BILL NUMBER: AB 2366 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 16, 2016
INTRODUCED BY Assembly Member Dababneh
FEBRUARY 18, 2016
An act to amend Section 10231.2 10235.52
of the Insurance Code, relating to long-term care insurance.
LEGISLATIVE COUNSEL'S DIGEST
AB 2366, as amended, Dababneh. Long-term care insurance.
Existing law provides for the regulation of long-term care
insurance, as defined, and requires the Insurance Commissioner to
review and approve individual and group policies, certificates,
riders, and outlines of coverage. Existing law requires every
long-term care policy to contain a provision that, in the event the
insurer develops new benefits or benefit eligibility or new policies
with new benefits or benefit eligibility not included in the
previously issued policy, the insurer shall grant specified current
policyholders certain rights, namely notifying the policyholders of
the new benefits or benefit eligibility or new policy within 12
months and offering the new benefits or benefit eligibility to those
policyholders, as specified. The insurer is required to file the
notice to current policyholders with the Department of
Insurance at the same time as the new policy or rider.
This bill would exempt life insurance-based combination policies
that include long-term care coverage provisions from the
above-described requirements.
This bill would make technical, nonsubstantive changes to that
provision.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 10235.52 of the
Insurance Code is amended to read:
10235.52. (a) Every Each policy
shall contain a provision that, in the event
if the insurer develops new benefits or benefit eligibility or
new policies with new benefits or benefit eligibility not included in
the previously issued policy, the insurer will
shall grant current holders of its policies who are not in
benefit or within the elimination period all of the
following rights:
(1) The policyholder will be notified
insurer shall notify the policyholder of the availability of
the new benefits or benefit eligibility or new policy within 12
months. The insurer's notice shall be filed
insurer shall file the notice with the department at the same
time as the new policy or rider.
(2) The insurer shall offer the policyholder new benefits or
benefit eligibility in one of the following ways:
(A) By adding a rider to the existing policy and paying a separate
premium for the new benefits or benefit eligibility based on the
insured's attained age. The premium for the existing policy
will shall remain unchanged based on the insured'
s age at issuance.
(B) By replacing the existing policy or certificate in accordance
with Section 10234.87.
(C) By replacing the existing policy or certificate with a new
policy or certificate in which case consideration for past insured
status shall be recognized by setting the premium for the replacement
policy or certificate at the issue age of the policy or certificate
being replaced.
(b) The insured may be required to undergo new underwriting, but
the underwriting can be no more restrictive than if the policyholder
or certificate holder were applying for a new policy or certificate.
(c) The insurer of a group policy as defined under subdivisions
(a) to (c), inclusive, of Section 10231.6 must
shall offer the group policyholder the opportunity to have
the new benefits and provisions extended to existing certificate
holders, but the insurer is relieved of the obligations imposed by
this section if the holder of the group policy declines the issuer's
offer.
(d) This section shall become operative on June 30, 2003.
(d) The provision described in subdivision (a) shall not be
required for life insurance-based combination policies that include
long-term care coverage provisions.
SECTION 1. Section 10231.2 of the Insurance
Code is amended to read:
10231.2. (a) "Long-term care insurance" includes any insurance
policy, certificate, or rider advertised, marketed, offered,
solicited, or designed to provide coverage for diagnostic,
preventive, therapeutic, rehabilitative, maintenance, or personal
care services that are provided in a setting other than an acute care
unit of a hospital. Long-term care insurance includes all products
containing any of the following benefit types: coverage for
institutional care including care in a nursing home, convalescent
facility, extended care facility, custodial care facility, skilled
nursing facility, or personal care home; home care coverage including
home health care, personal care, homemaker services, hospice, or
respite care; or community-based coverage including adult day care,
hospice, or respite care. Long-term care insurance includes
disability based long-term care policies but does not include
insurance designed primarily to provide Medicare supplement or major
medical expense coverage.
(b) Long-term care policies, certificates, and riders shall be
regulated under this chapter. The commissioner shall review and
approve individual and group policies, certificates, riders, and
outlines of coverage. Other applicable laws and regulations shall
also apply to long-term care insurance insofar as they do not
conflict with the provisions in this chapter. Long-term care benefits
designed to provide coverage of one year or more that are contained
in or amended to Medicare supplement or other disability policies and
certificates shall be regulated under this chapter.