BILL NUMBER: SB 1091	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 19, 2016
	AMENDED IN SENATE  APRIL 4, 2016

INTRODUCED BY   Senator Liu

                        FEBRUARY 17, 2016

   An act to add Sections 10231.3, 10233.8, and 10235.9a to the
Insurance Code, relating to insurance.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1091, as amended, Liu. Long-term care insurance.
   Under existing law, the Department of Insurance, headed by the
Insurance Commissioner, licenses and regulates insurers. Existing law
divides insurance into various classes, including long-term care
insurance, which includes an insurance policy, certificate, or rider
advertised, marketed, offered, solicited, or designed to provide
coverage for diagnostic,  preventative,  
preventive,  therapeutic, rehabilitative, maintenance, or
personal care services that are provided in a setting other than an
acute care unit of a hospital. Existing law defines "policy" for
these purposes.
    This bill would, among other things, define "alternate plan of
care" as a  plan of care authorized by a provision in a 
policy, rider, endorsement, or amendment  containing a
provision  that allows benefits for long-term care services
that are not specifically defined as a covered service under the
policy. The bill would prohibit an insurer from designating,
advertising, marketing, offering, or soliciting a policy as
"family-friendly," "catastrophic,"  "deferred," 
"short-term," or "standardized," unless the respective policy
contains specified provisions.
    Existing law requires an insurer to report annually by June 30 to
the department the total number of claims denied by each class of
business in the state, as specified, and to provide a policyholder or
certificate holder whose claim is denied written notice of the
reasons for denial, as specified. Existing law requires the
department to provide that information to the public upon request.
   This bill would require an insurer to report information to the
department regarding denial of requests for treatment under an
alternate plan of care, and to provide a policyholder or certificate
holder written notice of denial of a request for treatment under an
alternate plan of care. The bill would require the department to
provide that information to the public upon request.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  The Legislature finds and declares both of the
following:
   (a) Long-term care insurance is a vital lifeline for many of
California's aging population.
   (b) Ensuring that the insurance available to consumers is fair and
accessible is essential to our aging community's quality of life.
  SEC. 2.  It is the intent of the Legislature to ensure that
insurance products provide appropriate benefits that fit consumers'
needs.
  SEC. 3.  Section 10231.3 is added to the Insurance Code, to read:
   10231.3.  An "alternate plan of care" means  a plan of care
authorized by a provision in  a policy, rider, endorsement, or
amendment  containing a provision  that allows
benefits for long-term care services that are not specifically
defined as a covered service under the policy.
  SEC. 4.  Section 10233.8 is added to the Insurance Code, to read:
   10233.8.  (a) An insurer shall not designate, advertise, market,
offer, or solicit a policy as "family-friendly" unless the policy
provides both of the following:
   (1) A coordination benefit as described in paragraph (1) of
subdivision (b) of Section 22005.1 of the Welfare and Institutions
Code.
   (2) One or both of the following benefits:
   (A) Permits family members to provide the care covered under the
policy and provides caregiver training.
   (B) Provides one or both of the following benefits:
   (i) Credit for unused benefits granted to another insured in the
same family.
   (ii) An annuity or death benefit assignable to the caregiver or
that covers legal services related to the care of a person, including
the preparation of a power of attorney, a health care power of
attorney or advance directive, or legal representation in a
conservatorship proceeding involving the person.
   (b) An insurer shall not designate, advertise, market, offer, or
solicit a policy as a "catastrophic policy" unless the insured
retains substantial risk before the insured becomes eligible to
receive benefits. 
   (c) An insurer shall not designate, advertise, market, offer, or
solicit a policy as a "deferred policy" unless the policy provides
coverage only after the insured reaches an age specified in the
policy.  
   (d) 
    (c)  An insurer shall not designate, advertise, market,
offer, or solicit a policy as a "short-term policy" unless the policy
provides benefits designed to last for a time period of less than
one year. 
   (e) 
    (d)  An insurer shall not designate, advertise, market,
offer, or solicit a policy as a "standardized policy" unless the
policy meets standardized benefit levels and other criteria as
determined by the commissioner.
  SEC. 5.  Section 10235.9a is added to the Insurance Code,
immediately following Section 10235.9, to read:
   10235.9a.  (a) An insurer shall provide a policyholder or
certificate holder, whose request for treatment under an alternate
plan of care has been denied, a written notice within 40 days of the
date of the denial, including the reasons for the denial and all
information directly related to the denial.
   (b) An insurer shall report to the department by June 30 of each
year, together with the information required pursuant to Section
10235.9, the number of requests from insureds for treatment to be
provided under an alternate plan of care, any reason used by the
insurer to deny those requests, and the number of requests denied for
each of those reasons.
   (c) The department shall make available to the public, upon
request, the information obtained pursuant to subdivision (b).