Amended in Assembly September 4, 2013

Amended in Assembly August 14, 2013

Amended in Assembly August 5, 2013

Amended in Senate April 16, 2013

Senate BillNo. 353


Introduced by Senator Lieu

February 20, 2013


An act to add Section 1367.041 to the Health and Safety Code, and to addbegin delete Sections 10127.45 andend deletebegin insert Sectionend insert 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, as specified, that advertises or markets products in the individual or small group health care service plan markets, or that allows others to market or advertise on its behalfbegin insert in those marketsend insert, in a non-English language, as provided, and that does not meet certain requirements, to translate into that language specified documents.begin delete Thisend deletebegin insert Theend insert bill would also require an insurer, as specified, 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 marketsbegin insert,end insert in a non-English language, as provided, and that does not meet certain requirements, to translate into that language specified documents.begin delete Thisend deletebegin insert Theend insert bill would require both those health care service plans and insurers to use trained and qualified translators.

begin delete

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.

end delete
begin delete

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.

end delete

By placing additional requirements on health care service plans, thebegin insert willfulend insert 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:

P3    1

SECTION 1.  

Section 1367.041 is added to the Health and
2Safety Code
, to read:

3

1367.041.  

(a) A health care service plan that advertises or
4markets products in the individual or small group health care
5service plan markets, or allows any other person or business to
6market or advertise on its behalfbegin insert in the individual or small group
7health care service plan marketsend insert
, in a non-English language that
8does not meet the requirements set forth in Sections 1367.04 and
91367.07, shall provide the following documents in the same
10non-English language:

11(1) Welcome letters or notices of initial coverage, if provided.

12(2) Applications for enrollment and any information pertinent
13to eligibility or participation.

14(3) Notices advising limited-English-proficient persons of the
15availability of no-cost translation and interpretation services.

16(4) Notices pertaining to the right and instructions on how an
17enrollee may file a grievance.

18(5) begin deleteUniform summaries end deletebegin insertThe uniform summary end insertof benefitsbegin delete ofend delete
19begin insert andend insert coverage required begin delete by Section 2715 of the federal Public Health
20Service Act (42 U.S.C. Sec. 300gg-11) and any rules or regulations
21promulgated thereunder.end delete
begin insert pursuant to subparagraph (A) of
22paragraph (3) of subdivision (b) of Section 1363.end insert

23(b) A health care service plan shall use a trained and qualified
24translator for all written translations of marketing and advertising
25materials relating to health care service plan products, and for all
26begin insert of end insert the documents specified in subdivision (a).

27(c) begin deleteThis section shall apply to any specialized health care service
28plan that offers an essential health benefit as defined in subdivision
29(a) of Section 1367.005. end delete
This section shall not apply to a
P4    1specialized health care service plan that does not offer an essential
2health benefit as defined in Section 1367.005.

begin delete
3

SEC. 2.  

Section 10127.45 is added to the Insurance Code, to
4read:

5

10127.45.  

(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 any deficiencies within the 30 days or any shorter time
18as the commissioner by rule or order may allow.

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.

end delete
24

begin deleteSEC. 3.end delete
25begin insertSEC. 2.end insert  

Section 10133.10 is added to the Insurance Code, to
26read:

27

10133.10.  

(a) An insurer that markets, advertises, or produces
28educational materials for a health insurance policy, as defined in
29Section 106, in the individual or small group health insurance
30markets, or allows any other person or business to market or
31advertise on its behalfbegin insert in the individual or small group health
32insurance marketsend insert
, in a non-English language that does not meet
33the requirements set forth in Sections 10133.8 and 10133.9, shall
34provide the following documents in the same non-English
35language:

36(1) Welcome letters or notices of initial coverage, if applicable.

37(2) Applications for health insurance and any information
38pertinent to eligibility or participation.

39(3) Notices advising limited-English-proficient persons of the
40availability of no-cost translation and interpretation services.

P6    1(4) Notices pertaining to the right and instructions on how an
2insured may file a grievance.

3(5)  begin deleteA matrix of the categories of health insurance benefits
4outlined in the insurance policy including copayments and
5coinsurance, exclusions, and limitations in the following sequence:
6deductibles, lifetime maximums, professional services, outpatient
7services, hospitalization services, diagnostic and therapeutic
8radiological services, preventative health services, emergency
9health care coverage including ambulance services, prescription
10drug coverage, durable medical equipment, mental health services,
11chemical dependency services, home health services, other services
12or the end delete
begin insertThe end insertuniform summary of benefitsbegin delete ofend deletebegin insert andend insert coverage required
13begin delete byend deletebegin insert pursuant to paragraph (2) of subdivision (a) ofend insert Sectionbegin delete 2715
14of the federal Public Health Service Act (42 U.S.C. Sec. 300gg-11)
15and any rules or regulations promulgated thereunder.end delete
begin insert 10603.end insert

16(b) An insurer shall use trained and qualified translators for the
17translation of all marketing and advertising materials relating to
18health insurance products and for allbegin insert ofend insert the documents specified
19in subdivision (a).

20(c) begin deleteThis section shall apply to a specialized health insurance
21policy that offers an essential health benefit as defined in
22subdivision (a) of Section 10112.27. end delete
This section shall not apply
23to a specialized health insurance policy that does not offer an
24essential health benefit as defined in Section 10112.27.

25

begin deleteSEC. 4.end delete
26begin insertSEC. 3.end insert  

No reimbursement is required by this act pursuant to
27Section 6 of Article XIII B of the California Constitution because
28the only costs that may be incurred by a local agency or school
29district will be incurred because this act creates a new crime or
30infraction, eliminates a crime or infraction, or changes the penalty
31for a crime or infraction, within the meaning of Section 17556 of
32the Government Code, or changes the definition of a crime within
33the meaning of Section 6 of Article XIII B of the California
34Constitution.



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