California Insurance Code 12682.2 – (a) (1) At least 60 days prior to the policy renewal date, …
(a) (1) At least 60 days prior to the policy renewal date, an insurer that does not otherwise issue individual health insurance policies shall issue the notice described in paragraph (2) to any policyholder of an individual health insurance policy issued pursuant to Section 12682.1 that is not a grandfathered health plan.
(2) The notice shall be in at least 12-point type and shall include all of the following information:
Terms Used In California Insurance Code 12682.2
- Commissioner: means the Insurance Commissioner of this State. See California Insurance Code 20
- Insurance: refers to health insurance, major medical, or comprehensive coverage paid by premium or contribution under a group policy, a hospital service contract, or as otherwise provided by a policyholder to its employees or members other than by self-insuring except in the case of a plan that is exempt from ERISA, but does include an employer plan that is exempt from ERISA as specified in subdivision (i). See California Insurance Code 12671
- Insurer: means the entity issuing a group policy, an individual or converted policy, a hospital service contract or an employer or employee organization otherwise providing medical, hospital, surgical, major medical, or comprehensive medical coverage to its employees or members. See California Insurance Code 12671
- Policyholder: means the holder of a group policy issued by an insurer, a holder of a group contract issued by a hospital service corporation or an employer, employee association, or other entity otherwise providing medical, hospital, surgical, major medical, or comprehensive medical coverage on a group basis to its employees or members. See California Insurance Code 12671
- Premium: means contribution or other consideration paid or payable for coverage under a group policy or converted policy. See California Insurance Code 12671
(A) Notice that, as of the renewal date, the individual policy will not be renewed.
(B) The availability of individual health coverage through Covered California, including at least all of the following:
(i) That, beginning on January 1, 2014, individuals seeking coverage may not be denied coverage based on health status.
(ii) That the premium rates for coverage offered by a health care service plan or a health insurer cannot be based on an individual’s health status.
(iii) That individuals obtaining coverage through Covered California may, depending upon income, be eligible for premium subsidies and cost-sharing subsidies.
(iv) That individuals seeking coverage must obtain this coverage during an open or special enrollment period, and describe the open and special enrollment periods that may apply.
(b) (1) At least 60 days prior to the policy renewal date, an insurer that issues individual health insurance policies shall issue the notice described in paragraph (2) to a policyholder of an individual health insurance policy issued pursuant to Section 10785 or 12682.1 that is not a grandfathered health plan.
(2) The notice shall be in at least 12-point type and shall include all of the following:
(A) Notice that, as of the renewal date, the individual policy shall not be renewed.
(B) Information regarding the individual health insurance policy that the insurer will issue as of January 1, 2014, which the insurer has reasonably concluded is the most comparable to the individual’s current policy. The notice shall include information on premiums for the possible replacement policy and instructions that the individual can continue their coverage by paying the premium stated by the due date.
(C) Notice of the availability of other individual health coverage through Covered California, including at least all of the following:
(i) That, beginning on January 1, 2014, individuals seeking coverage may not be denied coverage based on health status.
(ii) That the premium rates for coverage offered by a health care service plan or a health insurer cannot be based on an individual’s health status.
(iii) That individuals obtaining coverage through Covered California may, depending upon income, be eligible for premium subsidies and cost-sharing subsidies.
(iv) That individuals seeking coverage must obtain this coverage during an open or special enrollment period, and describe the open and special enrollment periods that may apply.
(c) No later than September 1, 2013, the commissioner, in consultation with the Department of Managed Health Care, shall adopt uniform model notices that health insurers shall use to comply with subdivisions (a) and (b) and Sections 10127.16, 10786, and 10965.13. Use of the model notices shall not require prior approval by the department. The model notices adopted for purposes of this section shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). The commissioner may modify the wording of these model notices specifically for purposes of clarity, readability, and accuracy.
(d) The notices required under this section are vital documents, pursuant to clause (iii) of subparagraph (B) of paragraph (1) of subdivision (b) of Section 10133.8, and shall be subject to the requirements of that section.
(e) For purposes of this section, the following definitions shall apply:
(1) “Covered California” means the California Health Benefit Exchange established pursuant to § 100500 of the Government Code.
(2) “Grandfathered health plan” has the same meaning as that term is defined in Section 1251 of PPACA.
(3) “PPACA” means the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued pursuant to that law.
(Added by Stats. 2013, Ch. 441, Sec. 25. (AB 1180) Effective October 1, 2013.)