SB 353, as introduced, Lieu. Health care coverage: language assistance.
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. Existing law provides for the regulation of health insurers by the Department of Insurance.
Existing law requires the departments to adopt regulations establishing standards and requirements to provide enrollees and insureds with access to language assistance in obtaining health care services. Existing law requires health care service plans and health insurers, if they exceed certain enrollment thresholds, to implement programs to assess the needs of enrollees and insureds, and to provide translation and interpretation for medical services and translation of vital documents, as defined, to enrollees and insureds, and to report to the respective departments regarding internal policies and procedures related to cultural appropriateness. Existing law provides that a health care service plan is in compliance with the requirements if it is required to meet and meets the same or similar standards, as imposed by the Medi-Cal program.
This bill would require a health care service plan that advertises or markets in a language other than English, as provided, and that does not meet certain enrollment thresholds, to translate into that language specified documents. This bill would also require an insurer that markets, advertises, or produces educational materials for health insurance policies in a language other than English, as provided, and that does not meet certain enrollment thresholds, to translate into that language specified documents. This bill would require both those health care service plans and insurers to use trained and qualified translators.
Existing law prohibits a health care service plan, except as provided, from publishing or distributing, or allowing to be published or distributed on its behalf, any advertisement unless a true copy of the advertisement has first been filed with the Director of the Department of Managed Health Care at least 30 days, or any shorter period of time by the director’s rule or order, prior to its use and the director, by notice, has not found the advertisement, wholly or in part, to be untrue, misleading, deceptive, or otherwise not in compliance with the applicable provisions, and specified the deficiencies, within the 30 days, or any shorter period of time by the director’s rule or order. The director, by rule or order, may classify plans and advertisements and exempt certain classes, wholly or in part, either unconditionally or upon specified terms and conditions, or for specified periods, from these requirements.
This bill would extend the approval requirements and exemptions to health insurers, as specified, and require the Department of Insurance to perform the related functions. The bill would prohibit the department from exempting certain classes of policies and advertisements from the requirements where it concerns new products or products offered by health insurers with a record, in the past 5 years, of violations of these provisions.
By placing additional requirements on health care service plans, the violation of which would be a crime, the bill would impose a state-mandated local program.
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 1367.041 is added to the Health and
2Safety Code, to read:
(a) A health care service plan that advertises or
4markets in a language other than English that does not meet the
5minimum enrollee thresholds established under Sections 1367.04
6and 1367.07, or the regulations adopted thereunder, shall translate
7into that language all of the following documents:
8(1) Welcome letters or notices of initial coverage, if provided.
9(2) Applications to participate in a program or activity or to
10receive a benefit or service.
11(3) Letters containing important information regarding eligibility
12or participation criteria.
13(4) Notices advising limited-English-proficient persons of the
14availability of no-cost translation and interpretation services.
15(5) Notices pertaining to the right and instructions on how to
16file a grievance.
17(6) Uniform summaries of benefits of coverage required by
18Section 2715 of the federal Public Health Service Act (42 U.S.C.
19Sec. 300gg-11) and any rules or regulations promulgated
20thereunder.
21(b) Once the enrolled non-English-language population in which
22the health care service plan has marketed or advertised meets a
23threshold listed in subparagraph (A) of paragraph (1) of subdivision
24(b) of Section 1367.04, the plan shall translate all vital documents
25as required under Section 1367.04 and the regulations adopted
26thereunder.
27(c) A
health care service plan shall use a trained and qualified
28translator for all written translations of marketing and advertising
29materials relating to health care service plan products, and for all
30the documents specified in subdivision (a).
Section 10127.45 is added to the Insurance Code, to
32read:
(a) Except as provided in subdivision (b), a health
34insurer offering policies of health insurance, as defined in Section
35106, shall not publish or distribute, or allow to be published or
36distributed on its behalf, any advertisement unless both the
37following conditions are met at least 30 days prior to the publishing
P4 1or distribution, or any shorter period as the department may allow
2by regulation:
3(1) A true copy of the advertisement has first been filed with
4the department.
5(2) The department, by notice, has not found the advertisement,
6wholly or in part, to be untrue, misleading, deceptive, or otherwise
7not in compliance with this code or the rules thereunder, and has
8specified
any deficiencies.
9(b) Except as provided in subdivision (c), a health insurer that
10has been admitted to transact health insurance under this part
11continuously licensed under this chapter for the preceding 18
12months may publish or distribute, or allow to be published or
13distributed on its behalf, an advertisement without having filed
14that advertisement with the department for prior approval, if the
15insurer and the material comply with each of the following
16conditions:
17(1) The advertisement or a material provision thereof has not
18been previously disapproved by the department by written notice
19to the insurer and the insurer reasonably believes that the
20advertisement does not violate any requirement of this code or the
21rules thereunder.
22(2) The insurer files a true copy of each new or materially
23revised advertisement,
used by it or by any person acting on behalf
24of the insurer, with the department not later than 10 business days
25after publication or distribution of the advertisement or within such
26additional period as the department may allow by regulation.
27(c) (1) If the department finds that any advertisement of a health
28insurer has materially failed to comply with this code or the rules
29thereunder, the department may, by order, require the insurer to
30publish, in the same or similar medium, an approved correction
31or retraction of any untrue, misleading, or deceptive statement
32contained in the advertising, and may prohibit the insurer from
33publishing or distributing, or allowing to be published or distributed
34on its behalf, the advertisement or any new materially revised
35advertisement without first having filed a copy thereof with the
36department, 30 days prior to the publication or distribution thereof,
37or any shorter period specified
in the order.
38(2) An order issued under this subdivision shall be effective for
3912 months from its issuance and may be renewed by order if the
40advertisements submitted under this subdivision indicate difficulties
P5 1of voluntary compliance with the applicable provisions of this
2code and the rules thereunder.
3(d) A health insurer, insurance agent, or other person regulated
4under this code may, within 30 days after receipt of any notice or
5order under this section, file a written request for a hearing with
6the department.
7(e) The department, by regulation, may classify plans and
8advertisements and exempt certain classes, wholly or in part, either
9unconditionally or upon specified terms and conditions or for
10specified periods, from the application of subdivisions (a) and (b).
11In no instance shall the department exempt new
products or
12products offered by health insurers with a record within the past
13five years of violations of this section.
Section 10133.10 is added to the Insurance Code, to
15read:
(a) An insurer that markets, advertises, or produces
17educational materials for a health insurance policy, as defined in
18Section 106, in a language other than English that does not meet
19the minimum insured thresholds established under Sections 10133.8
20and 10133.9 or the regulations adopted thereunder, shall translate
21into that language all of the following documents:
22(1) Welcome letters.
23(2) Bill notices and statements.
24(3) Applications to participate in a program or activity or to
25receive a benefit or service.
26(4) Letters containing important
information regarding eligibility
27or participation criteria.
28(5) Notices advising limited-English-proficient persons of the
29availability of no-cost translation and interpretation services.
30(6) Notices pertaining to the right and instructions on how to
31file a grievance.
32(7) A matrix of the categories of health insurance benefits
33outlined in the insurance policy including copayments and
34coinsurance, exclusions, and limitations in the following sequence:
35deductibles, lifetime maximums, professional services, outpatient
36services, hospitalization services, diagnostic and therapeutic
37radiological services, preventative health services, emergency
38health care coverage including ambulance services, prescription
39drug coverage, durable medical equipment, mental health services,
40chemical dependancy services, home health
services, other services
P6 1or the uniform summary of benefits of coverage required by Section
22715 of the federal Public Health Service Act (42 U.S.C. Sec.
3300gg-11) and any rules or regulations promulgated thereunder.
4(b) Once the insured non-English-language population in which
5the insurer has marketed or advertised, or for which the insurer
6produced education materials, meets a threshold listed in
7subparagraph (A) of paragraph (3) of subdivision (b) of Section
810133.8, the insurer shall translate all vital documents as required
9under Sections 10133.8 and 10133.9 and the regulations adopted
10thereunder.
11(c) An insurer shall use trained and qualified translators for the
12translation of all marketing and advertising materials relating to
13health insurance products and for all the documents specified in
14subdivision (a).
No reimbursement is required by this act pursuant to
16Section 6 of Article XIII B of the California Constitution because
17the only costs that may be incurred by a local agency or school
18district will be incurred because this act creates a new crime or
19infraction, eliminates a crime or infraction, or changes the penalty
20for a crime or infraction, within the meaning of Section 17556 of
21the Government Code, or changes the definition of a crime within
22the meaning of Section 6 of Article XIII B of the California
23Constitution.
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