Amended in Assembly June 30, 2014

Amended in Senate April 10, 2014

Senate BillNo. 1182


Introduced by Senator Leno

February 20, 2014


An act to amend Sections 1374.8, 1385.03, and 1385.04 of the Health and Safety Code, and to amend Sections 791.27 and 10181.4 of the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

SB 1182, as amended, Leno. Health care coverage: rate review.

Existing law, the federal Patient Protection and Affordable Care Act (PPACA), requires the United States Secretary of Health and Human Services to establish a process for the annual review of unreasonable increases in premiums for health insurance coverage in which health insurance issuers submit to the secretary and the relevant state a justification for an unreasonable premium increase prior to implementation of the increase. 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 and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer in the individual, small group, or large group markets to file rate information with the Department of Managed Health Care or the Department of Insurance. For individual and small group contracts and policies, existing law requires a plan or insurer to file rate information at least 60 days prior to implementing a rate change and requires a plan or insurer to disclose with each filing specified information by aggregate benefit category. Existing law allows a health care service plan that exclusively contracts with no more than 2 medical groups to provide or arrange for professional medical services for enrollees of the plan to meet this requirement by disclosing its actual trend experience for the prior year using benefit categories that are the same or similar to those used by other plans.

This bill would specify the benefit categories to be used for that purpose and would make other related changes.

For large group plan contracts and policies, existing law requires a plan or insurer to file rate information with the department at least 60 days prior to implementing an unreasonable rate increase, as defined in PPACA. Existing law requires the plan or insurer to also disclose specified aggregate data with that rate filing.

This bill would instead require the plan or insurer to file rate information with the department at least 60 days prior to implementing a rate increase that exceeds 5% of the prior year’s rate. The bill would also require that the plan or insurer disclose specified data for each rate filing that exceeds 5% of the prior year’s rate for that group, including, but not limited to, company name and contact information, annual rate, and average ratebegin delete increaseend deletebegin insert changeend insert initially requested. The bill would require a plan or insurer to annually disclose additional aggregate data for all products sold in the large group market and to provide deidentified claims data at no charge to a large group purchaser that requests the information and meets specified conditions.

Existing law prohibits, with exceptions, a health care service plan or health insurer from releasing any information to an employer that would directly or indirectly indicate to the employer that an employee is receiving or has received services from a health care provider covered by the plan unless authorized to do so by the employee.

This bill would exempt from the prohibition the release of relevant information for the purposes set forth in the provisions regarding the review of rate increases.

Because a willful violation of the bill’s requirements by a health care service plan 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 1374.8 of the Health and Safety Code is
2amended to read:

3

1374.8.  

(a) A health care service plan shall not release any
4information to an employer that would directly or indirectly
5indicate to the employer that an employee is receiving or has
6received services from a health care provider covered by the plan
7unless authorized to do so by the employee. An insurer that has,
8pursuant to an agreement, assumed the responsibility to pay
9compensation pursuant to Article 3 (commencing with Section
103750) of Chapter 4 of Part 1 of Division 4 of the Labor Code, shall
11not be considered an employer for the purposes of this section.

12(b) Nothing in this section prohibits a health care service plan
13from releasing relevant information described in this section for
14the purposes set forth in Chapter 12 (commencing with Section
151871) of Part 2 of Division 1 of the Insurance Code.

16(c) Nothing in this section prohibits a health care service plan
17from releasing relevant information described in this section for
18the purposes set forth inbegin delete Article 6.2 (commencing with Section
191385.01)end delete
begin insert subdivision (f) of Section 1385.04end insert.

20

SEC. 2.  

Section 1385.03 of the Health and Safety Code is
21amended to read:

22

1385.03.  

(a) begin delete(1)end deletebegin deleteend deleteAll health care service plans shall file with
23the department all required rate information for individual and
24small group health care service plan contracts at least 60 days prior
25to implementing any rate change.

begin delete

26(2) For individual health care service plan contracts, the filing
27shall be concurrent with the notice required under Section 1389.25.

end delete
begin delete

28(3) For small group health care service plan contracts, the filing
29shall be concurrent with the notice required under subdivision (a)
30of Section 1374.21.

end delete

31(b) A plan shall disclose to the department all of the following
32for each individual and small group rate filing:

33(1) Company name and contact information.

34(2) Number of plan contract forms covered by the filing.

35(3) Plan contract form numbers covered by the filing.

P4    1(4) Product type, such as a preferred provider organization or
2health maintenance organization.

3(5) Segment type.

4(6) Type of plan involved, such as for profit or not for profit.

5(7) Whether the products are opened or closed.

6(8) Enrollment in each plan contract and rating form.

7(9) Enrollee months in each plan contract form.

8(10) Annual rate.

9(11) Total earned premiums in each plan contract form.

10(12) Total incurred claims in each plan contract form.

11(13) Average ratebegin delete increaseend deletebegin insert changeend insert initially requested.

12(14) Review category: initial filing for new product, filing for
13existing product, or resubmission.

14(15) Average rate ofbegin delete increaseend deletebegin insert changeend insert.

15(16) Effective date of ratebegin delete increaseend deletebegin insert changeend insert.

16(17) Number of subscribers or enrollees affected by each plan
17contract form.

18(18) The plan’s overall annual medical trend factor assumptions
19in each rate filing for all benefits and by aggregate benefit category,
20including hospital inpatient, hospital outpatient, physician services,
21prescription drugs and other ancillary services, laboratory, and
22radiology. A plan may provide aggregated additional data that
23demonstrates or reasonably estimates year-to-year costbegin delete increasesend delete
24begin insert changesend insert in specific benefit categories inbegin delete major geographic regions
25of the state. For purposes of this paragraph, “major geographic
26region” shall be defined by the department and shall include no
27more than nine regionsend delete
begin insert the geographic regions listed in Sections
281357.512 and 1399.855end insert
. A health plan that exclusively contracts
29with no more than two medical groups in the state to provide or
30arrange for professional medical services for the enrollees of the
31plan shall instead disclose the amount of its actual trend experience
32for the prior contract year by aggregate benefit category, using
33service categories that are, to the maximum extent possible, the
34same or similar to the benefit categories used by other plans. For
35this purpose, benefit categories shall be those specified in
36subdivision (e) of Section 1385.04.

37(19) The amount of the projected trend attributable to the use
38of services, price inflation, or fees and risk for annual plan contract
39trends by aggregate benefit category, such as hospital inpatient,
40hospital outpatient, physician services, prescription drugs and other
P5    1ancillary services, laboratory, and radiology. A health plan that
2exclusively contracts with no more than two medical groups in the
3state to provide or arrange for professional medical services for
4the enrollees of the plan shall instead disclose the amount of its
5actual trend experience for the prior contract year by aggregate
6service category, using service categories that are, to the maximum
7extent possible, the same or similar to those used by other plans.
8For this purpose, benefit categories shall be those specified in
9subdivision (e) of Section 1385.04.

10(20) A comparison of claims cost and rate of changes over time.

11(21) Any changes in enrollee cost-sharing over the prior year
12associated with the submitted rate filing.

13(22) Any changes in enrollee benefits over the prior year
14associated with the submitted rate filing.

15(23) The certification described in subdivision (b) of Section
161385.06.

17(24) Any changes in administrative costs.

18(25) Any other information required for rate review under
19PPACA.

20(c) A health care service plan subject to subdivision (a) shall
21also disclose the following aggregate data for all rate filings
22submitted under this section in the individual and small group
23health plan markets:

24(1) Number and percentage of rate filings reviewed by the
25following:

26(A) Plan year.

27(B) Segment type.

28(C) Product type.

29(D) Number of subscribers.

30(E) Number of covered lives affected.

31(2) The plan’s average ratebegin delete increaseend deletebegin insert changeend insert by the following
32categories:

33(A) Plan year.

34(B) Segment type.

35(C) Product type.

36(3) Any cost containment and quality improvement efforts since
37the plan’s last rate filing for the same category of health benefit
38plan. To the extent possible, the plan shall describe any significant
39new health care cost containment and quality improvement efforts
P6    1and provide an estimate of potential savings together with an
2estimated cost or savings for the projection period.

3(d) The department may require all health care service plans to
4submit all rate filings to the National Association of Insurance
5Commissioners’ System for Electronic Rate and Form Filing
6(SERFF). Submission of the required rate filings to SERFF shall
7be deemed to be filing with the department for purposes of
8compliance with this section.

9(e) A plan shall submit any other information required under
10PPACA. A plan shall also submit any other information required
11pursuant to any regulation adopted by the department to comply
12with this article.

13

SEC. 3.  

Section 1385.04 of the Health and Safety Code is
14amended to read:

15

1385.04.  

(a) For large group health care service plan contracts,
16all health plans shall file with the department at least 60 days prior
17to implementing any rate change all required rate information for
18rate increases that exceed 5 percent of the prior year’s rate. This
19filing shall be concurrent with the written notice described in
20subdivision (a) of Section 1374.21.

21(b) For large group rate filings, health plans shall submit all
22information that is required by PPACA. A plan shall also submit
23any other information required pursuant to any regulation adopted
24by the department to comply with this article.

25(c) A health care service plan subject to subdivision (a) shall
26disclose for each rate filing that exceeds 5 percent of the prior
27year’s rate for that group all of the following:

28(1) Company name and contact information.

29(2) Number of plan contract forms covered by the filing.

30(3) Plan contract form numbers covered by the filing.

31(4) Product type, such as a preferred provider organization or
32health maintenance organization.

33(5) Segment type.

34(6) Type of plan involved, such as for profit or not for profit.

35(7) Whether the products are opened or closed.

36(8) Enrollment in each plan contract and rating form.

37(9) Enrollee months in each plan contract form.

38(10) Annual rate.

39(11) Total earned premiums in each plan contract form.

40(12) Total incurred claims in each plan contract form.

P7    1(13) Average ratebegin delete increaseend deletebegin insert changeend insert initially requested.

2(14) Review category: initial filing for new product, filing for
3existing product, or resubmission.

4(15) Average rate ofbegin delete increaseend deletebegin insert changeend insert.

5(16) Effective date of ratebegin delete increaseend deletebegin insert changeend insert.

6(17) Number of subscribers or enrollees affected by each plan
7contract form.

8(18) The plan’s overall annual medical trend factor assumptions
9in each rate filing for all benefits and by aggregate benefit category,
10including hospital inpatient, hospital outpatient, physician services,
11prescription drugs and other ancillary services, laboratory, and
12radiology. A plan may provide aggregated additional data that
13demonstrates or reasonably estimates year-to-year costbegin delete increasesend delete
14begin insert changesend insert in specific benefit categories in major geographic regions
15of thebegin delete state. For purposes of this paragraph, “major geographic
16region” shall be defined by the department and shall include no
17more than nine regionsend delete
begin insert state if rates vary by region. If rates vary
18by region, the plan shall provide a description of the regions used
19by the planend insert
. A health plan that exclusively contracts with no more
20than two medical groups in the state to provide or arrange for
21professional medical services for the enrollees of the plan shall
22instead disclose the amount of its actual trend experience for the
23prior contract year by aggregate benefit category, using service
24categories that are, to the maximum extent possible, the same or
25similar to the benefit categories used by other plans. For this
26purpose, benefit categories shall be those specified in subdivision
27(e).

28(19) The amount of the projected trend attributable to the use
29of services, price inflation, or fees and risk for annual plan contract
30trends by aggregate benefit category, such as hospital inpatient,
31hospital outpatient, physician services, prescription drugs and other
32ancillary services, laboratory, and radiology. A health plan that
33exclusively contracts with no more than two medical groups in the
34state to provide or arrange for professional medical services for
35the enrollees of the plan shall instead disclose the amount of its
36actual trend experience for the prior contract year by aggregate
37service category, using service categories that are, to the maximum
38extent possible, the same or similar to those used by other plans.
39For this purpose, benefit categories shall be those specified in
40subdivision (e).

P8    1(20) A comparison of claims cost and rate of changes over time.

2(21) Any changes in enrollee cost-sharing over the prior year
3associated with the submitted rate filing.

4(22) Any changes in enrollee benefits over the prior year
5associated with the submitted rate filing.

6(23) The certification described in subdivision (b) of Section
71385.06.

8(24) Any changes in administrative costs.

9(25) Any other information required for rate review under
10PPACA.

11(d) Except as provided in subdivision (e), a health care service
12plan shall annually disclose the following aggregate data for all
13products sold in the large group market:

14(1) Plan year.

15(2) Segment type.

16(3) Product type.

17(4) Number of subscribers.

18(5) Number of covered lives affected.

19(6) The plan’s average ratebegin delete increaseend deletebegin insert changeend insert by the following:

20(A) Plan year.

21(B) Segment type.

22(C) Product type.

23(D) Benefit category, including, but not limited to, hospital,
24medical, ancillary, and other benefit categories reported publicly
25for individual and small employer rate filings.

26(E) Trend attributable to cost and trend attributable to utilization
27 by benefit category.

28(e) A health care service plan that is unable to provide
29information on rate increases by benefit categories, as defined in
30subdivision (d) of Section 1385.07, including, but not limited to,
31hospital, outpatient medical, and mental health, or information on
32trend attributable to cost and trend attributable to utilization by
33benefit category pursuant to subdivision (d), shall annually disclose
34all of the following aggregate data for its large group health care
35service plan contracts:

36(1) (A) The plan’s overall aggregate data demonstrating or
37reasonably estimating year-to-year cost increases in the aggregate
38for large group rates by major service category. The plan shall
39distinguish between the increase ascribed to the volume of services
P9    1provided and the increase ascribed to the cost of services provided
2for those assumptions that shall include the following categories:

3(i) Hospital inpatient.

4(ii) Outpatient visits.

5(iii) Outpatient surgical or other procedures.

6(iv) Professional medical.

7(v) Mental health.

8(vi) Substance abuse.

9(vii) Skilled nursing facility, if covered.

10(viii) Prescription drugs.

11(ix) Other ancillary services.

12(x) Laboratory.

13(xi) Radiology or imaging.

14(B) A plan may provide aggregated additional data that
15demonstrate or reasonably estimate year-to-year cost increases in
16each of the specific service categories specified in subparagraph
17(A) for each of the major geographic regions of the statebegin insert if anyend insert.

18(2) The amount of projected trend attributable to the following
19categories:

20(A) Use of services by service and disease category.

21(B) Capital investment.

22(C) Community benefit expenditures, excluding bad debt and
23valued at cost.

24(3) The amount and proportion of costs attributed to contracting
25medical groups that would not have been attributable as medical
26losses if incurred by the health plan rather than the medical group.

27(f) (1) A health care service plan shall annually provide claims
28data at no charge to a large group purchaser if the large group
29purchaser requests the information. The health care service plan
30shall provide claims data that a qualified statistician has determined
31are deidentified so that the claims data do not identify or do not
32provide a reasonable basis from which to identify an individual.

33(2) Information provided to a large group purchaser under this
34subdivision is not subject to Section 1385.07.

35(3) (A) If claims data are not available, the plan shall provide,
36at no charge to the purchaser, all of the following:

37(i) Deidentified data sufficient for the large group purchaser to
38calculate the cost of obtaining similar services from other health
39plans and evaluate cost-effectiveness by service and disease
40category.

P10   1(ii) Deidentified patient-level data on demographics, prescribing,
2encounters, inpatient services, outpatient services, and any other
3data as may be required of the health plan to comply with risk
4adjustment, reinsurance, or risk corridors pursuant to the federal
5Patient Protection and Affordable Care Act (Public Law 111-148),
6as amended by the federal Health Care and Education
7Reconciliation Act of 2010 (Public Law 111-152), and any rules,
8regulations, or guidance issued thereunder.

9(iii) Deidentified patient-level data used to experience rate the
10large group, including diagnostic and procedure coding and costs
11assigned to each service.

12(B) The health care service plan shall obtain a formal
13determination from a qualified statistician that the data provided
14pursuant to this paragraph have been deidentified so that the data
15do not identify or do not provide a reasonable basis from which
16to identify an individual. The statistician shall certify the formal
17determination in writing and shall, upon request, provide the
18protocol used for deidentification to the department.

19(4) Data provided pursuant to this subdivision shall only be
20provided to a large group purchaser that meets both of the
21following conditions:

22(A) Is able to demonstrate its ability to comply with state and
23federal privacy laws.

24(B) Is a large group purchaser that is either an employer with
25an enrollment of greater than 1,000 covered lives or a
26multiemployer trust.

27(g) The department may require all health care service plans to
28submit all rate filings to the National Association of Insurance
29Commissioners’ System for Electronic Rate and Form Filing
30(SERFF). Submission of the required rate filings to SERFF shall
31be deemed to be filing with the department for purposes of
32compliance with this section.

33

SEC. 4.  

Section 791.27 of the Insurance Code is amended to
34read:

35

791.27.  

(a) A disability insurer that provides coverage for
36hospital, medical, or surgical expenses shall not release any
37information to an employer that would directly or indirectly
38indicate to the employer that an employee is receiving or has
39received services from a health care provider covered by the plan
40unless authorized to do so by the employee. An insurer that has,
P11   1pursuant to an agreement, assumed the responsibility to pay
2compensation pursuant to Article 3 (commencing with Section
33750) of Chapter 4 of Part 1 of Division 4 of the Labor Code, shall
4not be considered an employer for the purposes of this section.

5(b) Nothing in this section prohibits a disability insurer from
6releasing relevant information described in this section for the
7purposes set forth in Chapter 12 (commencing with Section 1871)
8of Part 2 of Division 1.

9(c)  Nothing in this section prohibits a health insurer from
10releasing relevant information described in this section for the
11purposes set forth inbegin delete Article 4.5 (commencing with Section 10181)
12of Chapter 1 of Part 2 of Division 2end delete
begin insert subdivision (f) of Section
1310181.4end insert
.

14

SEC. 5.  

Section 10181.4 of the Insurance Code is amended to
15read:

16

10181.4.  

(a) For large group health insurance policies, all
17health insurers shall file with the department at least 60 days prior
18to implementing any rate change all required rate information for
19rate increases that exceed 5 percent of the prior year’s rate. This
20filing shall be concurrent with the written notice described in
21Section 10199.1.

22(b) For large group rate filings, health insurers shall submit all
23information that is required by PPACA. A health insurer shall also
24submit any other information required pursuant to any regulation
25adopted by the department to comply with this article.

26(c) A health insurer subject to subdivision (a) shall disclose for
27each rate filing that exceeds 5 percent of the prior year’s rate for
28that group all of the following:

29(1) Company name and contact information.

30(2) Number of policy forms covered by the filing.

31(3) Policy form numbers covered by the filing.

32(4) Product type, such as indemnity or preferred provider
33organization.

34(5) Segment type.

35(6) Type of insurer involved, such as for profit or not for profit.

36(7) Whether the products are opened or closed.

37(8) Enrollment in each policy and rating form.

38(9) Insured months in each policy form.

39(10) Annual rate.

40(11) Total earned premiums in each policy form.

P12   1(12) Total incurred claims in each policy form.

2(13) Average ratebegin delete increaseend deletebegin insert changeend insert initially requested.

3(14) Review category: initial filing for new product, filing for
4existing product, or resubmission.

5(15) Average rate ofbegin delete increaseend deletebegin insert changeend insert.

6(16) Effective date of ratebegin delete increaseend deletebegin insert changeend insert.

7(17) Number of policyholders or insureds affected by each
8policy form.

9(18) The insurer’s overall annual medical trend factor
10assumptions in each rate filing for all benefits and by aggregate
11benefit category, including hospital inpatient, hospital outpatient,
12physician services, prescription drugs and other ancillary services,
13laboratory, and radiology. An insurer may provide aggregated
14additional data that demonstrates or reasonably estimates
15year-to-year costbegin delete increasesend deletebegin insert changesend insert in specific benefit categories
16in major geographic regions of thebegin delete state. For purposes of this
17paragraph, “major geographic region” shall be defined by the
18department and shall include no more than nine regionsend delete
begin insert state if
19rates vary by region. If rates vary by region, the insurer shall
20provide a description of the regions used by the insurerend insert
.

21(19) The amount of the projected trend attributable to the use
22of services, price inflation, or fees and risk for annual policy trends
23by aggregate benefit category, such as hospital inpatient, hospital
24outpatient, physician services, prescription drugs and other
25ancillary services, laboratory, and radiology.

26(20) A comparison of claims cost and rate of changes over time.

27(21) Any changes in insured cost-sharing over the prior year
28associated with the submitted rate filing.

29(22) Any changes in insured benefits over the prior year
30associated with the submitted rate filing.

31(23) The certification described in subdivision (b) of Section
3210181.6.

33(24) Any changes in administrative costs.

34(25) Any other information required for rate review under
35PPACA.

36(d) Except as provided in subdivision (e), a health insurer shall
37annually disclose the following aggregate data for all products
38sold in the large group market:

39(1) Policy year.

40(2) Segment type.

P13   1(3) Product type.

2(4) Number of policyholders.

3(5) Number of covered lives affected.

4(6) The insurer’s average ratebegin delete increaseend deletebegin insert changeend insert by the following:

5(A) Policy year.

6(B) Segment type.

7(C) Product type.

8(D) Benefit category, including, but not limited to, hospital,
9medical, ancillary, and other benefit categories reported publicly
10for individual and small employer rate filings.

11(E) Trend attributable to cost and trend attributable to utilization
12by benefit category.

13(e) A health insurer that is unable to provide information on
14rate increases by benefit categories, as defined in subdivision (d)
15of Section 10181.7 including, but not limited to, hospital, outpatient
16medical, and mental health, or information on trend attributable
17to cost and trend attributable to utilization by benefit category
18pursuant to subdivision (d), shall annually disclose all of the
19following aggregate data for its large group health insurance
20policies:

21(1) (A) The insurer’s overall aggregate data demonstrating or
22reasonably estimating year-to-year cost increases in the aggregate
23for large group rates by major service category. The insurer shall
24distinguish between the increase ascribed to the volume of services
25provided and the increase ascribed to the cost of services provided
26for those assumptions that shall include the following categories:

27(i) Hospital inpatient.

28(ii) Outpatient visits.

29(iii) Outpatient surgical or other procedures.

30(iv) Professional medical.

31(v) Mental health.

32(vi) Substance abuse.

33(vii) Skilled nursing facility, if covered.

34(viii) Prescription drugs.

35(ix) Other ancillary services.

36(x) Laboratory.

37(xi) Radiology or imaging.

38(B) An insurer may provide aggregated additional data that
39demonstrate or reasonably estimate year-to-year cost increases in
P14   1each of the specific service categories specified in subparagraph
2(A) for each of the major geographic regions of the statebegin insert if anyend insert.

3(2) The amount of projected trend attributable to the following
4categories:

5(A) Use of services by service and disease category.

6(B) Capital investment.

7(C) Community benefit expenditures, excluding bad debt and
8valued at cost.

9(3) The amount and proportion of costs attributed to contracting
10medical groups that would not have been attributable as medical
11losses if incurred by the health insurer rather than the medical
12group.

13(f) (1) A health insurer shall annually provide claims data at
14no charge to a large group purchaser if the large group purchaser
15requests the information. The health insurer shall provide claims
16data that a qualified statistician has determined are deidentified so
17that the claims data do not identify or do not provide a reasonable
18basis from which to identify an individual.

19(2) Information provided to a large group purchaser under this
20subdivision is not subject to Section 10181.7.

21(3) (A) If claims data are not available, the insurer shall provide,
22at no charge to the purchaser, all of the following:

23(i) Deidentified data sufficient for the large group purchaser to
24calculate the cost of obtaining similar services from other health
25insurers and plans and evaluate cost-effectiveness by service and
26disease category.

27(ii) Deidentified patient-level data on demographics, prescribing,
28encounters, inpatient services, outpatient services, and any other
29data as may be required of the health insurer to comply with risk
30adjustment, reinsurance, or risk corridors pursuant to the federal
31Patient Protection and Affordable Care Act (Public Law 111-148),
32as amended by the federal Health Care and Education
33Reconciliation Act of 2010 (Public Law 111-152), and any rules,
34regulations, or guidance issued thereunder.

35(iii) Deidentified patient-level data used to experience rate the
36large group, including diagnostic and procedure coding and costs
37assigned to each service.

38(B) The health insurer shall obtain a formal determination from
39a qualified statistician that the data provided pursuant to this
40paragraph have been deidentified so that the data do not identify
P15   1or do not provide a reasonable basis from which to identify an
2individual. The statistician shall certify the formal determination
3in writing and shall, upon request, provide the protocol used for
4deidentification to the department.

5(4) Data provided pursuant to this subdivision shall only be
6provided to a large group purchaser that meets both of the
7following conditions:

8(A) Is able to demonstrate its ability to comply with state and
9federal privacy laws.

10(B) Is a large group purchaser that is either an employer with
11an enrollment of greater than 1,000 covered lives or a
12multiemployer trust.

13(g) The department may require all health insurers to submit all
14rate filings to the National Association of Insurance
15Commissioners’ System for Electronic Rate and Form Filing
16 (SERFF). Submission of the required rate filings to SERFF shall
17be deemed to be filing with the department for purposes of
18compliance with this section.

19

SEC. 6.  

No reimbursement is required by this act pursuant to
20Section 6 of Article XIII B of the California Constitution because
21the only costs that may be incurred by a local agency or school
22district will be incurred because this act creates a new crime or
23infraction, eliminates a crime or infraction, or changes the penalty
24for a crime or infraction, within the meaning of Section 17556 of
25the Government Code, or changes the definition of a crime within
26the meaning of Section 6 of Article XIII B of the California
27Constitution.



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