Amended in Senate June 8, 2016

Amended in Assembly March 30, 2016

California Legislature—2015–16 Regular Session

Assembly Bill No. 2884

Introduced by Committee on Insurance (Assembly Members Daly (Chair), Bigelow, Calderon, Chu, Cooley, Cooper, Dababneh, Frazier, Gatto, Gonzalez, and Rodriguez)

February 25, 2016

An act to amend Sections 660, 789, begin insert 1215.5, end insert 1669, 1681, 1726, begin delete 1749.6, end delete 1807.5, 10168.6, 10234.6, 10234.95, begin insert 10236.1, 10236.13, 10236.14, 10236.15, end insert 11520.5, begin delete and 11691 end delete begin insert 11691, and 12921.1 end insert of, begin insert to repeal Section 736.5 of, end insert and to repeal and add Section 1682 of, the Insurance Code, relating to insurance.

LEGISLATIVE COUNSEL’S DIGEST

AB 2884, as amended, Committee on Insurance. Insurance: licensees: Internet: disclosures.

(1) Existing law defines “policy,” to mean, among others, an automobile liability, automobile physical damage, or automobile collision policy insuring a single individual or individuals residing in the same household, as the named insured, and under which the insured vehicles designated under are of specified types including a motor vehicle, as specified, and any other 4-wheel motor vehicle with a load capacity of 1,500 pounds or less, for the purposes of various requirements for a notice of cancellation of a policy. Existing law further provides that the requirements for a notice of cancellation of a policy do not apply to any policy issued under an automobile assigned risk plan, any policy insuring more than 4 vehicles, and begin delete to end delete any policy covering, among other things, garage, automobile sales agency, or public parking place operation hazards.

This bill would, among other things, remove the exemption for any policy insuring more than 4 automobiles.

begin insert

(2) Existing law authorizes the Insurance Commissioner, under specified circumstances, to examine the business and affairs of an insurer. That examination is required to be at the expense of the insurer, organization, or person examined by the commissioner, as specified.

end insert begin insert

Existing law prohibits the revenue raised from the examination of insurers in the 1996-97 fiscal year from exceeding the examination fee revenue estimate for the 1996-97 Governor’s Budget by more than $2,000,000.

end insert begin insert

This bill would delete the provision relating to revenue raised during the 1996-97 fiscal year.

end insert begin insert

(3) The Insurance Holding Company System Regulatory Act requires each insurer that is authorized to do business in this state and that is a member of an insurance holding company system to register with the commissioner and to file a registration statement containing specified information, including the capital structure and general financial condition of the insurer and specified transactions between the insurer and its affiliates.

end insert begin insert

The act provides that the transactions by registered insurers with their affiliates are subject to various standards, including the requirement that the terms be fair and reasonable.

end insert begin insert

The act provides that any insurer or any director, officer, employee, or agent of the insurer that commits a willful violation of the act is subject to criminal proceedings.

end insert begin insert

This bill would require that the terms also be consistent with the current version of the NAIC Insurance Holding Company System Model Regulation.

end insert begin insert

Because a willful violation of this provision would be subject to criminal proceedings, the bill would create a state-mandated local program.

end insert begin delete

(2)

end delete

begin insert (4) end insert  Existing law prohibits a person from soliciting, negotiating, or effecting contracts of insurance, or acting in the capacity of various types of insurance agents, unless the person holds a valid license from the Insurance Commissioner authorizing the person to act in that capacity. Existing law authorizes the commissioner to deny an application for a license for various reasons including if the applicant committed a felony or a misdemeanor as shown by a plea of guilty or nolo contendere. Existing law also requires an applicant to pass the qualifying examination for the license prior to receiving a permanent license and allows the applicant to retake the qualifying examination subject to reasonable time limits limiting when a person who has failed the examination may retake.

This bill would add that the commissioner may deny an application for a license if the applicant has been convicted of a felony or misdemeanor, as specified. The bill would also prohibit a person who has failed any license qualification examination 10 times within the previous 12-month period from enrolling in any further license qualification examinations for a period of 12 months.

begin delete

(3)

end delete

begin insert (5) end insert  Existing law requires a person who is licensed in this state as an insurance agent or broker, advertises insurance on the Internet, and transacts insurance in this state, to identify certain information on the Internet, regardless of whether the insurance agent or broker maintains his or her Internet presence or if the presence is maintained on his or her behalf. The required information includes, but is not limited to, his or her name as it appears on his or her license, and any fictitious name approved by the commissioner.

This bill would instead require that the person provide his or her name as filed with the commissioner that has not been disapproved pursuant to the provisions regarding the use of fictitious names.

begin delete

(4) Existing law automatically terminates the license of a person failing to meet various requirements and who has not been granted an extension of time within which to comply by the commissioner until the person demonstrates that he or she has complied with all of the requirements, as specified.

end delete begin delete

This bill would add the failure by an insurance adjuster and a public insurance adjuster to complete continuing education requirements to the list of requirements for which the failure to complete will result in an automatic termination of the license.

end delete begin delete

(5)

end delete

begin insert (6) end insert  Existing law prohibits an insurer from executing an undertaking of bail except by and through a person holding a bail license, as provided. Existing law also prohibits the commissioner from suspending or revoking any license, issued as specified, without first granting a hearing, as specified.

This bill would prohibit the commissioner from denying a license to an applicant without first granting a hearing, as specified.

begin delete

(6)

end delete

begin insert (7) end insert  Existing law provides that for the purpose of determining certain benefits, that in the case of annuity contracts under which an election may be made to have annuity payments commence at optional maturity dates, the maturity date shall be deemed to be the latest date for which election is permitted by the contract.

This bill would add that in the case of annuity contracts under which the fixed maturity date is later than the later of the anniversary of the contract next following the annuitant’s 70th birthday or the 10th anniversary of the contract, the maturity date shall be deemed to be the later of the anniversary of the contract next following the annuitant’s 70th birthday or the 10th anniversary of the contract.

begin delete

(7)

end delete

begin insert (8) end insert  Existing law requires the commissioner to annually prepare a consumer rate guide for long-term care insurance and to include specified information, including a history of the rates of all policies issued in California for the current year and for the 4 preceding years.

This bill would require the history of the rates of all policies issued in California to be listed for the 9 preceding years.

begin insert

(9) Existing law provides for the regulation of insurers, including insurers issuing policies of long-term care insurance, by the Insurance Commissioner. Existing law prohibits an insurer from increasing the premium for an individual or group long-term care insurance policy or certificate approved for sale unless the insurer has received prior approval for the increase from the commissioner and requires the insurer to submit to the commissioner for approval all premium rate schedule increases, as specified. Existing law further requires that approval of all premium rate schedule increases, and approved premium rate schedule increases be subject to various requirements, including filing updated projections annually for the next 3 years, as specified.

end insert begin insert

This bill would require that for the above-described rate schedules, the lifetime expected loss ratio be calculated as specified. The bill would also modify the requirements that approved premium rate schedule increases are subject to by requiring the insurer to file composite rate projections if it is necessary to maintain consistent premium rates for new certificates receiving a rate increase.

end insert begin delete

(8)

end delete

begin insert (10) end insert  Existing law requires an insurer, in order to be admitted in this state to transact specified workers’ compensation transactions, among other things, to deposit cash instruments or approved interest-bearing securities or approved stocks readily convertible into cash, investment certificates, or share accounts issued by a savings and loan association doing business in this state and insured by the Federal Deposit Insurance Corporation, certificates of deposit, or savings deposits in a bank licensed to do business in this state that is either domiciled in and with its principal place of business in this state or that is a national banking association with a trust office located in this state.

This bill would instead include a bank licensed to do business in this state, or a trust company, licensed to do business and located in this state that is either domiciled in and with its principal place of business in this state or that is a national banking association with a trust office located in this state.

begin insert

(11) Existing law requires the Insurance Commissioner to establish a program to investigate complaints and respond to inquiries received regarding the handling of insurance claims and, when warranted, to bring enforcement actions against insurers or production agencies. Existing law requires the commissioner to promulgate a regulation that sets forth the criteria that the department shall apply to determine if a complaint is deemed to be justified prior to the public release of a complaint against a specifically named insurer or production agency.

end insert begin insert

This bill would authorize the commissioner to establish an Internet-accessible complaint response system to distribute and receive complaint information, as specified.

end insert begin insert

(12) 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.

end insert begin insert

This bill would provide that no reimbursement is required by this act for a specified reason.

end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program:  begin delete no end delete begin insert yes end insert .

The people of the State of California do enact as follows:

SECTION 1.  

Section 660 of the Insurance Code is amended
to read:

660.  

As used in this chapter:

(a) “Policy” means an automobile liability, automobile physical
damage, or automobile collision policy, or any combination thereof,
delivered or issued for delivery in this state, insuring a single
individual or individuals residing in the same household, as named
insured, and under which the insured vehicles therein designated
are of the following types only:

(1) A motor vehicle of the private passenger or station wagon
type that is not used as a public or livery conveyance for
passengers, nor rented to others; or

(2) Any other four-wheel motor vehicle with a load capacity of
1,500 pounds or less; provided, however, that this chapter shall
not apply to either of the following:

(A) Any policy issued under an automobile assigned risk plan.

(B) Any policy covering garage, automobile sales agency, repair
shop, service station, or public parking place operation hazards.

(3) A motorcycle.

(b) “Automobile liability coverage” includes only coverage of
bodily injury and property damage liability, medical payments,
and uninsured motorists coverage.

(c) “Automobile physical damage coverage” includes all
coverage of loss or damage to an automobile insured under the
policy except loss or damage resulting from collision or upset.

(d) “Automobile collision coverage” includes all coverage of
loss or damage to an automobile insured under the policy resulting
from collision or upset.

(e) “Renewal” or “to renew” means to continue coverage with
either the insurer which issued the policy or an affiliated insurer,
as defined in Section 1215, for an additional policy period upon
expiration of the current policy period of a policy, provided that
if coverage is continued with an affiliated insurer, it shall be the
same or broader coverage as provided by the present insurer, and
the insured shall be notified in writing at least 20 days prior to
expiration of the current policy period of all of the following:

(1) That the insurer has determined that it will not offer renewal
of the policy with the present insurer.

(2) That it is offering replacement in an affiliated insurer.

(3) That the insured may obtain in writing the reasons for the
change in insurers if he or she requests in writing not later than
one month following the expiration of the policy period the reason
or reasons for the change in insurers. Any policy with a policy
period or term of six months or less, whether or not made
continuous for successive terms upon the payment of additional
premiums, begin delete shall end delete begin insert shall, end insert for the purpose of this chapter be considered
as if written for a policy period or term of six months. Any policy
written for a term longer than one year, or any policy with no fixed
expiration date, shall for the purpose of this chapter, be considered
as if written for successive policy periods or terms of one year.

(f) “Nonpayment of premium” means failure of the named
insured to discharge when due any of his obligations in connection
with the payment of premiums on a policy, or any installment of
such premium, whether the premium is payable directly to the
insurer or its agent or indirectly under any premium finance plan
or extension of credit.

(g) “Cancellation” means termination of coverage by an insurer
(other than termination at the request of the insured) during a policy
period.

(h) “Nonrenewal” means a notice by the insurer to the named
insured that the insurer is unwilling to renew a policy.

(i) “Expiration” means termination of coverage by reason of
the policy having reached the end of the term for which it was
issued or the end of the period for which a premium has been paid.

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 736.5 of the end insert begin insert Insurance Code end insert begin insert is repealed. end insert

begin delete

736.5.  

The provisions of Section 736 notwithstanding, the
revenue raised from the examination of insurers and other persons
under this article in the 1996-97 fiscal year shall not exceed the
examination fee revenue estimate for the 1996-97 Governor’s
Budget by more than two million dollars ($2,000,000).

end delete

begin delete SEC. 2. end delete

begin insert SEC. 3. end insert   

Section 789 of the Insurance Code is amended to read:

789.  

(a) The commissioner shall have the administrative
authority to assess penalties against insurers, brokers, agents, and
other entities engaged in the transaction of insurance or any other
person or entity for violations of this article.

(b) Upon a showing of a violation of this article in any civil
action, a court may also assess the penalties prescribed in this
article.

(c) Whenever the commissioner has reasonable cause to believe
or determines after a public hearing that any insurer, agent, broker,
or other person or entity engaged in the transaction of insurance,
has violated this article the commissioner shall make and serve
upon the insurer, broker, agent, or other person or entity a notice
of hearing. The notice shall state the commissioner’s intent to
assess the administrative penalties, the time and place of the
hearing, and the conduct, begin delete condition end delete begin insert condition, end insert or ground upon
which the commissioner is holding the hearing, and assessing the
penalties. The hearing shall occur within 30 days after the notice
is served. Within 30 days after the hearing the commissioner shall
issue an order specifying the amount of the penalties to be paid.
The penalties resulting from the hearing shall be paid to the
Insurance Fund.

(d) The powers vested in the commissioner by this section shall
be in addition to any and all powers and remedies vested in the
commissioner by law.

(e) Actions for injunctive relief, penalties specified in Section
789.3, damages, restitution, and all other remedies in law, may be
brought in superior court by the Attorney General, district attorney,
or city attorney on behalf of the people of California. The court
shall award reasonable attorney’s fees and court costs to the
prevailing plaintiff who establishes a violation of this article.

begin insert

begin insert SEC. 4. end insert   

end insert

begin insert Section 1215.5 of the end insert begin insert Insurance Code end insert begin insert is amended to
read: end insert

1215.5.  

(a) Transactions by registered insurers with their
affiliates are subject to the following standards:

(1) The terms shall be fair and begin delete reasonable. end delete begin insert reasonable and
consistent with the current version of Section 19 of the NAIC
Insurance Holding Company System Model Regulation, subject
to the requirements of this article. end insert

(2) Charges or fees for services performed shall be reasonable.

(3) Expenses incurred and payment received shall be allocated
to the insurer in conformity with customary insurance accounting
practices consistently applied.

(4) The books, accounts, and records of each party to all
transactions shall be so maintained as to clearly and accurately
disclose the precise nature and details of the transactions, including
accounting information that is necessary to support the
reasonableness of the charges or fees to the parties.

(5) The insurer’s policyholder’s surplus following any dividends
or distributions to shareholder affiliates shall be reasonable in
relation to the insurer’s outstanding liabilities and adequate to its
financial needs.

(b) The following transactions involving a domestic insurer or
commercially domiciled insurer, as defined in Section 1215.14,
and any person in its insurance holding company system, including
amendments or modifications of affiliate agreements previously
filed pursuant to this section, may be entered into only if the insurer
has notified the commissioner in writing of its intention to enter
into the transaction at least 30 days prior thereto, or a shorter period
as the commissioner may permit, and the commissioner has not
disapproved it within that period. The notice for amendments or
modifications shall include the reasons for the change and the
financial impact on the domestic insurer or commercially domiciled
insurer. Informal notice shall be reported, within 30 days after a
termination of a previously filed agreement, to the commissioner
for determination of the type of filing required, if any. The
commissioner shall require the payment of one thousand eight
hundred eighty-nine dollars ($1,889) as a fee for filings pursuant
to this subdivision, and the filings shall be on a form and in a
format prescribed by the NAIC. The payment shall accompany
the filing.

(1) Sales, purchases, exchanges, loans, extensions of credit, or
investments, if the transactions are equal to or exceed:

(A) For a nonlife insurer, the lesser of 3 percent of the insurer’s
admitted assets or 25 percent of the policyholder’s surplus as of
the preceding December 31st.

(B) For a life insurer, 3 percent of the insurer’s admitted assets
as of the preceding December 31st.

(2) Loans or extensions of credit to a person who is not an
affiliate, if made with the agreement or understanding that the
proceeds of the transactions, in whole or in substantial part, are to
be used to make loans or extensions of credit to, to purchase assets
of, or to make investments in, any affiliate of the insurer, if the
transactions are equal to or exceed:

(A) For a nonlife insurer, the lesser of 3 percent of the insurer’s
admitted assets or 25 percent of the policyholder’s surplus as of
the preceding December 31st.

(B) For a life insurer, 3 percent of the insurer’s admitted assets
as of the preceding December 31st.

(3) Reinsurance agreements and pooling agreements and
modifications thereto in which the reinsurance premium or a
change in the insurer’s liabilities, or the projected reinsurance
premium or a change in the insurer’s liabilities in any of the next
three years, equals or exceeds 5 percent of the insurer’s
policyholder’s surplus, as of the preceding December 31st,
including those agreements that may require as consideration the
transfer of assets from an insurer to a nonaffiliate, if an agreement
or understanding exists between the insurer and nonaffiliate that
any portion of the assets will be transferred to one or more affiliates
of the insurer.

(4) All management agreements, service contracts, tax sharing
agreements, and cost-sharing arrangements. However, subscription
agreements or powers of attorney executed by subscribers of a
reciprocal or interinsurance exchange are not required to be
reported pursuant to this section if the form of the agreement was
in use before 1943 and was not amended in any way to modify
payments, fees, or waivers of fees or otherwise substantially
amended after 1943. Payment or waiver of fees or other amounts
due under subscription agreements or powers of attorney forms
that were in use before 1943 and that have not been amended in
any way to modify payments, fees, or waiver of fees, or otherwise
substantially amended after 1943 shall not be subject to regulation
pursuant to paragraph (2) of subdivision (a).

(5) Guarantees when initiated or made by a domestic or
commercially domiciled insurer, provided that a guarantee that is
quantifiable as to amount is not subject to the notice requirements
of this paragraph unless it exceeds the lesser of one-half of 1
percent of the insurer’s admitted assets or 10 percent of surplus as
regards policyholders as of the 31st day of December next
preceding. Further, all guarantees that are not quantifiable as to
amount are subject to the notice requirements of this paragraph.

(6) Derivative transactions or series of derivative transactions.
The written filing to the commissioner shall include the type or
types of derivative transactions, the affiliate or affiliates engaging
with the insurer in the derivative transactions, the objective and
the rationale for the derivative transaction or series of derivative
transactions, the maximum maturity and economic effect of the
derivative transactions, and any other information required by the
commissioner. Derivative transactions entered into pursuant to
this subdivision shall comply with the provisions of Section 1211.

(7) Direct or indirect acquisitions or investments in a person
that controls the insurer or in an affiliate of the insurer in an amount
that, together with its present holdings in those investments,
exceeds 2.5 percent of the insurer’s policyholder’s surplus. Direct
or indirect acquisitions or investments in subsidiaries acquired
under Section 1215.1, or in nonsubsidiary insurance affiliates that
are subject to the provisions of this article, or in subsidiaries
acquired pursuant to Section 1199, are exempt from this
requirement.

(8) Any material transactions, specified by regulation, that the
commissioner determines may adversely affect the interests of the
insurer’s policyholders.

(c) A domestic insurer may not enter into transactions that are
part of a plan or series of transactions with persons within the
holding company system if the purpose of those transactions is to
avoid the statutory threshold amount and thus avoid review. If the
commissioner determines that separate transactions were entered
into over any 12-month period to avoid review, the commissioner
may exercise his or her authority under Section 1215.11.

(d) The commissioner, in reviewing transactions under
subdivision (b), shall consider whether the transactions comply
with the standards set forth in subdivision (a) and whether they
may adversely affect the interests of policyholders.

(e) The commissioner shall be notified within 30 days of any
investment by the insurer in any one corporation if the total
investment in the corporation by the insurance holding company
system exceeds 10 percent of the corporation’s voting securities.

(f) For purposes of this article, in determining whether an
insurer’s policyholder’s surplus is reasonable in relation to the
insurer’s outstanding liabilities and adequate to its financial needs,
the following factors, among others, shall be considered:

(1) The size of the insurer, as measured by its assets, capital
and surplus, reserves, premium writings, insurance in force, and
other appropriate criteria.

(2) The extent to which the insurer’s business is diversified
among the several lines of insurance.

(3) The number and size of risks insured in each line of business.

(4) The extent of the geographical dispersion of the insurer’s
insured risks.

(5) The nature and extent of the insurer’s reinsurance program.

(6) The quality, diversification, and liquidity of the insurer’s
investment portfolio.

(7) The recent past and projected future trend in the size of the
insurer’s investment portfolio.

(8) The recent past and projected future trend in the size of the
insurer’s surplus, and the policyholder’s surplus maintained by
other comparable insurers.

(9) The adequacy of the insurer’s reserves.

(10) The quality and liquidity of investments in subsidiaries
made under Section 1215.1. The commissioner may treat those
investments as a disallowed asset for purposes of determining the
adequacy of the policyholder’s surplus whenever, in his or her
judgment, the investment so warrants.

(11) The quality of the company’s earnings and the extent to
which the reported earnings include extraordinary accounting
items.

(g) No insurer subject to registration under Section 1215.4 shall
pay any extraordinary dividend or make any other extraordinary
distribution to its stockholders until 30 days after the commissioner
has received notice of the declaration thereof and has approved
the payment or has not, within the 30-day period, disapproved the
payment.

For purposes of this section, an extraordinary dividend or
distribution is any dividend or distribution which, together with
other dividends or distributions made within the preceding 12
months, exceeds the greater of (1) 10 percent of the insurer’s
policyholder’s surplus as of the preceding December 31st, or (2)
the net gain from operations of the insurer, if the insurer is a life
insurer, or the net income, if the insurer is not a life insurer, for
the 12-month period ending the preceding December 31st.

Notwithstanding any other provision of law, an insurer may
declare an extraordinary dividend or distribution that is conditional
upon the commissioner’s approval. The declaration confers no
rights upon stockholders until the commissioner has approved the
payment of the dividend or distribution or until the commissioner
has not disapproved the payment within the 30-day period referred
to in this subdivision.

(h) Notwithstanding the control of a domestic insurer by any
person, the officers and directors of the insurer shall not thereby
be relieved of any obligation or liability to which they would
otherwise be subject to by law, and the insurer shall be managed
to ensure its separate operating identity consistent with the
provisions of this article. However, nothing in this article shall
preclude a domestic insurer from having or sharing a common
management or cooperative or joint use of personnel, property, or
services with one or more other persons under arrangements
meeting the standards of subdivision (a).

(i) The provisions of this section do not apply to any insurer,
information, or transaction exempted by the commissioner.

begin delete SEC. 3. end delete

begin insert SEC. 5. end insert   

Section 1669 of the Insurance Code is amended to
read:

1669.  

The commissioner may, without hearing, deny an
application if the applicant has done one or more of the following:

(a) (1) Been convicted of a felony.

(2) Been convicted of a misdemeanor denounced by this code
or by other laws regulating insurance.

(3) A judgment, plea, or verdict of guilty or a conviction
following a plea of nolo contendere is deemed to be a conviction
within the meaning of this subdivision.

(b) Had a previous application for a professional, occupational,
or vocational license denied for cause by any licensing authority,
within five years of the date of the filing of the application to be
acted upon, on grounds that should preclude the granting of a
license by the commissioner under this chapter.

(c) Had a previously issued professional, occupational, or
vocational license suspended or revoked for cause by any licensing
authority, within five years of the date of the filing of the
application to be acted upon, on grounds that should preclude the
granting of a license by the commissioner under this chapter.

In the event the commissioner issues an order based on a plea
that does not at any time result in a judgment of conviction, the
commissioner shall vacate the order upon petition by the applicant.

begin delete SEC. 4. end delete

begin insert SEC. 6. end insert   

Section 1681 of the Insurance Code is amended to
read:

1681.  

If an applicant fails the qualifying examination, he or
she may, subject to the provisions of Section 1682, retake a
qualifying examination.

begin delete SEC. 5. end delete

begin insert SEC. 7. end insert   

Section 1682 of the Insurance Code is repealed.

begin delete SEC. 6. end delete

begin insert SEC. 8. end insert   

Section 1682 is added to the Insurance Code, to read:

1682.  

(a) A person who has failed any license qualification
examination 10 times within the previous 12-month period shall
not be permitted to enroll in any further license qualification
examinations for a period of 12 months, beginning from the date
of the 10th license qualification examination failure.

(b) For the purpose of this section, “license qualification
examination” includes examinations for all types of licenses issued
by the commissioner pursuant to this chapter, Chapter 7
(commencing with Section 1800) and Chapter 8 (commencing
with Section 1831), and Chapter 1 (commencing with Section
14000) and Chapter 2 (commencing with Section 15000) of
Division 5.

begin delete SEC. 7. end delete

begin insert SEC. 9. end insert   

Section 1726 of the Insurance Code is amended to
read:

1726.  

(a) A person who is licensed in this state as an insurance
agent or broker, advertises insurance on the Internet, and transacts
insurance in this state, shall identify all of the following
information on the Internet, regardless of whether the insurance
agent or broker maintains his or her Internet presence or if the
presence is maintained on his or her behalf:

(1) His or her name as filed with the commissioner that has not
been disapproved pursuant to Section 1724.5.

(2) The state of his or her domicile and principal place of
business.

(3) His or her license number.

(b) A person shall be deemed to be transacting insurance in this
state when the person advertises on the Internet, regardless of
whether the insurance agent or broker maintains his or her Internet
presence or if it is maintained on his or her behalf, and does any
of the following:

(1) Provides an insurance premium quote to a California
resident.

(2) Accepts an application for coverage from a California
resident.

(3) Communicates with a California resident regarding one or
more terms of an agreement to provide insurance or an insurance
policy.

begin delete

SEC. 8.  

Section 1749.6 of the Insurance Code is amended to
read:

1749.6.  

Any person failing to meet the requirements imposed
by Section 1749.3, 1749.31, 14090.1, or 15059.1 and who has not
been granted an extension of time within which to comply by the
commissioner shall have his or her license automatically terminated
until the time that the person demonstrates to the satisfaction of
the commissioner that he or she has complied with all of the
requirements of this article and all other laws applicable thereto.
If a person cannot perform the requirements of this article due to
a disability or inactivity due to special circumstances, the
commissioner shall provide a procedure for the person to place
his or her license on inactive status until the time that the person
demonstrates to the satisfaction of the commissioner that he or she
has complied with or made up all of the requirements of this article
for the period of disability or inactivity.

end delete

begin delete SEC. 9. end delete

begin insert SEC. 10. end insert   

Section 1807.5 of the Insurance Code is amended to
read:

1807.5.  

Except as provided in Sections 1669 and 1738, the
commissioner shall not deny, suspend, or revoke any license, issued
under this article, without first granting a hearing, upon reasonable
notice to the applicant or licensee, except that he may temporarily
suspend a license for a period not exceeding 15 days pending the
hearing. Where a hearing is held under this section the proceedings
shall be conducted in accordance with Chapter 5 (commencing
with Section 11500) of Part 1 of Division 3 of Title 2 of the
Government Code, and the commissioner shall have all the powers
granted pursuant to that chapter.

begin delete SEC. 10. end delete

begin insert SEC. 11. end insert   

Section 10168.6 of the Insurance Code is amended
to read:

10168.6.  

For the purpose of determining the benefits calculated
under Sections 10168.4 and 10168.5, the following apply:

(a) In the case of annuity contracts under which the fixed
maturity date is later than the later of the anniversary of the contract
next following the annuitant’s 70th birthday or the 10th anniversary
of the contract, the maturity date shall be deemed to be the later
of the anniversary of the contract next following the annuitant’s
70th birthday or the 10th anniversary of the contract.

(b) In the case of annuity contracts under which an election may
be made to have annuity payments commence at optional maturity
dates, the maturity date shall be deemed to be the latest date for
which election shall be permitted by the contract, but shall not be
deemed to be later than the anniversary of the contract next
following the annuitant’s seventieth birthday or the tenth
anniversary of the contract, whichever is later.

begin delete SEC. 11. end delete

begin insert SEC. 12. end insert   

Section 10234.6 of the Insurance Code is amended
to read:

10234.6.  

(a) The commissioner shall, by June 1 of each year,
jointly design the format and content of a consumer rate guide for
long-term care insurance with a working group that includes
representatives of the Health Insurance Counseling and Advocacy
Program, the insurance industry, and insurance agents. The
commissioner shall annually prepare the consumer rate guide for
long-term care insurance that shall include, but not be limited to,
the following information:

(1) A comparison of the different types of long-term care
insurance and coverages available to California consumers and a
specimen outline of coverage for each product currently marketed
by each insurer listed in the rate guide.

(2) A premium history of each insurer that writes long-term
care policies for all the types of long-term care insurance and
coverages issued by the insurer in California.

(b) The consumer rate guide to be prepared by the commissioner
shall consist of two parts: a history of the rates for all policies
issued in California for the current year and for nine preceding
years, and a comparison of the policies, benefits, and sample
premiums for all policies currently being issued for delivery in
California.

(1) For the rate history portion of the rate guide required by this
section, the department shall collect, and each insurer shall provide
to the department, all of the following information for each
long-term care policy, including all policies, whether issued by
the insurer or purchased or acquired from another insurer, issued
in California for the current year and for nine preceding years:

(A) Company name.

(B) Policy type.

(C) Policy form identification.

(D) Dates sold.

(E) Date acquired (if applicable).

(F) Premium rate increases requested.

(G) Premium rate increases approved.

(H) Dates of premium rate increase approvals.

(I) Any other information requested by the department.

(2) For the policy comparison portion of the rate guide required
by this section, the department shall collect, and each insurer shall
provide to the department, the information needed to complete the
following form, along with any other information requested by the
department, for each long-term care policy currently issued for
delivery in California, including all policies, whether issued by
the insurer or purchased or acquired from another insurer:

PRINTER PLEASE NOTE: TIP-IN MATERIAL TO BE
INSERTED

[1 page]

If an insurer does not offer a policy for sale that fits the criteria
set forth in the sample premium portion of the policy comparison
section of the rate guide, the department shall include in that section
of the form for that policy a statement explaining that a policy
fitting that criteria is not offered by the insurer and that the
consumer may seek, from an agent, sample premium information
for the insurer’s policy that most closely resembles the policy in
the sample.

The department shall use the format set forth in this section for
the policy comparison portion of the rate guide, unless the working
group convened pursuant to subdivision (a) designs an alternative
format and agrees that it should be used instead.

In compiling the policy comparison portion of the rate guide,
the department shall separate the group policies from the individual
policies available for sale so that group policies for all insurers
appear together in the guide and individual policies for all insurers
appear together in the guide.

The policy comparison portion of the rate guide shall contain a
cross-reference for each policy form listed indicating the page in
the rate guide where rate information on the policy form can be
found.

(c) The department shall publish, on the department’s Internet
Web site, a premium history of each insurer that writes long-term
care policies for all the types of long-term care insurance and
coverages issued by the insurer in each state. Each insurer shall
provide to the department all of the information listed in paragraph
(1) of subdivision (b) for each long-term care policy, including all
policies, whether issued by the insurer or purchased or acquired
from another insurer, issued in the United States for the current
year and for the nine preceding years.

(d) Insurers shall provide the information required pursuant to
subdivisions (b) and (c) no later than July 31 of each year,
commencing in 2000.

(e) The consumer rate guide shall be published no later than
December 1 of each year commencing in 2000, and shall be
distributed using all of the following methods:

(1) Through Health Insurance Counseling and Advocacy
Program (HICAP) offices.

(2) By telephone using the department’s consumer toll-free
telephone number.

(3) On the department’s Internet Web site.

(4) A notice in the Long-Term Care Insurance Personal
Worksheet required by Section 10234.95.

(f) Notwithstanding any other provision of law, the data
submitted by insurers to the department pursuant to this section
are public records, and shall be open to inspection by members of
the public pursuant to the procedures of the California Public
Records Act. However, a trade secret, as defined in subdivision
(d) of Section 3426.1 of the Civil Code, is not subject to this
subdivision.

begin delete SEC. 12. end delete

begin insert SEC. 13. end insert   

Section 10234.95 of the Insurance Code is amended
to read:

10234.95.  

(a) Every insurer or other entity marketing long-term
care insurance shall:

(1) Develop and use suitability standards to determine whether
the purchase or replacement of long-term care insurance is
appropriate for the needs of the applicant.

(2) Train its agents in the use of its suitability standards.

(3) Maintain a copy of its suitability standards and make them
available for inspection upon request by the commissioner.

(b) The agent and insurer shall develop procedures that take
into consideration, when determining whether the applicant meets
the standards developed by the insurer, the following:

(1) The ability to pay for the proposed coverage and other
pertinent financial information related to the purchase of the
coverage.

(2) The applicant’s goals or needs with respect to long-term
care and the advantages and disadvantages of insurance to meet
these goals or needs.

(3) The value, benefits, and costs of the applicant’s existing
insurance, if any, when compared to the values, benefits, and costs
of the recommended purchase or replacement.

(c) (1) The issuer, and where an agent is involved, the agent,
shall make reasonable efforts to obtain the information set out in
subdivision (b). The efforts shall include presentation to the
applicant, at or prior to application, of the “Long-Term Care
Insurance Personal Worksheet,” contained in the Long-Term Care
Insurance Model Regulations of the National Association of
Insurance Commissioners. The personal worksheet used by the
insurer shall contain, at a minimum, the information in the NAIC
worksheet in not less than 12-point type. The insurer may request
the applicant to provide additional information to comply with its
suitability standards.

(2) In the premium section of the personal worksheet, the insurer
shall disclose all rate increases and rate increase requests for all
policies, whether issued by the insurer or purchased or acquired
from another insurer, in the United States for the current year and
for nine preceding years.

(3) The premium section shall include a statement that reads as
follows: “A rate guide is available that compares the policies sold
by different insurers, the benefits provided in those policies, and
sample premiums. The rate guide also provides a history of the
rate increases, if any, for the policies issued by different insurers
in each state in which they do business, for the current year and
for the nine preceding years. You can obtain a copy of this rate
guide by calling the Department of Insurance’s consumer toll-free
telephone number (1-800-927-HELP), by calling the Health
Insurance Counseling and Advocacy Program (HICAP) toll-free
telephone number (1-800-434-0222), or by accessing the
Department of Insurance’s Internet Web site
(www.insurance.ca.gov).” If the personal worksheet is approved
prior to the availability of the rate guide, the worksheet shall
indicate that the rate guide will be available beginning December
1, 2000.

(4) A copy of the issuer’s personal worksheet shall be filed and
approved by the commissioner. A new personal worksheet shall
be filed and approved by the commissioner each time a rate is
increased in California and each time a new policy is filed for
approval by the commissioner. The new personal worksheet shall
disclose the amount of the rate increase in California and all prior
rate increases for the nine preceding years in California as well as
all prior rate increases and rate increase requests or filings in any
other state for the nine preceding years. The new personal
worksheet shall be used by the insurer within 60 days of approval
by the commissioner in place of the previously approved personal
worksheet.

(d) A completed personal worksheet shall be returned to the
issuer prior to the issuer’s consideration of the applicant for
coverage, except the personal worksheet need not be returned for
sale of employer group long-term care insurance to employees and
their spouses and dependents.

(e) The sale or dissemination outside the company or agency
by the issuer or agent of information obtained through the personal
worksheet is prohibited.

(f) The issuer shall use the suitability standards it has developed
pursuant to this section in determining whether issuing long-term
care insurance coverage to an applicant is appropriate.

(g) Agents shall use the suitability standards developed by the
insurer in marketing long-term care insurance.

(h) If the issuer determines that the applicant does not meet its
financial suitability standards, or if the applicant has declined to
provide the information, the issuer may reject the application.
Alternatively, the issuers shall send the applicant a letter similar
to the “Long-Term Care Insurance Suitability Letter” contained
in the Long-Term Care Model Regulations of the National
Association of Insurance Commissioners. However, if the applicant
has declined to provide financial information, the issuer may use
some other method to verify the applicant’s intent. Either the
applicant’s returned letter or a record of the alternative method of
verification shall be made part of the applicant’s file.

(i) The insurer shall report annually to the commissioner the
total number of applications received from residents of this state,
the number of those who declined to provide information on the
personal worksheet, the number of applicants who did not meet
the suitability standards, and the number who chose to conform
after receiving a suitability letter.

(j) This section shall not apply to life insurance policies that
accelerate benefits for long-term care.

begin insert

begin insert SEC. 14. end insert   

end insert

begin insert Section 10236.1 of the end insert begin insert Insurance Code end insert begin insert is amended
to read: end insert

10236.1.  

(a) Benefits under individual long-term care insurance
policies issued before new premium rate schedules are approved
under Section 10236.11 shall be deemed reasonable in relation to
premiums if the expected loss ratio is at least 60 percent, calculated
in a manner that provides for adequate reserving of the long-term
care insurance risk.

(b) (1) For individual long-term care insurance policies issued
before new premium rate schedules are approved under Section
10236.11, and for which rate revisions are filed on or after January
1, 2010, benefits shall be deemed reasonable in relation to the
premium if the premium rate schedules have a lifetime expected
loss ratio of at least 60 percent of the premium scale in effect on
December 31, 2009, plus 70 percent of premium increases filed
on or after January 1, 2010, calculated in a manner that provides
for adequate reserving of the long-term care insurance risk. begin insert The
lifetime expected loss ratio shall be calculated using the discount
rate defined in paragraph (9) of subdivision (c). end insert

(2) However, if the premiums in any rate revision filing
calculated in the manner provided in paragraph (1) produce a
lifetime expected loss ratio that is less than the highest lifetime
expected loss ratio for this policy form in the initial filing or that
for requested premium rates in any filing made after January 1,
2013, the insurer shall reduce the premiums in the filing so that
the current lifetime expected loss ratio is equal to or greater than
the highest initially filed loss ratio or that for requested premium
rates filed after January 1, 2013. In the determination of a lifetime
expected loss ratio, a margin may reflect changes in the manner
in which risks are shared between the insurer and a block of
policies due to changes in this law effective January 1, 2013, and
that margin shall not be increased unless the manner in which risks
are shared between the insurer and the block of policies is changed
further by law or regulation. The determination of the lifetime
expected loss ratio shall be based on the actual distribution of
policies in force at the time of the first filing after January 1, 2013,
and not any prior assumed distribution.

(c) In evaluating the expected loss ratio, due consideration shall
be given to all relevant factors, including the following:

(1) Statistical credibility of incurred claims experience and
earned premiums.

(2) The period for which rates are computed to provide coverage.

(3) Experienced and projected trends.

(4) Concentration of experience within early policy duration.

(5) Expected claim fluctuation.

(6) Experience refunds, adjustments, or dividends.

(7) Renewability features.

(8) All appropriate expense factors.

(9) The discount rate used in the calculation of lifetime expected
loss ratios. begin insert All present and accumulated values used to determine
rate increases should use the maximum valuation interest rate for
contract reserves. If one rate increase filing includes policy forms
with different discount rates, separate projections for each discount
rate should be prepared and then combined to create the total
projection for the filings. end insert

(10) Experimental nature of the coverage.

(11) Policy reserves.

(12) Mix of business by risk classification.

(13) Product features, such as long elimination periods, high
deductibles, and high maximum limits.

(d) Asset investment yield rate changes may not be used to
justify a rate increase unless the insurer can demonstrate that its
return on investments is lower than the maximum valuation interest
rate for contract reserves for those policies or the commissioner
determines that a change in interest rates is justified due to changes
in laws or regulations that are retroactively applicable to long-term
care insurance previously sold in this state.

(e) The experience on all similar long-term care policy forms
issued in this state by an insurer and its affiliates and retained
within the affiliated group shall be pooled together and the
combined experience shall be used as the basis for assumptions
that satisfy the requirements in subdivisions (a) and (b). Those
assumptions and requested rate increases may vary by policy form
if actuarially appropriate. Similar long-term care policy forms shall
be classified into one of the following benefit classifications:
nursing facility and residential care facility only, home care only,
or comprehensive long-term care benefits.

(f) Notwithstanding any other provision of this section, for rate
revisions filed on or after January 1, 2010, the commissioner may
approve an application for a rate revision based on less than a 70
percent loss ratio, but not less than a 60 percent loss ratio, for the
portion attributable to the rate increase if an insurer can
demonstrate that the rates are necessary to protect the financial
condition of the insurer, including avoidance of further reductions
in capital and surplus.

(g) This section applies only to long-term care insurance policies
issued before the approval of rate schedules under Section
10236.11.

begin insert

begin insert SEC. 15. end insert   

end insert

begin insert Section 10236.13 of the end insert begin insert Insurance Code end insert begin insert is amended
to read: end insert

10236.13.  

No insurer may increase the premium for an
individual or group long-term care insurance policy or certificate
approved for sale under this chapter unless the insurer has received
prior approval for the increase from the commissioner.

The insurer shall submit to the commissioner for approval all
proposed premium rate schedule increases, including at least all
of the following information:

(a) Certification by an actuary, who is a member of the American
Academy of Actuaries and who meets the qualification standards
of that organization, that:

(1) If the requested premium rate schedule increase is
implemented and the underlying assumptions, which reflect
moderately adverse conditions, are realized, no further premium
rate schedule increases are anticipated.

(2) The premium rate filing is in compliance with the provisions
of this section.

(b) An actuarial memorandum justifying the rate schedule
change request that includes all of the following:

(1) Lifetime projections of earned premiums and incurred claims
based on the filed premium rate schedule increase, and the method
and assumptions used in determining the projected values,
including reflection of any assumptions that deviate from those
used for pricing other forms currently available for sale.

(A) Annual values for the five years preceding and the three
years following the valuation date shall be provided separately.

(B) The projections shall include the development of the lifetime
loss ratio. begin insert The lifetime expected loss ratio shall be calculated using
the discount rate provided by subdivision (c) of Section 10236.14. end insert

(C) For policies issued with premium rate schedules approved
under Section 10236.11, the projections shall demonstrate
compliance with subdivision (a) of Section 10236.14. For all other
policies, the projections shall demonstrate compliance with Section
10236.1.

(D) If the commissioner determines that a premium rate increase
is justified due to changes in laws or regulations that are
retroactively applicable to long-term care insurance previously
sold in this state, then:

(i) The projected experience should be limited to the increases
in claims expenses attributable to the changes in law or regulations.

(ii) If the commissioner determines that potential offsets to
higher claims costs may exist, the insurer shall be required to use
appropriate net projected experience.

(2) Disclosure of how reserves have been incorporated in this
rate increase.

(3) Disclosure of the analysis performed to determine why a
rate adjustment is necessary, which pricing assumptions were not
realized and why, and what other actions taken by the company
have been relied on by the actuary.

(4) A statement that policy design, underwriting, and claims
adjudication practices have been taken into consideration.

(5) A statement that asset investment yield rate changes have
not been used to justify the rate increase unless the insurer can
demonstrate that its return on investments is lower than the
maximum valuation interest rate for contract reserves for those
policies or the commissioner determines that a change in interest
rates is justified due to changes in laws or regulations that are
retroactively applicable to long-term care insurance previously
sold in this state.

(6) If it is necessary to maintain consistent premium rates for
new certificates and certificates receiving a rate increase, the
insurer shall file composite rates reflecting projections of new
certificates.

(c) A statement that renewal premium rate schedules are not
greater than new business premium rate schedules except for
differences attributable to benefits, unless sufficient justification
is provided to the commissioner.

(d) Sufficient information for approval of the premium rate
schedule increase by the commissioner.

(e) (1) The insurer, at its discretion, may request a premium
rate schedule increase that is lower than the rate increase necessary
to provide the certification required by subdivision (a) or a series
of premium rate schedule increases with a present value of not
more than the rate increase necessary to provide the certification
required by subdivision (a). The commissioner may accept the
premium rate schedule increase or series of increases without
submission of the certification required by subdivision (a) if all of
the following apply:

(A) In the opinion of the commissioner, accepting the lower
premium rate schedule increase or increases is in the best interest
of California policyholders.

(B) The actuarial memorandum discloses to the commissioner
the rate increase necessary to provide the certification required by
subdivision (a).

(C) The rate increase filing satisfies all other requirements of
this section.

(D) The insurer discloses to policyholders affected by the
approved increases the filed increase, the approved premium rate
schedule increase or increases, and the amount and timing of any
subsequent rate schedule increases included in the rate increase
filing whether those subsequent rate schedule increases are
approved or not approved by the commissioner.

(2) The commissioner may approve a lower requested premium
rate schedule increase and may approve the initial increase or more
than just the initial increase requested pursuant to paragraph (1).

(3) If the amount of increase after all increases disclosed
pursuant to subparagraph (D) of paragraph (1), whether the increase
or increases are approved or not approved by the commissioner,
triggers the contingent benefit upon lapse, the commissioner shall
require the administration by an insurer of the contingent benefit
upon lapse as a condition of approval of a premium rate schedule
increase that is lower than the amount necessary to provide the
certification required by paragraph (1) of subdivision (a) or with
the initial increase and each subsequent increase in a series of
premium rate schedule increases. The commissioner may waive
this condition of approval if an insurer demonstrates that the waiver
is necessary to protect the financial condition of the insurer,
including avoidance of further reductions in capital and surplus.

(4) For purposes of paragraph (2) of subdivision (a) of Section
10236.14, the loss ratio calculation shall assume future premiums
are based on the total filed rate schedule increase or series of
increases disclosed pursuant to subparagraph (D) of paragraph (1),
whether the increase or increases are approved or not approved by
the commissioner.

(5) Premium rate schedule increases requested pursuant to
paragraph (1) or approved as described in paragraph (2) shall
comply with the provisions of Sections 10234.6 and 10234.95.

(f) The provisions of this section are applicable to all individual
and group policies issued in this state on or after July 1, 2002.

begin insert

begin insert SEC. 16. end insert   

end insert

begin insert Section 10236.14 of the end insert begin insert Insurance Code end insert begin insert is amended
to read: end insert

10236.14.  

Approval of all premium rate schedule increases
shall be subject to the following requirements:

(a) (1) Premium rate schedule increases shall demonstrate that
the sum of the accumulated value of incurred claims, without the
inclusion of active life reserves, and the present value of future
projected incurred claims, without the inclusion of active life
reserves, will not be less than the sum of the following:

(A) The accumulated value of the initial earned premium times

begin delete 58 percent. end delete begin insert the maximum of both of the following: end insert

begin insert

(i) 58 percent.

end insert begin insert

(ii) The lifetime expected loss ratio calculated using the initial
pricing assumption, actual distribution of policies issued, and the
discount rate provided by subdivision (c).

end insert

(B) Eighty-five percent of the accumulated value of prior
premium rate schedule increases on an earned basis.

(C) The present value of future projected initial earned premiums
times begin delete 58 percent. end delete begin insert the maximum of both of the following: end insert

begin insert

(i) 58 percent.

end insert begin insert

(ii) The lifetime expected loss ratio calculated using the initial
pricing assumption, actual distribution of policies issued, and the
discount rate provided by subdivision (c).

end insert

(D) Eighty-five percent of the present value of future projected
premiums not in subparagraph (C) on an earned basis.

(2) However, if the premiums in any rate revision filing
calculated in this manner produce a lifetime expected loss ratio
that is less than the highest lifetime expected loss ratio for this
policy form in the initial filing or that for requested premium rates
in any filing made after January 1, 2013, the insurer shall reduce
the premiums in the filing so that the current lifetime expected
loss ratio is equal to or greater than the highest initially filed loss
ratio or that for requested premium rates filed after January 1,
2013. In the determination of a lifetime expected loss ratio, the
margin for moderately adverse experience shall be reflected and
shall not be increased unless the manner in which risks are shared
between the insurer and block of policies has been changed by this
law or any future law or regulation. The determination of the
lifetime expected loss ratio shall be based on the actual distribution
of policies issued and not any assumed distribution prior to actual
sales.

(b) In the event the commissioner determines that a premium
rate increase is justified due to changes in laws or regulations that
are retroactively applicable to long-term care insurance previously
sold in this state, a premium rate schedule increase may be
approved if the increase provides that 70 percent of the present
value of projected additional premiums shall be returned to
policyholders in benefits and the other requirements applicable to
other premium rate schedule increases are met.

(c) All present and accumulated values used to determine rate
increases should use the maximum valuation interest rate for
contract reserves. begin delete The actuary shall disclose as part of the actuarial
memorandum the use of any appropriate averages. end delete begin insert If one rate
increase filing includes policy forms with different discount rates,
separate projections for each discount rate should be prepared
and then combined to create the total projection for the filing. end insert

(d) No request for a rate increase on any policy form approved
under Section 10236.11 shall be approved by the commissioner
except as follows: the experience on all similar long-term care
policy forms issued in this state by the insurer and its affiliates and
retained by the affiliated group that have been approved either
prior to approval under, or pursuant to, Section 10236.11 shall be
pooled together and the combined experience shall be used as the
basis for assumptions that satisfy the requirements in subdivision
(a). Those assumptions and requested rate increases may vary by
policy form if actuarially appropriate. Similar long-term care policy
forms shall be classified into one of the following benefit
classifications: nursing facility and residential care facility only,
home care only, or comprehensive long-term care benefits. An
insurer is not precluded from filing requests for premium rate
schedule increases on all of its policy forms if the combined
experiences after pooling all applicable policy forms satisfies the
requirements of subdivision (a).

(e) Notwithstanding any other provision of this section, for
applications for rate revisions filed on or after January 1, 2013,
the commissioner may approve the application if an insurer
demonstrates that the rates are necessary to protect the financial
condition of the insurer, including avoidance of further reductions
in capital and surplus.

(f) The provisions of this section are applicable to all individual
and group policies issued in this state on or after July 1, 2002.

begin insert

begin insert SEC. 17. end insert   

end insert

begin insert Section 10236.15 of the end insert begin insert Insurance Code end insert begin insert is amended
to read: end insert

10236.15.  

Premium rate schedule increases that have been
approved shall be subject to the following:

(a) For each rate increase that is implemented, the insurer shall
file for approval by the commissioner updated projections, as
defined in paragraph (1) of subdivision (b) of Section 10236.13,
annually for the next three years and include a comparison of actual
results to projected values. The commissioner may extend the
period to greater than three years.

(b) (1) If the commissioner has determined that the actual
experience following a rate increase does not adequately match
the projected experience and that the current projections under
moderately adverse conditions demonstrate that incurred claims
will not exceed proportions of premiums specified in subdivision
(a), the commissioner may require the insurer to implement any
of the following:

(A) Premium rate schedule adjustments.

(B) Other measures to reduce the difference between the
projected and actual experience.

(2) In determining whether the actual experience adequately
matches the projected experience, consideration should be given
to paragraph begin delete (5) end delete begin insert (6) end insert of subdivision (b) of Section 10236.13, if
applicable.

(c) If the commissioner demonstrates, based upon credible
evidence, that an insurer has engaged in a persistent practice of
filing inadequate premium schedules, the commissioner may, in
addition to any other authority of the commissioner under this
chapter, and after the insurer is afforded proper notice and due
process, prohibit the insurer from filing and marketing comparable
coverage for a period of up to five years or from offering all other
similar coverages, and may limit marketing of new applications
to the products subject to recent premium rate schedule increases.

(d) This section shall not apply to life insurance policies and
certificates that accelerate benefits for long-term care.

(e) The provisions of this section are applicable to all individual
and group policies issued in this state on or after July 1, 2002.

begin delete SEC. 13. end delete

begin insert SEC. 18. end insert   

Section 11520.5 of the Insurance Code is amended
to read:

11520.5.  

No person shall transact in this state the business
described in this chapter without first procuring a certificate of
authority from the commissioner for such purpose. Application
for such certificate shall be made on a form prescribed by the
commissioner accompanied by a filing fee of one thousand seven
hundred seventy dollars ($1,770). The certificate shall not be
granted until the applicant conforms to the requirements of this
chapter and the laws of this state prerequisite to its issue. After
such issue the holder shall continue to comply with the
requirements of this chapter and the laws of this state. When a
hearing is held under this section the proceedings shall be
conducted in accordance with Chapter 5 (commencing with Section
11500) of Part begin delete 1, Division 3, end delete begin insert 1 of Division 3 of end insert Title 2 of the
Government Code, and the commissioner shall have all of the
powers granted therein.

Subject to the annual fee provisions herein, every certificate of
authority issued or held under this chapter shall be for an indefinite
term and, unless sooner revoked by the commissioner, shall
terminate upon occurrence of any of the following:

(a) Upon the holder’s ceasing to exist as a separate entity.

(b) Upon the winding up or dissolution, or expiration or
forfeiture of the corporate existence of a corporate holder thereof.

(c) Upon winding up or dissolution of a holder not a corporation.

(d) In any event upon surrender by the holder of its certificate
of authority and cancellation of the same by the commissioner.

The commissioner shall not cancel a surrendered certificate of
authority until he begin insert or she end insert is satisfied by examination, or otherwise,
that the former holder has discharged its annuity liabilities to
residents of this state or satisfactorily reinsured the same.

Notwithstanding the preceding provisions for a certificate of
authority of indefinite term, each holder of a certificate of authority
under this chapter shall owe and pay in advance to the
commissioner in lawful money of the United States an annual fee
of fifty-eight dollars ($58) on account of a certificate of authority
until its final termination or revocation. The fee shall be for annual
periods commencing on July 1st of each year and ending on June
30th of each year and shall be due on each March 1st and shall be
delinquent on and after each April 1st.

Each holder of a certificate of authority shall also be subject to
the payment in advance of the following fees, as appropriate:

(1) One hundred eighteen dollars ($118) for each amended
certificate of authority caused by a change of the name of the
holder.

(2) Eighty-nine dollars ($89) for the services and expenses of
the commissioner in connection with the filing of amended articles
by a holder.

(3) Three hundred fifty-four dollars ($354) for all services and
expenses of the commissioner in connection with the withdrawal
of a holder of a certificate of authority under this chapter.

(e) Upon the receipt of a notice of filing of a petition by or
against a certificate holder under the United States Bankruptcy
Code for bankruptcy or reorganization, the commissioner shall
cease imposing, billing, or collecting the annual fees due under
this chapter and this section to the certificate holder.

(f) Upon notice of the suspension of the corporate status of the
certificate holder for a period of 12 months by the Secretary of
State, the commissioner shall terminate the certificate of authority
and shall deem the certificate to be terminated.

begin delete SEC. 14. end delete

begin insert SEC. 19. end insert   

Section 11691 of the Insurance Code is amended to
read:

11691.  

(a) (1) In order to provide protection to the workers
of this state in the event that the insurers issuing workers’
compensation insurance to employers fail to pay compensable
workers’ compensation claims when due, except in the case of the
State Compensation Insurance Fund, every insurer desiring
admission to transact workers’ compensation insurance, or workers’
compensation reinsurance business, or desiring to reinsure the
injury, disablement, or death portions of policies of workers’
compensation insurance under the class of disability insurance
shall, as a prerequisite to admission, or ability to reinsure the injury,
disablement, or death portion of policies of workers’ compensation
insurance under the class of disability insurance, deposit cash
instruments or approved interest-bearing securities or approved
stocks readily convertible into cash, investment certificates, or
share accounts issued by a savings and loan association doing
business in this state and insured by the Federal Deposit Insurance
Corporation, certificates of deposit, or savings deposits in a bank
licensed to do business in this state, or approved letters of credit
that perform in material respects as any other security allowable
as a form of deposit for purposes of a workers’ compensation
deposit and that meet the standard set forth in Section 922.5, or
approved securities registered with a qualified depository located
in a reciprocal state as defined in Section 1104.9, with that deposit
to be in an amount and subject to any exceptions as set forth in
this article. The deposit shall be made from time to time as
demanded by the commissioner and may be made with the
Treasurer, or a bank or savings and loan association authorized to
engage in the trust business pursuant to Division 1 (commencing
with Section 99) or Division 2 (commencing with Section 5000)
of the Financial Code, or a trust company. A deposit of securities
registered with a qualified depository located in a reciprocal state
as defined in Section 1104.9 may only be made in a bank or savings
and loan association authorized to engage in the trust business
pursuant to Division 1 (commencing with Section 99) or Division
2 (commencing with Section 5000) of the Financial Code, or a
trust company, licensed to do business and located in this state
that is either domiciled in and has a principal place of business in
this state, or is a national bank association with a trust office
located in this state, that is a qualified custodian as defined in
paragraph (1) of subdivision (a) of Section 1104.9, and that
maintains deposits of at least seven hundred fifty million dollars
($750,000,000). The deposit shall be made subject to the approval
of the commissioner under those rules and regulations that he or
she shall promulgate. The deposit shall be maintained at a deposit
value specified by the commissioner, but in any event no less than
one hundred thousand dollars ($100,000), nor less than the reserves
required of the insurer to be maintained under any of the provisions
of Article 1 (commencing with Section 11550) of Chapter 1,
relating to loss reserves on workers’ compensation business of the
insurer in this state, nor less than the sum of the amounts specified
in subdivision (a) of Section 11693, whichever is greater. The
deposit shall be for the purpose of paying compensable workers’
compensation claims under policies issued by the insurer or
reinsured by the admitted reinsurer and expenses as provided in
Section 11698.02, in the event the insurer or reinsurer fails to pay
those claims when they come due. If the insurer providing the
deposit is domiciled in a state where a state statute, regulation, or
court decision provides that, with respect to covered claims within
the deductible amount that are paid by a guarantee association
after the entry of an order of liquidation under large deductible
workers’ compensation policies, any part of the reimbursement
proceeds, other than the reasonable expenses of the receiver related
to treatment of deductible policy arrangements of insurance
companies in liquidation, owed by insureds on those deductible
amounts, whether paid directly or through a draw of collateral, are
general assets of the estate, then the amount of the insurer’s deposit
pursuant to this article shall be calculated based on the gross
amount of that insurer’s liabilities for loss and loss adjustment
expenses under those policies without regard to the deductible,
and those reserves shall not be reduced by any collateral or
reimbursement obligations insureds were required to provide under
those policies.

(2) This section does not require that the deposit be calculated
based on gross amounts of liabilities described above if the
domiciliary state does not have an existing statute, regulation, or
court decision providing that the reimbursement proceeds described
above are general assets of the estate.

(b) Each insurer or reinsurer desiring to have the ability to
reinsure the injury, disablement, or death portions of policies of
workers’ compensation under the class of disability insurance shall
provide prior notice to the commissioner, in the manner and form
prescribed by the commissioner of its intent to reinsure that
insurance. In the event of late notice, a late filing fee shall be
imposed on the reinsurer pursuant to Section 924 for failure to
notify the commissioner of its intent to reinsure workers’
compensation insurance.

(c) If the deposit required by this section is not made with the
Treasurer, then the depositor shall execute a trust agreement in a
form approved by the commissioner between the insurer, the
institution in which the deposit is made or, where applicable, the
qualified custodian of the deposit, and the commissioner, that
grants to the commissioner the authority to withdraw the deposit
as set forth in Sections 11691.2, 11696, 11698, and 11698.3. The
insurer shall also execute and deliver in duplicate to the
commissioner a power of attorney in favor of the commissioner
for the purposes specified herein, supported by a resolution of the
depositor’s board of directors. The power of attorney and director’s
resolution shall be on forms approved by the commissioner, shall
provide that the power of attorney cannot be revoked or withdrawn
without the consent of the commissioner, and shall be
acknowledged as required by law.

(d) (1) The commissioner shall require payment in advance of
fees for the initial filing of a trust agreement with a bank, savings
and loan association, or trust company on deposits made pursuant
to subdivision (a); for each amendment, supplement, or other
change to the deposit agreement; for receiving and processing
deposit schedules pursuant to this section; and for each withdrawal,
substitution, or any other change in the deposit. The fees shall be
set forth in the department’s Schedule of Fees and Charges.

(2) The commissioner shall require payment in advance of a
fee for the initial filing of each letter of credit utilized pursuant to
subdivision (a). In addition, the commissioner shall require
payment in advance of a fee for each amendment of a letter of
credit. The fees shall be set forth in the department’s Schedule of
Fees and Charges.

(e) Any workers’ compensation insurer that deposits cash or
cash equivalents pursuant to this section shall be entitled to a
prompt refund of those deposits in excess of the amount determined
by the commissioner pursuant to subdivision (a). The commissioner
shall cause to be refunded any deposits determined by the
commissioner to be in excess of the amount required by subdivision
(a) within 30 days of that determination. In the alternative, an
insurer may use any excess deposit funds to offset a demand by
the commissioner to increase its deposit due to the failure of a
reinsurer to make a deposit pursuant to this section.

(f) (1) An admitted insurer reinsuring business covered in this
article (hereafter referred to as reinsurer) shall identify to the
commissioner, in a form prescribed by the commissioner, amounts
deposited for credit in the name of each ceding insurer.

(2) All reinsurance agreements covering claims and obligations
under business covered by this article, and allowable for purposes
of granting a ceding carrier a deposit credit, shall include a
provision granting the commissioner, in the event of a delinquency
proceeding, receivership, or insolvency of a ceding insurer, any
sums from a reinsurer’s deposit that are necessary for the
commissioner to pay those reinsured claims and obligations, or to
ensure their payment by the California Insurance Guarantee
Association, deemed by the commissioner due under the
reinsurance agreement, upon failure of the reinsurer for any reason
to make payments under the policy of reinsurance. The
commissioner shall give 30 days’ notice prior to drawing upon
these funds of an intent to do so. Notwithstanding the
commissioner’s right to draw on these funds, the reinsurer shall
otherwise retain its right to determine the validity of those claims
and obligations and to contest their payment under the reinsurance
agreement. Prior to a reinsurer’s deposit being drawn upon, in
whole or in part, by the department, the department shall provide
a reinsurer with an explanation of procedures that a reinsurer may
use to explain to the department why the use of the reinsurer’s
deposit may not be appropriate under the reinsurance agreement.

(3) A reinsurer entering into a contract identified in paragraph
(2), beginning on or after January 1, 2005, may not cede claims
or obligations assumed from a ceding insurer unless the deposit
securing the ceded claims or obligations is governed by paragraph
(2) or, upon approval of the commissioner, would secure the ceded
claims or obligations in all material respects and in the same
manner as a deposit identified in paragraph (2) above.

(4) All sums received from the reinsurer by the commissioner
for those claims paid by the California Insurance Guarantee
Association shall be held separate and apart from and not included
in the general assets of the insolvent insurer, and shall be
transferred to the California Insurance Guarantee Association upon
receipt by the commissioner. In the event of a final judgment or
settlement adverse to the drawing of funds by the commissioner
pursuant to paragraph (2) or (3), the California Insurance Guarantee
Association shall repay funds it obtained to pay covered claims
and shall, if necessary, either levy a surcharge as needed or seek
legislative approval to levy the surcharge if the California Insurance
Guarantee Association is already levying the maximum surcharge
permissible under law.

(g) If a reinsurer has not maintained deposits as required by
subdivision (a) in amounts equal to the amounts of deposit credits
claimed by its ceding insurers, the commissioner, after notifying
the reinsurer and its ceding insurers of the deposit shortfall and
allowing 15 days from the date of the notice for the deposit shortfall
to be corrected, may disallow all or a portion of the reserve credits
claimed by the ceding insurers. A ceding insurer disallowed a
reserve credit pursuant to this provision shall immediately make
the deposit required by this section.

(h) For interest-bearing securities that are debt securities and
include principal payment features prior to maturity that are utilized
pursuant to subdivision (a), all principal payments received shall
be retained as part of the deposit.

(i) Withdrawal of any amount of the deposit required under
subdivision (a) that results in a reduction of the required amount
of the deposit may only occur with the prior written consent of the
commissioner.

begin insert

begin insert SEC. 20. end insert   

end insert

begin insert Section 12921.1 of the end insert begin insert Insurance Code end insert begin insert is amended
to read: end insert

12921.1.  

(a) The commissioner shall establish a program on
or before July 1, 1991, to investigate complaints and respond to
inquiries received pursuant to Section 12921.3, to comply with
Section 12921.4, and, when warranted, to bring enforcement
actions against insurers or production agencies, as those terms are
defined in subdivision (a) of Section 1748.5. The program shall
include, but not be limited to, the following:

(1) A toll-free telephone number published in telephone books
throughout the state, dedicated to the handling of complaints and
inquiries.

(2) Public service announcements to inform consumers of the
toll-free telephone number and how to register a complaint or make
an inquiry to the department.

(3) A simple, standardized complaint form designed to assure
that complaints will be properly registered and tracked.

(4) Retention of records on complaints for at least three years
after the complaint has been closed.

(5) Guidelines to disseminate complaint and enforcement
information on individual insurers to the public, that shall include,
but not be limited to, the following:

(A) License status.

(B) Number and type of complaints closed within the last full
calendar year, with analogous statistics from the prior two years
for comparison. The proportion of those complaints determined
by the department to require that corrective action be taken against
the insurer, or leading to insurer compromise, or other remedy for
the complainant, as compared to those that are found to be without
merit. This information shall be disseminated in a fashion that will
facilitate identification of meritless complaints and discourage
their consideration by consumers and others interested in the
records of insurers.

(C) Number and type of violations found, by reference to the
line of insurance and the law violated. For the purposes of this
subparagraph, the department shall separately report this
information for health insurers.

(D) Number and type of enforcement actions taken.

(E) Ratio of complaints received to total policies in force, or
premium dollars paid in a given line, or both. Private passenger
automobile insurance ratios shall be calculated as the number of
complaints received to total car years earned in the period studied.

(F) Any other information the department deems is appropriate
public information regarding the complaint record of the insurer
that will assist the public in selecting an insurer. However, nothing
in this section shall be construed to permit disclosure of information
or documents in the possession of the department to the extent that
the information and those documents are protected from disclosure
under any other provision of law.

(6) Procedures and average processing times for each step of
complaint mediation, investigation, and enforcement. These
procedures shall be consistent with those in Article 6.5
(commencing with Section 790) of Chapter 1 of Part 2 of Division
1 for complaints within the purview of that article, consistent with
those in Article 7 (commencing with Section 1858) of Chapter 9
of Part 2 of Division 1 for complaints within the purview of that
article, and consistent with any other provisions of law requiring
certain procedures to be followed by the department in
investigating or prosecuting complaints against insurers or
production agencies.

(7) A list of criteria to determine which violations should be
pursued through enforcement action, and enforcement guidelines
that set forth appropriate penalties for violations based on the
nature, severity, and frequency of the violations.

(8) Referral of complaints not within the department’s
jurisdiction to appropriate public and private agencies.

(9) Complaint handling goals that can be tested against surveys
carried out pursuant to subdivision (a) of Section 12921.4.

(10) Inclusion in its annual report to the Governor, required by
Section 12922, detailed information regarding the program required
by this section, that shall include, but not be limited to: a
description of the operation of the complaint handling process,
listing civil, criminal, and administrative actions taken pursuant
to complaints received; the percentage of the department’s
personnel years devoted to the handling and resolution of
complaints; and suggestions for legislation to improve the
complaint handling apparatus and to increase the amount of
enforcement action undertaken by the department pursuant to
complaints if further enforcement is deemed necessary to ensure
proper compliance by insurers or production agencies with the
law.

(b) The commissioner shall promulgate a regulation that sets
forth the criteria that the department shall apply to determine if a
complaint is deemed to be justified prior to the public release of
a complaint against a specifically named insurer or production
agency.

(c) The commissioner shall provide to the insurer or production
agency a description of any complaint against the insurer or
production agency that the commissioner has received and has
deemed to be justified at least 30 days prior to public release of a
report summarizing the information required by this section. This
description shall include all of the following:

(1) The name of the complainant.

(2) The date the complaint was filed.

(3) A succinct description of the facts of the complaint.

(4) A statement of the department’s rationale for determining
that the complaint was justified that applies the department’s
criteria to the facts of the complaint.

(d) An insurer shall provide to the department the name, mailing
address, telephone number, and facsimile number of a person
whom the insurer designates as the recipient of all notices,
correspondence, and other contacts from the department concerning
complaints described in this section. The insurer may change the
designation at any time by providing written notice to the
Consumer Services Division of the department.

begin insert

(e) The commissioner may establish an Internet-accessible
complaints response system to distribute and receive complaint
information as described in subdivisions (a) and (c). Insurers shall
be required to submit and receive complaint information, including,
but not limited to, requested claim files, underwriting files,
correspondence, and other supporting documents, using any system
established by the commissioner pursuant to this subdivision.

end insert begin delete

(e)

end delete

begin insert (f) end insert  For the purposes of this section, notices, correspondence,
and other contacts with the designated person shall be deemed
contact with the insurer.

begin insert

begin insert SEC. 21. end insert   

end insert begin insert

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.

end insert