
determine liability for a claim within 30 calendar days after receipt
of the claim, the insurer shall notify the insured in writing and
include a written list of all information it reasonably needs to
determine liability for the claim. In that event, the 30-calendar-day
period set out in subdivision (a) shall commence when the insured
has provided to the insurer all information in that notification. If
no notice is sent by the insurer within 30 calendar days after the
claim is filed by the insured, interest shall begin to accrue on the
payment of benefits on the 31st calendar day after receipt of the
claim, at the rate of 10 percent per year.
(c) When the insurer has received all information needed to
determine liability for a claim, and the insurer determines that
liability exists and fails to make payment of benefits to the insured
within 30 calendar days after the insurer has received that
information, any delayed payment shall bear interest, beginning the
31st calendar day, at the rate of 10 percent per year. Liability
shall, in all cases, be determined by the insurer within 30 calendar
days of receiving all information set out in the insurer's written
notification to the insured.
(d) Nothing in this section is intended to restrict any other
remedies available to an insured by statute or any other law.
SEC. 12. Section 10127.13 of the Insurance Code, as added by
Section 8 of Chapter 166 of the Statutes of 2014, is amended to read:
10127.13. (a) All individual life insurance policies and
individual annuity contracts for senior citizens that contain a
charge upon surrender, partial surrender, excess withdrawal, or
penalties upon surrender shall contain a notice disclosing the
location of all of the following: the charge, the charge
time period, the charge information, and any associated penalty
information, information. The notice shall be
in bold 12-point print on the front of the policy jacket or on
the cover page of the policy.
(b) A policy shall have just one cover page. If the notice
required by this section and the statutorily required right to
examine notice are both on the cover page, as opposed to the front
cover of the policy jacket, they shall appear on the same page.
(c) General references to "policy" in this section refer to both
life insurance policies and annuity contracts.
(d) This section shall become operative on July 1, 2015.
SEC. 13. Section 10169 of the Insurance Code, as added by Section
8 of Chapter 872 of the Statutes of 2012, is amended to read:
10169. (a) Commencing January 1, 2001, there is hereby
established in the department the Independent Medical Review System.
(b) For the purposes of this chapter, "disputed health care
service" means any health care service eligible for coverage and
payment under a disability insurance contract that has been denied,
modified, or delayed by a decision of the insurer, or by one of its
contracting providers, in whole or in part due to a finding that the
service is not medically necessary. A decision regarding a disputed
health care service relates to the practice of medicine and is not a
coverage decision. A disputed health care service does not include
services provided by a group or individual policy of vision-only or
dental-only coverage, except to the extent that (1) the service
involves the practice of medicine, or (2) is provided pursuant to a
contract with a disability insurer that covers hospital, medical, or
surgical benefits. If an insurer, or one of its contracting
providers, issues a decision denying, modifying, or delaying health
care services, based in whole or in part on a finding that the
proposed health care services are not a covered benefit under the
contract that applies to the insured, the statement of decision shall
clearly specify the provision in the contract that excludes that
coverage.
(c) For the purposes of this chapter, "coverage decision" means
the approval or denial of health care services by a disability
insurer, or by one of its contracting entities, substantially based
on a finding that the provision of a particular service is included
or excluded as a covered benefit under the terms and conditions of
the disability insurance contract. A coverage decision does not
encompass a disability insurer or contracting provider decision
regarding a disputed health care service.
(d) (1) All insured grievances involving a disputed health care
service are eligible for review under the Independent Medical Review
System if the requirements of this article are met. If the department
finds that an insured grievance involving a disputed health care
service does not meet the requirements of this article for review
under the Independent Medical Review System, the insured request for
review shall be treated as a request for the department to review the
grievance. All other insured grievances, including grievances
involving coverage decisions, remain eligible for review by the
department.
(2) In any case in which an insured or provider asserts that a
decision to deny, modify, or delay health care services was based, in
whole or in part, on consideration of medical necessity, the
department shall have the final authority to determine whether the
grievance is more properly resolved pursuant to an independent
medical review as provided under this article.
(3) The department shall be the final arbiter when there is a
question as to whether an insured grievance is a disputed health care
service or a coverage decision. The department shall establish a
process to complete an initial screening of an insured grievance. If
there appears to be any medical necessity issue, the grievance shall
be resolved pursuant to an independent medical review as provided
under this article.
(e) Every disability insurance contract that is issued, amended,
renewed, or delivered in this state on or after January 1, 2000,
shall provide an insured with the opportunity to seek an independent
medical review whenever health care services have been denied,
modified, or delayed by the insurer, or by one of its contracting
providers, if the decision was based in whole or in part on a finding
that the proposed health care services are not medically necessary.
For purposes of this article, an insured may designate an agent to
act on his or her behalf. The provider may join with or otherwise
assist the insured in seeking an independent medical review, and may
advocate on behalf of the insured.
(f) Medicare beneficiaries enrolled in Medicare + Choice products
shall not be excluded unless expressly preempted by federal law.
(g) The department may seek to integrate the quality of care and
consumer protection provisions, including remedies, of the
Independent Medical Review System with related dispute resolution
procedures of other health care agency programs, including the
Medicare program, in a way that minimizes the potential for
duplication, conflict, and added costs. Nothing in this subdivision
shall be construed to limit any rights conferred upon insureds under
this chapter.
(h) The independent medical review process authorized by this
article is in addition to any other procedures or remedies that may
be available.
(i) Every disability insurer shall prominently display in every
insurer member handbook or relevant informational brochure, in every
insurance contract, on insured evidence of coverage forms, on copies
of insurer procedures for resolving grievances, on letters of denials
issued by either the insurer or its contracting organization, and on
all written responses to grievances, information concerning the
right of an insured to request an independent medical review
in cases where when the insured believes that
health care services have been improperly denied, modified, or
delayed by the insurer, or by one of its contracting providers.
The department's telephone number, 1-800-927-4357, and Internet Web
site, www.insurance.ca.gov, shall also be displayed.
(j) An insured may apply to the department for an independent
medical review when all of the following conditions are met:
(1) (A) The insured's provider has recommended a health care
service as medically necessary, or
(B) The insured has received urgent care or emergency services
that a provider determined was medically necessary, or
(C) The insured, in the absence of a provider recommendation under
subparagraph (A) or the receipt of urgent care or emergency services
by a provider under subparagraph (B), has been seen by a contracting
provider for the diagnosis or treatment of the medical condition for
which the insured seeks independent review. The insurer shall
expedite access to a contracting provider upon request of an insured.
The contracting provider need not recommend the disputed health care
service as a condition for the insured to be eligible for an
independent review.
For purposes of this article, the insured's provider may be a
noncontracting provider. However, the insurer shall have no liability
for payment of services provided by a noncontracting provider,
except as provided pursuant to Section 10169.3.
(2) The disputed health care service has been denied, modified, or
delayed by the insurer, or by one of its contracting providers,
based in whole or in part on a decision that the health care service
is not medically necessary.
(3) The insured has filed a grievance with the insurer or its
contracting provider, and the disputed decision is upheld or the
grievance remains unresolved after 30 days. The insured shall not be
required to participate in the insurer's grievance process for more
than 30 days. In the case of a grievance that requires expedited
review, the insured shall not be required to participate in the
insurer's grievance process for more than three days.
(k) An insured may apply to the department for an independent
medical review of a decision to deny, modify, or delay health care
services, based in whole or in part on a finding that the disputed
health care services are not medically necessary, within six months
of any of the qualifying periods or events under subdivision (j). The
commissioner may extend the application deadline beyond six months
if the circumstances of a case warrant the extension.
( l ) The insured shall pay no application or
processing fees of any kind.
(m) As part of its notification to the insured regarding a
disposition of the insured's grievance that denies, modifies, or
delays health care services, the insurer shall provide the insured
with a one- or two-page application form approved by the department,
and an addressed envelope, which the insured may return to initiate
an independent medical review. The insurer shall include on the form
any information required by the department to facilitate the
completion of the independent medical review, such as the insured's
diagnosis or condition, the nature of the disputed health care
service sought by the insured, a means to identify the insured's
case, and any other material information. The form shall also include
the following:
(1) Notice that a decision not to participate in the independent
review process may cause the insured to forfeit any statutory right
to pursue legal action against the insurer regarding the disputed
health care service.
(2) A statement indicating the insured's consent to obtain any
necessary medical records from the insurer, any of its contracting
providers, and any noncontracting provider the insured may have
consulted on the matter, to be signed by the insured.
(3) Notice of the insured's right to provide information or
documentation, either directly or through the insured's provider,
regarding any of the following:
(A) A provider recommendation indicating that the disputed health
care service is medically necessary for the insured's medical
condition.
(B) Medical information or justification that a disputed health
care service, on an urgent care or emergency basis, was medically
necessary for the insured's medical condition.
(C) Reasonable information supporting the insured's position that
the disputed health care service is or was medically necessary for
the insured's medical condition, including all information provided
to the insured by the insurer or any of its contracting providers,
still in the possession of the insured, concerning an insurer or
provider decision regarding disputed health care services, and a copy
of any materials the insured submitted to the insurer, still in the
possession of the insured, in support of the grievance, as well as
any additional material that the insured believes is relevant.
(4) A section designed to collect information on the insured's
ethnicity, race, and primary language spoken that includes both of
the following:
(A) A statement of intent indicating that the information is used
for statistics only, in order to ensure that all insureds get the
best care possible.
(B) A statement indicating that providing this information is
optional and will not affect the independent medical review process
in any way.
(n) Upon notice from the department that the insured has applied
for an independent medical review, the insurer or its contracting
providers, shall provide to the independent medical review
organization designated by the department a copy of all of the
following documents within three business days of the insurer's
receipt of the department's notice of a request by an insured for an
independent review:
(1) (A) A copy of all of the insured's medical records in the
possession of the insurer or its contracting providers relevant to
each of the following:
(i) The insured's medical condition.
(ii) The health care services being provided by the insurer and
its contracting providers for the condition.
(iii) The disputed health care services requested by the insured
for the condition.
(B) Any newly developed or discovered relevant medical records in
the possession of the insurer or its contracting providers after the
initial documents are provided to the independent medical review
organization shall be forwarded immediately to the independent
medical review organization. The insurer shall concurrently provide a
copy of medical records required by this subparagraph to the insured
or the insured's provider, if authorized by the insured, unless the
offer of medical records is declined or otherwise prohibited by law.
The confidentiality of all medical record information shall be
maintained pursuant to applicable state and federal laws.
(2) A
copy of all information provided to the insured by the insurer and
any of its contracting providers concerning insurer and provider
decisions regarding the insured's condition and care, and a copy of
any materials the insured or the insured's provider submitted to the
insurer and to the insurer's contracting providers in support of the
insured's request for disputed health care services. This
documentation shall include the written response to the insured's
grievance. The confidentiality of any insured medical information
shall be maintained pursuant to applicable state and federal laws.
(3) A copy of any other relevant documents or information used by
the insurer or its contracting providers in determining whether
disputed health care services should have been provided, and any
statements by the insurer and its contracting providers explaining
the reasons for the decision to deny, modify, or delay disputed
health care services on the basis of medical necessity. The insurer
shall concurrently provide a copy of documents required by this
paragraph, except for any information found by the commissioner to be
legally privileged information, to the insured and the insured's
provider. The department and the independent medical review
organization shall maintain the confidentiality of any information
found by the commissioner to be the proprietary information of the
insurer.
(o) This section shall become operative on July 1, 2015.
SEC. 14. Section 10192.18 of the Insurance Code is amended to
read:
10192.18. (a) Application forms shall include the following
questions designed to elicit information as to whether, as of the
date of the application, the applicant currently has Medicare
supplement, Medicare Advantage, Medi-Cal coverage, or another health
insurance policy or certificate in force or whether a Medicare
supplement policy or certificate is intended to replace any other
disability policy or certificate presently in force. A supplementary
application or other form to be signed by the applicant and agent
containing those questions and statements may be used.
(Statements)
(1) You do not need more than one Medicare supplement policy.
(2) If you purchase this policy, you may want to evaluate your
existing health coverage and decide if you need multiple coverages.
(3) You may be eligible for benefits under Medi-Cal and may not
need a Medicare supplement policy.
(4) If after purchasing this policy you become eligible for
Medi-Cal, the benefits and premiums under your Medicare supplement
policy can be suspended, if requested, during your entitlement to
benefits under Medi-Cal for 24 months. You must request this
suspension within 90 days of becoming eligible for Medi-Cal. If you
are no longer entitled to Medi-Cal, your suspended Medicare
supplement policy or if that is no longer available, a substantially
equivalent policy, will be reinstituted if requested within 90 days
of losing Medi-Cal eligibility. If the Medicare supplement policy
provided coverage for outpatient prescription drugs and you enrolled
in Medicare Part D while your policy was suspended, the reinstituted
policy will not have outpatient prescription drug coverage, but will
otherwise be substantially equivalent to your coverage before the
date of the suspension.
(5) If you are eligible for, and have enrolled in, a Medicare
supplement policy by reason of disability and you later become
covered by an employer or union-based group health plan, the benefits
and premiums under your Medicare supplement policy can be suspended,
if requested, while you are covered under the employer or
union-based group health plan. If you suspend your Medicare
supplement policy under these circumstances and later lose your
employer or union-based group health plan, your suspended Medicare
supplement policy or if that is no longer available, a substantially
equivalent policy, will be reinstituted if requested within 90 days
of losing your employer or union-based group health plan. If the
Medicare supplement policy provided coverage for outpatient
prescription drugs and you enrolled in Medicare Part D while your
policy was suspended, the reinstituted policy will not have
outpatient prescription drug coverage, but will otherwise be
substantially equivalent to your coverage before the date of the
suspension.
(6) Counseling services are available in this state to provide
advice concerning your purchase of Medicare supplement insurance and
concerning medical assistance through the Medi-Cal program, including
benefits as a qualified Medicare beneficiary (QMB) and a specified
low-income Medicare beneficiary (SLMB). If you want to discuss buying
Medicare supplement insurance with a trained insurance counselor,
call the California Department of Insurance's toll-free telephone
number 1-800-927-HELP, or access the department's Internet Web
site, www.insurance.ca.gov, and ask how to contact your local
Health Insurance Counseling and Advocacy Program (HICAP) office.
HICAP is a service provided free of charge by the State of
California.
(Questions)
If you lost or are losing other health insurance coverage and
received a notice from your prior insurer saying you were eligible
for guaranteed issue of a Medicare supplement insurance policy or
that you had certain rights to buy such a policy, you may be
guaranteed acceptance in one or more of our Medicare supplement
plans. Please include a copy of the notice from your prior insurer
with your application. PLEASE ANSWER ALL QUESTIONS.
Please mark Yes or No below with an "X."]
To the best of your knowledge,
(1) (a) Did you turn 65 years of age in the last 6 months
Yes____ No____
(b) Did you enroll in Medicare Part B in the last 6 months
Yes____ No____
(c) If yes, what is the effective date ___________________
(2) Are you covered for medical assistance through California's
Medi-Cal program
NOTE TO APPLICANT: If you have a share of cost under the Medi-Cal
program, please answer NO to this question.
Yes____ No____
If yes,
(a) Will Medi-Cal pay your premiums for this Medicare supplement
policy
Yes____ No____
(b) Do you receive benefits from Medi-Cal OTHER THAN payments
toward your Medicare Part B premium
Yes____ No____
(3) (a) If you had coverage from any Medicare plan other than
original Medicare within the past 63 days (for example, a Medicare
Advantage plan or a Medicare HMO or PPO), fill in your start and end
dates below. If you are still covered under this plan, leave "END"
blank.
START __/__/__ END __/__/__
(b) If you are still covered under the Medicare plan, do you
intend to replace your current coverage with this new Medicare
supplement policy
Yes____ No____
(c) Was this your first time in this type of Medicare plan
Yes____ No____
(d) Did you drop a Medicare supplement policy to enroll in the
Medicare plan
Yes____ No____
(4) (a) Do you have another Medicare supplement policy in force
Yes____ No____
(b) If so, with what company, and what plan do you have optional
for direct mailers]
Yes____ No____
(c) If so, do you intend to replace your current Medicare
supplement policy with this policy
Yes____ No____
(5) Have you had coverage under any other health insurance within
the past 63 days (For example, an employer, union, or individual
plan)
Yes____ No____
(a) If so, with what companies and what kind of policy
________________________________________________
________________________________________________
________________________________________________
________________________________________________
(b) What are your dates of coverage under the other policy
START __/__/__ END __/__/__
(If you are still covered under the other policy, leave "END"
blank.)
(b) Agents shall list any other health insurance policies they
have sold to the applicant as follows:
(1) List policies sold that are still in force.
(2) List policies sold in the past five years that are no longer
in force.
(c) In the case of a direct response issuer, a copy of the
application or supplemental form, signed by the applicant, and
acknowledged by the issuer, shall be returned to the applicant by the
issuer upon delivery of the policy.
(d) Upon determining that a sale will involve replacement of
Medicare supplement coverage, any issuer, other than a direct
response issuer, or its agent, shall furnish the applicant, prior to
issuance for delivery of the Medicare supplement policy or
certificate, a notice regarding replacement of Medicare supplement
coverage. One copy of the notice signed by the applicant and the
agent, except where the coverage is sold without an agent, shall be
provided to the applicant and an additional signed copy shall be
retained by the issuer as provided in Section 10508. A direct
response issuer shall deliver to the applicant at the time of the
issuance of the policy the notice regarding replacement of Medicare
supplement coverage.
(e) The notice required by subdivision (d) for an issuer shall be
in the form specified by the commissioner, using, to the extent
practicable, a model notice prepared by the National Association of
Insurance Commissioners for this purpose. The replacement notice
shall be printed in no less than 12-point type in substantially the
following form:
Insurer's name and address]
NOTICE TO APPLICANT REGARDING REPLACEMENT OF MEDICARE SUPPLEMENT
COVERAGE OR MEDICARE ADVANTAGE
SAVE THIS NOTICE! IT MAY BE IMPORTANT IN THE FUTURE.
If you intend to cancel or terminate existing Medicare supplement
or Medicare Advantage insurance and replace it with coverage issued
by company name], please review the new coverage carefully and
replace the existing coverage ONLY if the new coverage materially
improves your position. DO NOT CANCEL YOUR PRESENT COVERAGE UNTIL YOU
HAVE RECEIVED YOUR NEW POLICY AND ARE SURE THAT YOU WANT TO KEEP IT.
If you decide to purchase the new coverage, you will have 30 days
after you receive the policy to return it to the insurer, for any
reason, and receive a refund of your money.
If you want to discuss buying Medicare supplement or Medicare
Advantage coverage with a trained insurance counselor, call the
California Department of Insurance's toll-free telephone number
1-800-927-HELP, and ask how to contact your local Health Insurance
Counseling and Advocacy Program (HICAP) office. HICAP is a service
provided free of charge by the State of California.
STATEMENT TO APPLICANT FROM THE INSURER AND AGENT: I have reviewed
your current health insurance coverage. To the best of my knowledge,
the replacement of insurance involved in this transaction does not
duplicate coverage or, if applicable, Medicare Advantage coverage
because you intend to terminate your existing Medicare supplement
coverage or leave your Medicare Advantage plan. In addition, the
replacement coverage contains benefits that are clearly and
substantially greater than your current benefits for the following
reasons:
__ Additional benefits that are: ______
__ No change in benefits, but lower premiums.
__ Fewer benefits and lower premiums.
__ Plan has outpatient prescription drug coverage and applicant is
enrolled in Medicare Part D.
__ Disenrollment from a Medicare Advantage plan. Reasons for
disenrollment:
__ Other reasons specified here: ______
1. Note: If the issuer of the Medicare supplement policy being
applied for does not impose, or is otherwise prohibited from
imposing, preexisting condition limitations, please skip to statement
3 below. Health conditions that you may presently have (preexisting
conditions) may not be immediately or fully covered under the new
policy. This could result in denial or delay of a claim for benefits
under the new policy, whereas a similar claim might have been payable
under your present policy.
2. State law provides that your replacement Medicare supplement
policy may not contain new preexisting conditions, waiting periods,
elimination periods, or probationary periods. The insurer will waive
any time periods applicable to preexisting conditions, waiting
periods, elimination periods, or probationary periods in the new
coverage for similar benefits to the extent that time was spent
(depleted) under the original policy.
3. If you still wish to terminate your present policy and replace
it with new coverage, be certain to truthfully and completely answer
any and all questions on the application concerning your medical and
health history. Failure to include all material medical information
on an application requesting that information may provide a basis for
the insurer to deny any future claims and to refund your premium as
though your policy had never been in force. After the application has
been completed and before you sign it, review it carefully to be
certain that all information has been properly recorded. If the
policy or certificate is guaranteed issue, this paragraph need not
appear.]
DO NOT CANCEL YOUR PRESENT POLICY UNTIL YOU HAVE RECEIVED YOUR NEW
POLICY AND ARE SURE THAT YOU WANT TO KEEP IT.
_________________________________________________
(Signature of Agent, Broker, or Other
Representative)
_________________________________________________
(Signature of Applicant)
_________________________________________________
(Date)
(f) No issuer, broker, agent, or other person shall cause an
insured to replace a Medicare supplement insurance policy
unnecessarily. In recommending replacement of any Medicare supplement
insurance, an agent shall make reasonable efforts to determine the
appropriateness to the potential insured.
(g) An issuer shall not require, request, or obtain health
information as part of the application process for an applicant who
is eligible for guaranteed issuance of, or open enrollment for, any
Medicare supplement coverage pursuant to Section 10192.11 or
10192.12, except for purposes of paragraph (1) or (2) of subdivision
(a) of Section 10192.11 when the applicant is first enrolled in
Medicare Part B. The application form shall include a clear and
conspicuous statement that the applicant is not required to provide
health information during a period where guaranteed issue or open
enrollment applies, as specified in Section 10192.11 or 10192.12,
except for purposes of paragraph (1) or (2) of subdivision (a) of
Section 10192.11 when the applicant is first enrolled in Medicare
Part B, and shall inform the applicant of those periods of guaranteed
issuance of Medicare supplement coverage. This subdivision shall not
prohibit an issuer from requiring proof of eligibility for a
guaranteed issuance of Medicare supplement coverage.
SEC. 15. Section 10232.3 of the Insurance Code is amended to read:
10232.3. (a) All applications for long-term care insurance except
that which is guaranteed issue, shall contain clear, unambiguous,
short, simple questions designed to ascertain the health condition of
the applicant. Each question shall contain only one health status
inquiry and shall require only a "yes" or "no" answer, except that
the application may include a request for the name of any prescribed
medication and the name of a prescribing physician. If the
application requests the name of any prescribed medication or
prescribing physician, then any mistake or omission shall not be used
as a basis for the denial of a claim or the rescission of a policy
or certificate.
(b) The following warning shall be printed conspicuously and in
close conjunction with the applicant's signature block:
"Caution: If your answers on this application are misstated or
untrue, the insurer may have the right to deny benefits or rescind
your coverage."
(c) Every application for long-term care insurance shall include a
checklist that enumerates each of the specific documents that this
chapter requires be given to the applicant at the time of
solicitation. The documents and notices to be listed in the checklist
include, but are not limited to, the following:
(1) The "Important Notice Regarding Policies Available" pursuant
to Section 10232.25.
(2)
(1) The outline of coverage pursuant to Section
10233.5.
(3)
(2) The HICAP notice pursuant to paragraph (8) of
subdivision (a) of Section 10234.93.
(4)
(3) The long-term care insurance shoppers guide
pursuant to paragraph (9) of subdivision (a) of Section 10234.93.
(5)
(4) The "Long-Term Care Insurance Personal Worksheet"
pursuant to subdivision (c) of Section 10234.95.
(6)
(5) The "Notice to Applicant Regarding Replacement of
Accident and Sickness or Long-Term Care Insurance" pursuant to
Section 10235.16 if replacement is not made by direct response
solicitation or Section 10235.18 if replacement is made by direct
response solicitation. Unless the solicitation was made by a direct
response method, the agent and applicant shall both sign at the
bottom of the checklist to indicate the required documents were
delivered and received.
(d) If an insurer does not complete medical underwriting and
resolve all reasonable questions arising from information submitted
on or with an application before issuing the policy or certificate,
then the insurer may only rescind the policy or certificate or deny
an otherwise valid claim, upon clear and convincing evidence of fraud
or material misrepresentation of the risk by the applicant. The
evidence shall:
(1) Pertain to the condition for which benefits are sought.
(2) Involve a chronic condition or involve dates of treatment
before the date of application.
(3) Be material to the acceptance for coverage.
(e) No long-term care policy or certificate may be field issued.
(f) The contestability period as defined in Section 10350.2 for
long-term care insurance shall be two years.
(g) A copy of the completed application shall be delivered to the
insured at the time of delivery of the policy or certificate.
(h) Every insurer shall maintain a record, in accordance with
Section 10508, of all policy or certificate rescissions, both state
and countrywide, and shall annually furnish this information to the
commissioner, which shall include the reason for rescission, the
length of time the policy or certificate was in force, and the age
and gender of the insured person, in a format prescribed by the
commissioner.
(i) The commissioner may, in his or her discretion, make public
the aggregate data collected under subdivision (h), upon request.
SEC. 16. Section 10233.5 of the Insurance Code is amended to read:
10233.5. (a) An outline of coverage shall be delivered to a
prospective applicant for long-term care insurance at the time of
initial solicitation through means which prominently direct the
attention of the recipient to the document and its purpose.
(b) In the case of agent solicitations, an agent shall deliver the
outline of coverage prior to the presentation of an application or
enrollment form.
(c) In the case of direct response solicitations, the outline of
coverage shall be presented in conjunction with any application or
enrollment form.
(d) The outline of coverage shall be a freestanding document,
using no smaller than 10-point type.
(e) The outline of coverage shall contain no material of an
advertising nature.
(f) Use of the text and sequence of the text of the outline of
coverage set forth in this section is mandatory, unless otherwise
specifically indicated.
(g) Text which that is capitalized
or underscored in the outline of coverage may be emphasized by other
means which that provide prominence
equivalent to capitalization or underscoring.
(h) The outline of coverage shall be in the following form:
(COMPANY NAME)
(ADDRESS--CITY AND STATE)
(TELEPHONE NUMBER)
LONG-TERM CARE INSURANCE
OUTLINE OF COVERAGE
(Policy Number or Group Master Policy and Certificate Number)
1. This policy is (an individual policy of insurance) ((a group
policy) which was issued in the (indicate jurisdiction in which group
policy was issued)).
2. PURPOSE OF OUTLINE OF COVERAGE. This outline of coverage
provides a very brief description of the important features of the
policy. You should compare this outline of coverage to outlines of
coverage for other policies available to you. This is not an
insurance contract, but only a summary of coverage. Only the
individual or group policy contains governing contractual provisions.
This means that the policy or group policy sets forth in detail the
rights and obligations of both you and the insurance company.
Therefore, if you purchase this coverage, or any other coverage, it
is important that you READ YOUR POLICY (OR CERTIFICATE) CAREFULLY!
3. TERMS UNDER WHICH THE POLICY OR CERTIFICATE MAY BE RETURNED
AND PREMIUM REFUNDED.
(a) Provide a brief description of the right to return--"free look"
provision of the policy.
(b) Include a statement that the policy either does or does not
contain provisions providing for a refund or partial refund of
premium upon the death of an insured or surrender of the policy or
certificate. If the policy contains those provisions, include a
description of them.
4. THIS IS NOT MEDICARE SUPPLEMENT COVERAGE. If you are eligible
for Medicare, review the Medicare Supplement Buyer's Guide available
from the insurance company.
(a) (For agents) Neither (insert company name) nor its agents
represent Medicare, the federal government or any state government.
(b) (For direct response) (insert company name) is not
representing Medicare, the federal government or any state
government.
5. LONG-TERM CARE COVERAGE. Policies of this category are
designed to provide coverage for one or more necessary or medically
necessary diagnostic, preventive, therapeutic, rehabilitative,
maintenance, or personal care services, provided in a setting other
than an acute care unit of a hospital, such as in a nursing home, in
the community, or in the home.
This policy provides coverage in the form of a fixed dollar
indemnity benefit for covered long-term care expenses, subject to
policy (limitations) (waiting periods) and (coinsurance)
requirements. (Modify this paragraph if the policy is not an
indemnity policy.)
6. BENEFITS PROVIDED BY THIS POLICY.
(a) (Covered services, related deductible(s), waiting periods,
elimination periods, and benefit maximums.)
(b) (Institutional benefits, by skill level.)
(c) (Noninstitutional benefits, by skill level.)
(Any benefit screens must be explained in this section. If these
screens differ for different benefits, explanation of the screen
should accompany each benefit description. If an attending physician
or other specified person must certify a certain level of functional
dependency in order to be eligible for benefits, this too must be
specified. If activities of daily living (ADLs) are used to measure
an insured's need for long-term care, then these qualifying criteria
or screens must be explained.)
7. LIMITATIONS AND EXCLUSIONS.
(Describe:
(a) Preexisting conditions.
(b) Noneligible facilities/provider.
(c) Noneligible levels of care (e.g., unlicensed providers, care
or treatments provided by a family member, etc.).
(d) Exclusions/exceptions.
(e) Limitations.)
(This section should provide a brief specific description of any
policy provisions which limit, exclude, restrict, reduce, delay, or
in any other manner operate to qualify payment of the benefits
described in (6) above.)
THIS POLICY MAY NOT COVER ALL THE EXPENSES ASSOCIATED WITH YOUR
LONG-TERM CARE NEEDS.
8. RELATIONSHIP OF COST OF CARE AND BENEFITS. Because the costs
of long-term care services will likely increase over time, you should
consider whether and how the benefits of this plan may be adjusted.
(As applicable, indicate the following:
(a) That the benefit level will NOT increase over time.
(b) Any automatic benefit adjustment provisions.
(c) Whether the insured will be guaranteed the option to buy
additional benefits and the basis upon which benefits will be
increased over time if not by a specified amount or percentage.
(d) If there is a guarantee, include whether additional
underwriting or health screening will be required, the frequency and
amounts of the upgrade options, and any significant restrictions or
limitations.
(e) And finally, describe whether there will be any additional
premium charge imposed, and how that is to be calculated.)
9. TERMS UNDER WHICH THE POLICY (OR CERTIFICATE) MAY BE CONTINUED
IN FORCE OR DISCONTINUED.
(a) Describe the policy renewability provisions.
(b) For group coverage, specifically describe
continuation/conversion provisions applicable to the certificate and
group policy.
(c) Describe waiver of premium provisions or state that there are
no waiver of premium provisions.
(d) State whether or not the company has a right to change
premium, and if that right exists, describe clearly and concisely
each circumstance under which the premium may change.
10. ALZHEIMER'S DISEASE, ORGANIC DISORDERS, AND RELATED
MENTAL DISEASES. ALL MENTAL ILLNESSES COVERED.
(State that the policy provides coverage for insureds
clinically diagnosed as having Alzheimer's Disease, organic
disorders, or related degenerative and dementing illnesses.
for all mental illnesses. Specifically describe each
benefit screen or other policy provision that provides preconditions
to the availability of policy benefits for that insured.)
11. PREMIUM.
(a) State the total annual premium for the policy.
(b) If the premium varies with an applicant's choice among benefit
options, indicate the portion of annual premium which corresponds to
each benefit option.
12. ADDITIONAL FEATURES.
(a) Indicate if medical underwriting is used.
(b) Describe other important features.
13. INFORMATION AND COUNSELING. The California Department of
Insurance has prepared a Consumer Guide to Long-Term Care Insurance.
This guide can be obtained by calling the Department of Insurance
toll-free telephone number. This number or by
accessing the department's Internet Web site at
www.insurance.ca.gov. The department's number is
1-800-927-HELP. Additionally, the Health Insurance Counseling and
Advocacy Program (HICAP) administered by the California Department of
Aging, provides long-term care insurance counseling to California
senior citizens. Call the HICAP toll-free telephone number
1-800-434-0222 for a referral to your local HICAP office."
SEC. 17. Section 10233.9 of the Insurance Code is
repealed.
10233.9. Any insurer offering long-term care insurance under this
chapter shall provide to the Department of Insurance, for the
commissioner's conveyance to the Department of Aging, a copy of the
following materials for all long-term care insurance coverage
advertised, marketed, or offered by that insurer in this state:
(a) Specimen individual policy form or group master policy and
certificate forms.
(b) Corresponding outline of coverage.
(c) Representative advertising materials to be used in this state.
SEC. 18. Section 10235.35 of the Insurance Code is amended to
read:
10235.35. (a) Notwithstanding any other provision of law, the
commissioner may require the administration by an insurer of the
contingent benefit upon lapse, as described in Section 26
28 (A), (D) (3), (E), (F), (G), and (J) of the
Long-Term Care Insurance Model Regulation promulgated by the National
Association of Insurance Commissioners, as adopted in
October 2000, September 2014, as a condition of
approval or acknowledgment of a rate adjustment for a block of
business for which the contingent benefit upon lapse is not otherwise
available.
(b) The insurer shall notify policyholders and certificate holders
of the contingent benefit upon lapse when required by the
commissioner in conjunction with the implementation of a rate
adjustment. The commissioner may require an insurer who files for
such a rate adjustment to allow policyholders and certificate holders
to reduce coverage pursuant to Section 10235.50 to avoid an increase
in the policy's premium amount.
(c) The commissioner may also approve any other alternative
mechanism filed by the insurer in lieu of the contingent benefit upon
lapse.
SEC. 19. Section 12418.4 of the Insurance Code is amended to read:
12418.4. (a) The provisions set forth in
Sections 1667, 1668, 1669, 1670, 1729, 1729.2, 1738,
1738.5, 1743, and in Article 6 (commencing with
Section 12404), shall apply to all applicants or holders of a
certificate of registration issued pursuant to this article.
(b) The department may revoke, suspend, restrict, or decline to
issue a certificate of registration if it determines that the title
marketing representative or applicant has violated provisions of
Article 6 (commencing with Section 12404) pursuant to the due process
and hearing requirements set forth in subdivision (c).
(c) Except as provided in Section 1669, a certificate of
registration shall not be denied, restricted, suspended, or revoked
without a hearing conducted in accordance with Chapter 5 (commencing
with Section 11500) of Part 1 of Division 3 of Title 2 of the
Government Code.
(d) In addition to, or in lieu of, any other penalty that may be
imposed under this article against a title marketing representative,
the commissioner may bring an administrative action against a title
marketing representative for any violation of the provisions of
Article 6 (commencing with Section 12404). If a title marketing
representative charged with a violation of Article 6 (commencing with
Section 12404) is determined by the commissioner to have committed
the violation, the commissioner may require the surrender of,
temporarily suspend or revoke either permanently or temporarily the
title marketing representative's certificate of registration, and, in
addition, may impose a monetary penalty. Any payment of a monetary
penalty pursuant to a settlement or final adjudication shall be made
from the title marketing representative's personal funds and not by
his or her employer either directly or through the title marketing
representative. This article shall not preclude an action against a
company that had actual knowledge of the violation by the title
marketing representative. A title marketing representative who is
issued a certificate of registration under this article may not
engage in any activity that is otherwise prohibited through a
separate entity controlled by the title marketing representative or
by the company or entity that employs him or her.
(e) A title marketing representative who has his or her
certificate of registration revoked by the department shall not be
permitted to reapply for another certificate of registration with the
department for five years from the date of revocation.
SEC. 20. Section 12820 of the Insurance Code is amended to read:
12820. (a) Prior to offering a vehicle service contract form to a
purchaser or providing a vehicle service contract form to a seller,
an obligor shall file with the commissioner a specimen of that
vehicle service contract form.
(b) A vehicle service contract form may include any or all of the
benefits described in subdivision (c) of Section 12800 and shall
comply with all of the following requirements:
(1) (A) If an obligor has complied with Section 12830, the vehicle
service contract shall include a disclosure in substantially the
following form: "Performance to you under this contract is guaranteed
by a California approved insurance company. You may file a claim
with this insurance company if any promise made in the contract has
been denied or has not been honored within 60 days after your
request. The name and address of the insurance company is: (insert
name and address). If you are not satisfied with the insurance
company's response, you may contact the California Department of
Insurance at 1-800-927-4357." 1-800-927-4357
or access the department's Internet Web site (www.insurance.ca.gov).
"
(B) If an obligor has complied with Section 12836, the vehicle
service contract shall include a disclosure in substantially the
following form: "If any promise made in the contract has been denied
or has not been honored within 60 days after your request, you may
contact the California Department of Insurance at
1-800-927-4357." 1-800-927-4357 or access the
department's Internet Web site (www.insurance.ca.gov). "
(2) All vehicle service contract language that excludes coverage,
or imposes duties upon the purchaser, shall be conspicuously printed
in boldface type no smaller than the surrounding type.
(3) The vehicle service contract shall do each of the following:
(A) State the obligor's full corporate name or a fictitious name
approved by the commissioner, the obligor's mailing address, the
obligor's telephone number, and the obligor's vehicle service
contract provider license number.
(B) State the name of the purchaser and the name of the seller.
(C) Conspicuously state the vehicle service contract's purchase
price.
(D) Comply with Sections 1794.4 and 1794.41 of the Civil Code.
(E) Name the administrator, if any, and provide the administrator'
s license number.
(4) If the vehicle service contract excludes coverage for
preexisting conditions, the contract must disclose this exclusion in
12-point type.
(c) The following benefits constitute insurance, whether offered
as part of a vehicle service contract or in a separate agreement:
(1) Indemnification for a loss caused by misplacement, theft,
collision, fire, or other peril typically covered in the
comprehensive coverage section of an automobile insurance policy, a
homeowner's policy, or a marine or inland marine policy.
(2) Locksmith services, unless offered as part of an emergency
road service benefit.
SEC. 21. Section 12921 of the Insurance Code is amended to read:
12921. (a) The commissioner shall perform all duties imposed upon
him or her by the provisions of this code and other laws regulating
the business of insurance in this state, and shall enforce the
execution of those provisions and laws.
(b) In an administrative action to enforce the provisions of this
code and other laws regulating the business of insurance in this
state, any settlement is subject to all of the following:
(1) The commissioner may delegate the power to negotiate the terms
and conditions of a settlement but the commissioner may not delegate
the power to approve the settlement.
(1) The commissioner may delegate the
power to negotiate the terms and conditions of a settlement. The
commissioner may delegate the power to approve a settlement, unless
the settlement involves any of the following:
(A) An insurer.
(B) A managing general agent or production agent that manages the
business of an insurer.
(C) A title company.
(D) A home protection company.
(E) An insurance adjuster whose claims practices are at issue.
(F) An insurance agent or broker, or an applicant for an insurance
agent or broker license, who has allegedly engaged in theft, fraud,
or the misappropriation of premium or other funds in an amount that
exceeds fifty thousand dollars ($50,000).
(2) Unless specifically provided for in a provision of this code,
the commissioner may not agree to any of the following:
(A) That the respondent contribute, deposit, or transfer any
moneys or other resources to a nonprofit entity.
(B) That a respondent contribute, deposit, or transfer any fine,
penalty, assessment, cost, or fee except to the commissioner for
deposit in the appropriate state fund pursuant to Section 12975.7.
(C) That the commissioner may or shall direct the transfer,
distribution, or payment to another person or entity of any fine,
penalty, assessment, cost, or fee.
(D) The use of the commissioner's name, likeness, or voice in any
printed material or audio or visual medium, either for general
distribution or for distribution to specific recipients.
(3) The commissioner may only agree to payment to those persons or
entities to whom payment may be due because of the respondent's
violation of a provision of this code or other law regulating the
business of insurance in this state.
(4) A settlement may only include the sanctions provided by this
code or other laws regulating the business of insurance in this
state, except that the settlement may include attorney's fees, costs
of the department in bringing the enforcement action, and future
costs of the department to ensure compliance with the settlement
agreement.
(c) Notwithstanding any other provision of law, the commissioner
may accept documents submitted for filing or approval, process
transactions, and maintain records in electronic form or as paper
documents, and may adopt regulations to further this subdivision.
SEC. 22. Section 1299.04 of the Penal Code is amended to read:
1299.04. (a) A bail fugitive recovery person, a bail agent, bail
permittee, or bail solicitor who contracts his or her services to
another bail agent or surety as a bail fugitive recovery person for
the purposes specified in subdivision (d) of Section 1299.01, and any
bail agent, bail permittee, or bail solicitor who obtains licensing
after January 1, 2000, and who engages in the arrest of a defendant
pursuant to Section 1301 shall comply with the following
requirements:
(1) The person shall be at least 18 years of age.
(2) The person shall have completed a 40-hour power of arrest
course certified by the Commission on Peace Officer Standards and
Training pursuant to Section 832. Completion of the course shall be
for educational purposes only and not intended to confer the power of
arrest of a peace officer or public officer, or agent of any
federal, state, or local government, unless the person is so employed
by a governmental agency.
(3) The person shall have completed a minimum of 20 hours of
classroom prelicensing education certified pursuant to
Section 1810.7 of the Insurance Code. For those persons licensed
by the department as a bail licensee prior to January 1, 1994, there
is no prelicensing education requirement. For those persons licensed
by the department as a bail licensee bet ween January 1,
1994, and December 31, 2012, a minimum of 12 hours of classroom
prelicensing education is required.
(4) The person shall not have been convicted of a felony, unless
the person is licensed by the Department of Insurance pursuant to
Section 1800 of the Insurance Code.
(b) Upon completion of any course or training program required by
this section, an individual authorized by Section 1299.02 to
apprehend a bail fugitive shall carry certificates of completion with
him or her at all times in the course of performing his or her
duties under this article.
