SB 353, as amended, 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 orbegin delete marketsend deletebegin insert markets, or allows others to market or advertise on its behalf,end insert 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,begin insert or allows others to market or
advertise on its behalf,end insert 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
4begin delete marketsend deletebegin insert markets, or allows any other person or business to market
5or advertise on its behalf,end insert in a language other than English that
6does not meet the minimum enrollee thresholds established under
7Sections 1367.04 and 1367.07, or the regulations adopted
8thereunder, shall translate into that language all of the following
9documents:
10(1) Welcome letters or notices of initial coverage, if provided.
11(2) Applicationsbegin delete to participate in a program or activity or to begin insert
for enrollment and any information
12receive a benefit or service.end delete
13pertinent to eligibility or participation.end insert
14(3) Letters containing important information regarding eligibility
15or participation criteria.
16(4)
end delete
17begin insert(3)end insert Notices advising limited-English-proficient persons of the
18availability of no-cost translation and interpretation services.
19(5)
end delete
20begin insert(4)end insert Notices pertaining to the right and instructions on how to
21file a grievance.
22(6)
end delete
23begin insert(5)end insert Uniform summaries of benefits of coverage required by
24Section 2715 of the federal Public Health Service Act (42 U.S.C.
25Sec. 300gg-11) and any rules or regulations promulgated
26thereunder.
27(b) Once the enrolled non-English-language population in which
28the health care service plan has marketed or advertised meets a
29threshold listed in subparagraph (A) of paragraph (1) of subdivision
30(b) of Section 1367.04, the plan shall translate all vital documents
31as required under Section 1367.04 and the regulations adopted
32thereunder.
33(c)
end delete
34begin insert(b)end insert A health care service plan shall use a trained and qualified
35translator for all written translations of marketing and advertising
P4 1materials relating to health care service plan products, and for all
2the documents specified in subdivision (a).
Section 10127.45 is added to the Insurance Code, to
4read:
(a) Except as provided in subdivision (b), a health
6insurer offering policies of health insurance, as defined in Section
7106, shall not publish or distribute, or allow to be published or
8distributed on its behalf, any advertisement unless both the
9following conditions are met at least 30 days prior to the publishing
10or distribution, or any shorter period as the department may allow
11by regulation:
12(1) A true copy of the advertisement has first been filed with
13the department.
14(2) The department, by notice, has not found the advertisement,
15wholly or in part, to be untrue, misleading, deceptive, or otherwise
16not in compliance with this code or the rules thereunder, and has
17specified
anybegin delete deficiencies.end deletebegin insert deficiencies within the 30 days or any
18shorter time as the director by rule or order may allow.end insert
19(b) Except as provided in subdivision (c), a health insurer that
20has been admitted to transact health insurance under this part
21continuously licensed under this chapter for the preceding 18
22months may publish or distribute, or allow to be published or
23distributed on its behalf, an advertisement without having filed
24that advertisement with the department for prior approval, if the
25insurer and the material comply with each of the following
26conditions:
27(1) The advertisement or a material provision thereof has not
28been previously disapproved by the department by written notice
29to the
insurer and the insurer reasonably believes that the
30advertisement does not violate any requirement of this code or the
31rules thereunder.
32(2) The insurer files a true copy of each new or materially
33revised advertisement, used by it or by any person acting on behalf
34of the insurer, with the department not later than 10 business days
35after publication or distribution of the advertisement or within such
36additional period as the department may allow by regulation.
37(c) (1) If the department finds that any advertisement of a health
38insurer has materially failed to comply with this code or the rules
39thereunder, the department may, by order, require the insurer to
40publish, in the same or similar medium, an approved correction
P5 1or retraction of any untrue, misleading, or deceptive statement
2contained in the advertising, and may prohibit the insurer from
3publishing or
distributing, or allowing to be published or distributed
4on its behalf, the advertisement or any new materially revised
5advertisement without first having filed a copy thereof with the
6department, 30 days prior to the publication or distribution thereof,
7or any shorter period specified in the order.
8(2) An order issued under this subdivision shall be effective for
912 months from its issuance and may be renewed by order if the
10advertisements submitted under this subdivision indicate difficulties
11of voluntary compliance with the applicable provisions of this
12code and the rules thereunder.
13(d) A health insurer, insurance agent, or other person regulated
14under this code may, within 30 days after receipt of any notice or
15order under this section, file a written request for a hearing with
16the department.
17(e) The
department, by regulation, may classify plans and
18advertisements and exempt certain classes, wholly or in part, either
19unconditionally or upon specified terms and conditions or for
20specified periods, from the application of subdivisions (a) and (b).
21In no instance shall the department exempt new products or
22products offered by health insurers with a record within the past
23five years of violations of this section.
Section 10133.10 is added to the Insurance Code, to
25read:
(a) An insurer that markets, advertises, or produces
27educational materials for a health insurance policy, as defined in
28Section 106,begin insert or allows any other person or business to market or
29advertise on its behalf,end insert in a language other than English that does
30not meet the minimum insured thresholds established under
31Sections 10133.8 and 10133.9 or the regulations adopted
32thereunder, shall translate into that language all of the following
33documents:
34(1) Welcomebegin delete letters.end deletebegin insert
letters or notices of initial coverage, if
35provided.end insert
36(2) Bill notices and statements.
end delete37(3)
end delete
38begin insert(2)end insert Applicationsbegin delete to participate in a program or activity or to begin insert for health insurance and any
39receive a benefit or service.end delete
40information pertinent to eligibility or participation.end insert
P6 1(4) Letters containing important
information regarding eligibility
2or participation criteria.
3(5)
end delete
4begin insert(3)end insert Notices advising limited-English-proficient persons of the
5availability of no-cost translation and interpretation services.
6(6)
end delete
7begin insert(4)end insert Notices pertaining to the right and instructions on how to
8file a grievance.
9(7)
end delete
10begin insert(5)end insert A matrix of the categories of health insurance benefits
11outlined in the insurance policy including copayments and
12coinsurance, exclusions, and limitations in the following sequence:
13deductibles, lifetime maximums, professional services, outpatient
14services, hospitalization services, diagnostic and therapeutic
15radiological services, preventative health services, emergency
16health care coverage including ambulance services, prescription
17drug coverage, durable medical equipment, mental health services,
18chemical dependency services, home health services, other services
19or the uniform summary of benefits of coverage required by Section
202715 of the federal Public Health Service Act (42 U.S.C. Sec.
21300gg-11) and any rules or regulations promulgated thereunder.
22(b) Once the insured non-English-language population in which
23the insurer has marketed or advertised, or for which the insurer
24produced education materials, meets a threshold listed in
25subparagraph (A) of paragraph (3) of subdivision (b) of Section
2610133.8, the insurer shall translate all vital documents as required
27under Sections 10133.8 and 10133.9 and the regulations adopted
28thereunder.
29(c)
end delete
30begin insert(b)end insert An insurer shall use trained and qualified translators for the
31translation of all marketing and advertising materials relating to
32health insurance products and for all the documents specified in
33subdivision (a).
No reimbursement is required by this act pursuant to
35Section 6 of Article XIII B of the California Constitution because
36the only costs that may be incurred by a local agency or school
37district will be incurred because this act creates a new crime or
38infraction, eliminates a crime or infraction, or changes the penalty
39for a crime or infraction, within the meaning of Section 17556 of
40the Government Code, or changes the definition of a crime within
P7 1the meaning of Section 6 of Article XIII B of the California
2Constitution.
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