BILL NUMBER: SB 615	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MAY 10, 2011
	AMENDED IN SENATE  APRIL 13, 2011

INTRODUCED BY   Senator Calderon

                        FEBRUARY 18, 2011

    An act to add Section 1361.5 to the Health and Safety
Code, and to amend Sections 1622, 1626, and 1631.5 of, and to add
Section 1632.5 to, the Insurance Code, relating to health care
coverage.   An act to amend Section 1359 of, and to add
Section 1361.5 to, the Health and Safety Code, and to amend Section
1631.5 of, and to add Section 1749.87 to, the Insurance Code,
relating to health care coverage. 


	LEGISLATIVE COUNSEL'S DIGEST


   SB 615, as amended, Calderon. Health care service plans: accident
and health agents: licensure. 
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care. A willful violation
of the act is a crime. The chief officer of the department is the
Director of the Department of Managed Health Care. Existing law
authorizes the director to require that solicitors and solicitor
firms, and principal persons engaged in the supervision of
solicitation for plans of solicitor firms, meet specified standards.
 
   This bill would change the director's authority as described above
to make it mandatory. On and after January 1, 2013, the bill would
also require solicitors and solicitor firms, and principal persons
engaged in the supervision of solicitation for health care service
plan contracts, specialized health care service plan contracts,
Medicare Advantage Plans under Medicare Part C, or Medicare
supplement contracts, to complete solicitor training that includes,
among other things, information relating to the act, the federal
Patient Protection and Affordable Care Act, and the California Health
Benefit Exchange. The bill would require the department to consult
with the Insurance Commissioner with respect to developing the
curriculum for the solicitor training.  
   Because a willful violation of the act constitutes a crime, the
bill would impose a state-mandated local program. 
   Existing  law authorizes a life licensee to act on behalf
of a life insurer or disability insurer to transact life insurance,
accident and health insurance, and life and accident and health
insurance. Existing  law requires  life licensees
and  accident and health agent licensees to be licensed by
the Insurance Commissioner, subject to prelicensure standards and
continuing education requirements  developed by the curriculum
board that consists of insurance industry representatives and
consumer groups  . Existing law authorizes the Insurance
Commissioner to enforce those provisions.  Existing law makes
it a misdemeanor to transact insurance without a license. 

   This bill would require any person who solicits, negotiates, or
sells health care service plan contracts, specialized health care
service plan contracts, Medicare Advantage Plans under Medicare Part
C, or Medicare supplement contracts to be licensed as an accident and
health agent by the Insurance Commissioner, effective July 1, 2012.
The bill would authorize the Insurance Commissioner to enforce those
provisions, and would require the Insurance Commissioner and the
Director of the Department of Managed Health Care to share
information with regard to investigations, discipline, and
enforcement. Because the failure to hold a license to transact
insurance under these provisions would be a crime, the bill would
impose a state-mandated local program.  
   This bill would require the curriculum board to make
recommendations to the commissioner to, among other things, instruct
accident and health licensees about the requirements of the federal
Patient Protection and Affordable Care Act and to include instruction
relating to the California Health Benefit Exchange. The bill would
require each course provider to submit its course content to the
commissioner for approval. 
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


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

   SECTION 1.    Section 1359 of the   Health
and Safety Code   is amended to read: 
   1359.  (a) The director  may   shall 
require that solicitors and solicitor firms, and principal persons
engaged in the supervision of solicitation for plans of solicitor
firms, meet  such  reasonable and appropriate
standards with respect to training, experience, and other
qualifications  consistent with Section 1361.5 and any additional
standards  as the director finds necessary and appropriate in
the public interest or for the protection of subscribers, enrollees,
and plans. For such purposes, the director may do the following:
   (1) Appropriately classify such persons and individuals.
   (2) Specify that all or any portion of such standards shall be
applicable to any such class.
   (3) Require individuals in any such class to pass examinations
prescribed in accordance with such rules.
   (b) The director may prescribe by rule reasonable fees and charges
to defray the costs of carrying out this section, including, but not
limited to, fees for any examination administered by the director or
under his or her direction.
   SECTION 1.   SEC. 2.   Section 1361.5 is
added to the Health and Safety Code, to read: 
   1361.5.  Effective July 1, 2012, a person shall not solicit,
negotiate, or sell health care service plan contracts, specialized
health care service plan contracts, Medicare Advantage Plans under
Medicare Part C, or Medicare supplement contracts, unless the person
is licensed as an accident and health agent by the Insurance
Commissioner. The director and the Insurance Commissioner shall share
information with regard to investigations, discipline, and
enforcement of violations under this section. 
    1361.5.   (a) On and after January 1, 2013, solicitors
and solicitor firms, and principal persons engaged in the supervision
of solicitation for health care service plan contracts, specialized
health care service plan contracts, Medicare Advantage Plans under
Medicare Part C, or Medicare supplement contracts, shall complete
training as a solicitor consistent with this section.
   (b) The training for a solicitor shall include the following:
   (1) Knowledge of the Knox-Keene Health Care Service Plan Act of
1975 (commencing with Section 1340) and regulations implemented under
that act.
   (2) Knowledge of the federal Patient Protection and Affordable
Care Act (Public Law 111-148) and other relevant federal laws,
federal regulations, and guidance implemented under those laws.
   (3) Knowledge of all public coverage programs and the California
Health Benefit Exchange.
   (4) Ethics training.
   (c) In developing the curriculum for solicitor training, the
department shall consult with the Insurance Commissioner. The
training developed by the department shall be at least as extensive
as the training for an accident and health agent, as required by the
Insurance Commissioner.
   (d) The department shall determine whether the ethics training
provided to those licensed as an accident and health agent by the
Insurance Commissioner is sufficient and appropriate for a solicitor.
If the department so determines, then an individual licensed and in
good standing as an accident and health agent shall not be required
to complete the ethics training described in this section; however,
all other requirements pursuant to this section shall apply.
   (e) Nothing in this section shall be deemed to affect the current
operations of the Healthy Families Program (Part 6.2 (commencing with
Section 12693) of Division 2 of the Insurance Code), the Access for
Infants and Mothers Program (Part 6.3 (commencing with Section 12695)
of Division 2 of the Insurance Code), or the Medi-Cal program
(Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of
the Welfare and Institutions Code). Nothing in this section shall be
deemed to affect the operations of the California Health Benefit
Exchange established in Title 22 (commencing with Section 100500) of
the Government Code.
   (f) Nothing in this section shall apply to the requirements or
qualifications for navigators pursuant to subdivision (l) of Section
100502 of the Government Code. 
  SEC. 2.    Section 1622 of the Insurance Code is
amended to read:
   1622.  (a) A life licensee is a person authorized to act on behalf
of a life insurer, a disability insurer, or a health care service
plan to transact any of the following:
   (1) Life insurance.
   (2) Accident and health insurance.
   (3) Life and accident and health insurance.
   (4) Effective July 1, 2012, health care service plan contracts,
specialized health care service plan contracts, Medicare Advantage
Plans under Medicare Part C, or Medicare supplement contracts.
   (b) Licenses to act as a life agent under this chapter shall be of
the types set forth in Section 1626.  
  SEC. 3.    Section 1626 of the Insurance Code is
amended to read:
   1626.  (a) A life licensee is a person authorized to act as a life
agent. Licenses to act as a life agent under this chapter shall be
of the following types:
   (1) Life-only, which license shall entitle the licensee to
transact insurance coverage on human lives, including benefits of
endowment and annuities, and may include benefits in the event of
death or dismemberment by accident and benefits for disability
income.
   (2) Accident and health, which license shall entitle the licensee
to transact insurance coverage for sickness, bodily injury, or
accidental death and may include benefits for disability income.
   (b) An accident and health agent licensee also is authorized to
transact 24-hour care coverage, as defined in Section 1749.02,
pursuant to subdivision (d) of Section 1749 or subdivision (d) of
Section 1749.33.
   (c) Effective July 1, 2012, an accident and health agent licensee
also is authorized to transact health care service plan contracts,
specialized health care service plan contracts, Medicare Advantage
Plans under Medicare Part C, and Medicare supplement contracts.

   SEC. 4.   SEC. 3.   Section 1631.5 of
the Insurance Code is amended to read:
   1631.5.   (a)    Nothing in this article shall
be deemed to affect the current operations of the Healthy Families
Program (Part 6.2 (commencing with Section 12693) of Division 2) or
the Access for Infants and Mothers Program (Part 6.3 (commencing with
Section 12695) of Division 2), or  , for purposes of Section
1632.5,  the Medi-Cal program (Chapter 7 (commencing with
Section 14000) of Part 3 of Division 9 of the Welfare and
Institutions Code).  Nothing in this article shall be deemed to
  affect the operations of the California Health Benefit
Exchange established in Title 22 (commencing with Section 100500) of
the Government Code.  
   (b) Nothing in this article shall apply to the requirements or
qualifications for navigators pursuant to subdivision (l) of Section
100502 of the Government Code.  
  SEC. 5.    Section 1632.5 is added to the
Insurance Code, to read:
   1632.5.  (a) Effective July 1, 2012, a person shall not solicit,
negotiate, or sell health care service plan contracts, specialized
health care service plan contracts, Medicare Advantage Plans under
Medicare Part C, or Medicare supplement contracts, unless the person
is licensed as an accident and health agent by the commissioner.
   (b) An applicant for licensure as an accident and health agent
under this section shall be subject to the same prelicensing
education standards as all other accident and health agents,
including, but not limited to, the standards imposed under Section
1749.
   (c) A licensee subject to licensure renewal under this section
shall be subject to the same continuing education requirements as all
other accident and health agents, including, but not limited to,
those specified in Sections 1749.3 and 1749.33.
   (d) The commissioner may adopt all necessary rules and regulations
to implement this section.
   (e) The commissioner has the sole authority to enforce the
provisions of this section and Section 1361.5 of the Health and
Safety Code against any person who violates those provisions or this
part, including, but not limited to, any provision related to
investigations, disciplinary actions, and enforcement of violations
under this part. This authority precludes the Director of the
Department of Managed Health Care from enforcing these provisions.
   (f) Notwithstanding subdivision (e), the commissioner and the
Director of the Department of Managed Health Care shall share
information with regard to investigations, discipline, and
enforcement of violations under this part, as specified in
subdivision (e).
   (g) In any provision in which "accident and health agent" is
referenced in this part, the term shall include any person licensed
under this section and the provisions that apply to those persons
shall apply to any person licensed under this part. The fees charged
to a life agent under Article 14 (commencing with Section 1750) shall
apply to an agent under this section. Any fines or penalties
collected from an agent subject to this section for a violation of
this part shall be subject to appropriation by the Legislature.
   (h) This section shall not affect the application or enforcement
by the Director of the Department of Managed Health Care of Section
1359 of the Health and Safety Code or any other provision of the
Health and Safety Code that relates to solicitors and is not intended
to supersede any other requirement or regulation that applies to
solicitors or solicitor firms.  
  SEC. 6.    Nothing in this act shall apply to
qualifications for navigators pursuant to paragraph (1) of
subdivision (l) of Section 100502 of the Government Code. 
   SEC. 4.    Section 1749.87 is added to the  
Insurance Code   , to read:  
   1749.87.  (a) The curriculum board shall, in 2012, make
recommendations to the commissioner to instruct accident and health
agents about the requirements imposed by the federal Patient
Protection and Affordable Care Act (Public Law 111-148). This
instruction shall include instruction on all public coverage programs
and the California Health Benefit Exchange established in Title 22
(commencing with Section 100500) of the Government Code.
   (b) The curriculum board shall make recommendations to revise both
prelicensing education and continuing education.
   (c) Each provider of courses based upon this curriculum shall
submit its course content to the commissioner for approval. 
   SEC. 7.   SEC. 5.   No reimbursement is
required by this act pursuant to Section 6 of Article XIII B of the
California Constitution because the only costs that may be incurred
by a local agency or school district will be incurred because this
act creates a new crime or infraction, eliminates a crime or
infraction, or changes the penalty for a crime or infraction, within
the meaning of Section 17556 of the Government Code, or changes the
definition of a crime within the meaning of Section 6 of Article XIII
B of the California Constitution.