Amended in Assembly August 5, 2013

Amended in Senate April 16, 2013

Senate Bill No. 353

Introduced by Senator Lieu

February 20, 2013

An act to add Section 1367.041 to the Health and Safety Code, and to add Sections 10127.45 and 10133.10 to the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

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 begin delete plan end delete begin insert plan, as specified, end insert that advertises or begin delete markets, end delete begin insert markets products in the individual or small group health care service plan markets, end insert or begin insert that end insert allows others to market or advertise on its behalf, in a begin delete language other than English, end delete begin insert non-English language, end insert as provided, and that does not meet certain begin delete enrollment thresholds, end delete begin insert requirements, end insert to translate into that language specified documents. This bill would also require an insurer that markets, advertises, or allows others to market or advertise on its behalf, or produces educational materials for health insurance policies begin insert , in the individual or small group health insurance markets end insert in a begin delete language other than English, end delete begin insert non-English language, end insert as provided, and that does not meet certain begin delete enrollment thresholds, end delete begin insert requirements, end insert 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 1.  

Section 1367.041 is added to the Health and
Safety Code, to read:

1367.041.  

(a) A health care service plan that advertises or
begin delete markets, end delete begin insert markets products in the individual or small group health
care service plan markets, end insert or allows any other person or business
to market or advertise on its behalf, in a begin delete language other than
English that does not meet the minimum enrollee thresholds
established under end delete begin insert non-English language that does not meet the
requirements set forth in end insert Sections 1367.04 and 1367.07, begin delete or the
regulations adopted thereunder, shall translate into that language
all of the following documents: end delete begin insert shall provide the following
documents in the same non-English language: end insert

(1) Welcome letters or notices of initial coverage, if provided.

(2) Applications for enrollment and any information pertinent
to eligibility or participation.

(3) Notices advising limited-English-proficient persons of the
availability of no-cost translation and interpretation services.

(4) Notices pertaining to the right and instructions on how begin delete to end delete
begin insert an enrollee may end insert file a grievance.

(5) Uniform summaries of benefits of coverage required by
Section 2715 of the federal Public Health Service Act (42 U.S.C.
Sec. 300gg-11) and any rules or regulations promulgated
thereunder.

(b) A health care service plan shall use a trained and qualified
translator for all written translations of marketing and advertising
materials relating to health care service plan products, and for all
the documents specified in subdivision (a).

begin insert

(c) This section shall apply to any specialized health care service
plan that offers an essential health benefit as defined in subdivision
(a) of Section 1367.005. This section shall not apply to a
specialized health care service plan that does not offer an essential
health benefit as defined in Section 1367.005.

end insert

SEC. 2.  

Section 10127.45 is added to the Insurance Code, to
read:

10127.45.  

(a) Except as provided in subdivision (b), a health
insurer offering policies of health insurance, as defined in Section
106, shall not publish or distribute, or allow to be published or
distributed on its behalf, any advertisement unless both the
following conditions are met at least 30 days prior to the publishing
or distribution, or any shorter period as the department may allow
by regulation:

(1) A true copy of the advertisement has first been filed with
the department.

(2) The department, by notice, has not found the advertisement,
wholly or in part, to be untrue, misleading, deceptive, or otherwise
not in compliance with this code or the rules thereunder, and has
specified any deficiencies within the 30 days or any shorter time
as the begin delete director end delete begin insert commissioner end insert by rule or order may allow.

(b) Except as provided in subdivision (c), a health insurer that
has been admitted to transact health insurance under this part
continuously licensed under this chapter for the preceding 18
months may publish or distribute, or allow to be published or
distributed on its behalf, an advertisement without having filed
that advertisement with the department for prior approval, if the
insurer and the material comply with each of the following
conditions:

(1) The advertisement or a material provision thereof has not
been previously disapproved by the department by written notice
to the insurer and the insurer reasonably believes that the
advertisement does not violate any requirement of this code or the
rules thereunder.

(2) The insurer files a true copy of each new or materially
revised advertisement, used by it or by any person acting on behalf
of the insurer, with the department not later than 10 business days
after publication or distribution of the advertisement or within such
additional period as the department may allow by regulation.

(c) (1) If the department finds that any advertisement of a health
insurer has materially failed to comply with this code or the rules
thereunder, the department may, by order, require the insurer to
publish, in the same or similar medium, an approved correction
or retraction of any untrue, misleading, or deceptive statement
contained in the advertising, and may prohibit the insurer from
publishing or distributing, or allowing to be published or distributed
on its behalf, the advertisement or any new materially revised
advertisement without first having filed a copy thereof with the
department, 30 days prior to the publication or distribution thereof,
or any shorter period specified in the order.

(2) An order issued under this subdivision shall be effective for
12 months from its issuance and may be renewed by order if the
advertisements submitted under this subdivision indicate difficulties
of voluntary compliance with the applicable provisions of this
code and the rules thereunder.

(d) A health insurer, insurance agent, or other person regulated
under this code may, within 30 days after receipt of any notice or
order under this section, file a written request for a hearing with
the department.

(e) The department, by regulation, 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 the application of subdivisions (a) and (b).
In no instance shall the department exempt new products or
products offered by health insurers with a record within the past
five years of violations of this section.

SEC. 3.  

Section 10133.10 is added to the Insurance Code, to
read:

10133.10.  

(a) An insurer that markets, advertises, or produces
educational materials for a health insurance policy, as defined in
Section 106, begin insert in the individual or small group health insurance
markets, end insert or allows any other person or business to market or
advertise on its behalf, in a begin delete language other than English that does
not meet the minimum insured thresholds established under end delete
begin insert non-English language that does not meet the requirements set forth
in end insert Sections 10133.8 and 10133.9 begin delete or the regulations adopted
thereunder, shall translate into that language all of the following
documents: end delete begin insert , shall provide the following documents in the same
non-English language: end insert

(1) Welcome letters or notices of initial coverage, begin delete if provided. end delete
begin insert if applicable. end insert

(2) Applications for health insurance and any information
pertinent to eligibility or participation.

(3) Notices advising limited-English-proficient persons of the
availability of no-cost translation and interpretation services.

(4) Notices pertaining to the right and instructions on how begin delete to end delete
begin insert an insured may end insert file a grievance.

(5) A matrix of the categories of health insurance benefits
outlined in the insurance policy including copayments and
coinsurance, exclusions, and limitations in the following sequence:
deductibles, lifetime maximums, professional services, outpatient
services, hospitalization services, diagnostic and therapeutic
radiological services, preventative health services, emergency
health care coverage including ambulance services, prescription
drug coverage, durable medical equipment, mental health services,
chemical dependency services, home health services, other services
or the uniform summary of benefits of coverage required by Section
2715 of the federal Public Health Service Act (42 U.S.C. Sec.
300gg-11) and any rules or regulations promulgated thereunder.

(b) An insurer shall use trained and qualified translators for the
translation of all marketing and advertising materials relating to
health insurance products and for all the documents specified in
subdivision (a).

SEC. 4.  

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.