BILL NUMBER: AB 2345	INTRODUCED
	BILL TEXT


INTRODUCED BY   Assembly Member De La Torre

                        FEBRUARY 19, 2010

   An act to amend Section 10113.95 of the Insurance Code, relating
to health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 2345, as introduced, De La Torre. Individual health care
coverage: health insurers.
   Existing law provides for the regulation of health insurers by the
Department of Insurance and requires a health insurer to have
written policies, procedures, and underwriting guidelines
establishing the criteria and process whereby the insurer makes its
decision to provide or to deny coverage to individuals who apply for
coverage and sets the rate for that coverage. Existing law requires
an insurer to annually file with the commissioner a general
description of the criteria, policies, procedures, or guidelines that
the insurer uses for rating and underwriting decisions related to
individual health insurance policies, as specified, and requires the
commissioner to make specified information available on its Internet
Web site regarding rating, underwriting criteria, and practices in
the individual market.
   This bill would make technical, nonsubstantive changes to those
provisions.
   Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.


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

  SECTION 1.  Section 10113.95 of the Insurance Code is amended to
read:
   10113.95.  (a) A health insurer that issues, renews, or amends
individual health insurance policies shall be subject to this
section.
   (b) An insurer subject to this section shall have written
policies, procedures, or underwriting guidelines establishing the
criteria and process whereby the insurer makes its decision to
provide or to deny coverage to individuals applying for coverage and
sets the rate for that coverage. These guidelines, policies, or
procedures shall assure that the plan rating and underwriting
criteria comply with Sections 10140 and 10291.5 and all other
applicable provisions.
   (c) On or before June 1, 2006, and annually thereafter, every
insurer shall file with the commissioner a general description of the
criteria, policies, procedures, or guidelines that the insurer uses
for rating and underwriting decisions related to individual health
insurance policies, which means automatic declinable health
conditions, health conditions that may lead to a coverage decline,
height and weight standards, health history, health care utilization,
lifestyle, or behavior that might result in a decline  for
  of  coverage or severely limit the health
insurance products for which  they   an
individual  would be eligible. An insurer may comply with this
section by submitting to the department underwriting materials or
resource guides provided to agents and brokers, provided that those
materials include the information required to be submitted by this
section.
   (d) Commencing September 1, 2006, the commissioner shall post on
the department's  Internet  Web site, in a manner accessible
and understandable to consumers, general, noncompany specific
information about rating and underwriting criteria and practices in
the individual market and information about the  California 
Major Risk Medical Insurance Program. The commissioner shall develop
the information for the  Internet  Web site in consultation
with the Department of Managed Health Care to enhance the
consistency of information provided to consumers. Information about
individual health insurance shall also include the following
notification:
   "Please examine your options carefully before declining group
coverage or continuation coverage, such as COBRA, that may be
available to you. You should be aware that companies selling
individual health insurance typically require a review of your
medical history that could result in a higher premium or you could be
denied coverage entirely."
   (e) Nothing in this section shall authorize public disclosure of
company-specific rating and underwriting criteria and practices
submitted to the commissioner.
   (f) This section shall not apply to a closed block of business, as
defined in Section 10176.10.