Bill Text: CA AB2035 | 2009-2010 | Regular Session | Amended

---

Bill Title: Self-funded dental benefit plans: administrators.

Spectrum: Partisan Bill (Democrat 3-0)

Status: (Engrossed - Dead) 2010-06-17 - In committee: Set, second hearing. Hearing canceled at the request of author. [AB2035 Detail]

Download: California-2009-AB2035-Amended.html

---

BILL NUMBER: AB 2035	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MAY 18, 2010

INTRODUCED BY   Assembly Member Coto
    (   Coauthors:   Assembly Members 
 Block   and Jones   ) 

                        FEBRUARY 17, 2010

   An act to add Section 1759.11 to the Insurance Code, relating to
health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 2035, as amended, Coto. Self-funded dental benefit plans:
administrators.
   Existing law provides for the regulation of insurers by the
Department of Insurance. Existing law requires administrators who
perform certain acts in connection with life or health insurance
coverage or annuities to be registered with the Insurance
Commissioner and to comply with certain other requirements.
   This bill would require an administrator providing administrative
services for a self-funded dental benefit plan to  include
certain language in explanation of benefits documents and in forms
sent to claimants in response to claims for benefits  
provide a claimant with a written notice of the claimant's right to
an appeal, the appeal process, and certain other information in the
case of an adverse benefit determination on a claim, as provided
 .
   Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.   (a)     It is the intent of this
act that adequate notification and information be provided to
claimants when a third-party administrator of a dental plan operating
under the federal Employee Retirement Income Security Act of 1974
(29 U.S.C. Sec. 1001 et seq.) renders an adverse payment decision on
a claim submitted to the plan. It is intended that this requirement
conform to the requirements regarding notices of adverse benefit
determinations as outlined in Section 2560.503-1(g) of Title 29 of
the Code of Federal Regulations. 
    (b)    The Legislature finds and declares that
third-party administrators of insurance are regulated by the
Insurance Commissioner. Therefore, the requirements of this act
constitute a regulation of insurance within the meaning of
subparagraph (A) of paragraph (2) of subdivision (b) of Section 1144
of Title 29 of the United States Code.
  SEC. 2.  Section 1759.11 is added to the Insurance Code, to read:
   1759.11.  (a) This section shall only apply to an administrator
who provides administrative services for a self-funded dental benefit
plan otherwise subject to the jurisdiction of the federal
government. 
   (b) The administrator shall include the following language or
similar language in explanation of benefits documents and in forms
sent to claimants response to claims for benefits:  

    "This dental benefit plan is self-funded and subject to
compliance with the federal Employee Retirement Income Security Act.
As such, it is not subject to state law governing health care
coverage for dental care. Any questions, appeals, or disputes arising
from the payment of a submitted claim should be directed to the
entity providing the coverage, or to the United States Department of
Labor, Office of Participant Assistance. You can contact the Office
of Participant Assistance at ____."  
   (c) The administrator shall fill in the blank in the notice
required by subdivision (b) with the appropriate telephone number for
the Office of Participant Assistance.  
   (b) In the case of an adverse determination on a claim involving a
denial, reduction, or termination of, or a failure to provide or
make payment for, a benefit, the administrator shall provide a
claimant with a written notice of the claimant's right to appeal the
determination, and the process for filing an appeal. The notice shall
also inform the claimant that the dental benefit plan is subject to
compliance with the federal Employee Retirement Income Security Act
of 1974 (29 U.S.C. Sec. 1001 et seq.), and as such, is not subject to
state law governing health care coverage for dental care.