BILL NUMBER: SB 353 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 5, 2013
AMENDED IN SENATE APRIL 16, 2013
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 plan
plan, as specified, that advertises or
markets, markets products in the individual or small
group health care service plan markets, or that
allows others to market or advertise on its behalf, in a
language other than English, non-English language,
as provided, and that does not meet certain enrollment
thresholds, requirements, 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 , in the individual or small group health
insurance markets in a language other than English,
non-English language, as provided, and that does
not meet certain enrollment thresholds,
requirements, 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
markets, markets products in the individual or
small group health care service plan markets, or allows any
other person or business to market or advertise on its behalf, in a
language other than English that does not meet the minimum
enrollee thresholds established under non-English
language that does not meet the requirements set forth in
Sections 1367.04 and 1367.07, or the regulations adopted
thereunder, shall translate into that language all of the following
documents: shall provide the following documents in
the same non-English language:
(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
to an enrollee may 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).
(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.
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 director commissioner 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, in the individual or small group health insurance
markets, or allows any other person or business to market or
advertise on its behalf, in a language other than English
that does not meet the minimum insured thresholds established under
non-English language that does not meet the
requirements set forth in Sections 10133.8 and 10133.9
or the regulations adopted thereunder, shall translate into that
language all of the following documents: ,
shall provide the following documents in the same non-English
language:
(1) Welcome letters or notices of initial coverage, if
provided. if applicable.
(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
to an insured may 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.