This law section states that certain insurance policies do not have to follow the rules in Sections 10130 and 10131. Specifically, it applies to group life and disability policies, and individual disability policies that cover loss of time, are noncancellable, and guaranteed renewable for at least five years. If these policies clearly state that benefits cannot be assigned, then the benefits must be paid as specified in the policy.

This law states that specific rules outlined in Sections 10130 and 10131 are not applicable to certain annuity contracts that fall under the regulations of Section 401(g) of the Internal Revenue Code.

In California, a life or disability insurance policy can be passed on to someone else through a transfer, will, or inheritance, even if that person doesn't have a direct insurable interest in the policy. The new owner of the policy can claim the benefits just as the original insured person could have.

If you sell or give away your life or disability insurance policy, you generally don't need to inform the insurance company for the policy to remain valid. The only exception is if the policy specifically says you have to notify them.

This law explains that if a life insurance policy pays out in regular installments, the policy can include rules that stop the person who gets the money (the beneficiary) from selling or using their future payments as collateral before they actually receive each installment.

This law explains how insurance companies should pay for hospital or medical services covered by a group disability insurance policy. They can pay the providers directly, but only if the insured person agrees and only up to the amount the policy covers. The insurer can't control which doctors or facilities the insured uses but can negotiate alternative payment rates with certain providers. If an insurance company makes agreements with policyholders to pay only specific providers, these contracts must include a program to regularly review service quality and costs. Changes made to this law in 1982 are applicable to both individual practitioners and healthcare institutions from July 1, 1983, onwards.

Insurance companies must supply group policyholders with an up-to-date list of the healthcare providers that have agreed to offer services at reduced rates under their group plan. They also need to ensure this list is accessible to the public during regular hours at their main office in the state.

This section states that when a disability insurance company in California forms agreements with healthcare providers to offer services at different payment rates, the patient's copayment should always be based solely on these negotiated alternative rates.

The insurance companies and providers are not allowed to charge more for copayments than what these rates dictate. This rule has been in effect since January 1, 1993.

If a self-insured government plan makes a deal with doctors or hospitals to provide services at specially negotiated rates, the copayment from the patient must be based on those negotiated rates. The plan or providers cannot charge or collect more than the copayment amount calculated from the negotiated rate.

This rule has been in effect since January 1, 1993.

This law clarifies who can be considered a primary care provider when insurers set up agreements with healthcare providers for alternative rates. It states that primary care can include physician assistants working under a doctor's supervision and nurse practitioners collaborating with doctors, based on specific legal chapters.

It also emphasizes that primary care providers aren't required to take on more patients than they can handle while maintaining high standards of care.

Additionally, this law doesn’t change existing regulations related to nurse practitioners and physician assistants.

This law requires the California Insurance Commissioner to create rules that ensure people can access healthcare services quickly when covered by health insurers that offer alternative rates. These rules focus on having enough healthcare providers and facilities relative to the insured group's size and location, ensuring the fairness of contracts, and maintaining good healthcare standards.

The regulations must consider federal and state laws, rural access, and professional guidelines. Health insurers must report complaints about service delays annually, which the state will review and publish. Additionally, the Department of Insurance must report progress on these regulations to state legislative committees, and the commissioner must review the regulations every three years for updates.

The California Legislature intends to ensure residents receive high-quality, cost-effective health care. To achieve this, they encourage contracts between health care payers and providers. These contracts should include groups of providers and purchasers to improve efficiency. Negotiations for alternative rate contracts are also supported to enhance the marketplace. The statute clarifies that forming these groups is seen as creating a new product in health care and should only face the same antitrust laws as other legitimate businesses. Additionally, current antitrust laws still apply and no one can be excluded from these groups based solely on not having the same license or certification as group members.

This law outlines how disability insurers must handle the reimbursement of group insurance benefits for medical expenses. Insurers are required to reimburse either the service provider or the person who paid for medical aid, provided specific proof of payment and relevant documents are submitted. These documents might include an itemized bill, proof of payment, a court order if the insured doesn't live with the person seeking aid, and other specified information.

For Medi-Cal beneficiaries, insurers must reimburse the State Department of Health Services for covered medical expenses. All payments should equal, but not exceed, the policy's benefit amounts and the expenses incurred.

This law requires health insurers to provide translated materials and language assistance to ensure insured individuals have access to information in their preferred language. The law mandates insurers to assess and update the language needs of their clients every three years, requiring translation of essential documents like applications, consent forms, and eligibility notices based on population size and language preference. Insurers must offer interpreter services, meeting specific qualifications, and cannot force insured individuals to bring their own interpreters, except in emergencies. The law also highlights standards for translation and interpretation services, urging insurers to adhere to federal and state guidelines, and to consider best practices from other states and organizations. The commissioner must report on compliance and can adjust implementation schedules based on costs and service availability. Moreover, the law allows for additional requirements by government contracts if needed.

This law requires health insurers in California to report to the Department of Insurance about their cultural appropriateness policies and procedures within a year after certain assessments. They must provide information on how they collect data about their insured members, educate staff on cultural sensitivity, and promote workforce diversity.

Insurers also need to evaluate their programs through complaint analysis and satisfaction surveys and share information about the ethnic diversity of their insured members with providers. Additionally, they must regularly educate insured members about company services using existing communication channels.

If a health insurance company markets or advertises its policies in a non-English language for individual or small group markets, it must also provide key documents in that language. These documents include welcome letters, insurance applications, notices about translation services, grievance procedures, and a summary of benefits. All translations must be done by trained translators. This requirement does not apply to special health insurance policies that don't include essential health benefits.

This law requires insurers to inform policyholders and the public about certain services and rights. They must provide notice of language assistance services in the top 15 non-English languages in California, as well as assistive aids for individuals with disabilities, available at no cost. Insurers must also confirm they do not discriminate based on race, gender, or other listed characteristics.

The law outlines how to file a complaint with the insurer or report discrimination to federal authorities. Information must be provided upon initial enrollment and yearly, visibly in coverage documents, through newsletters, and on the insurer's website. Specialized insurance policies not covered by federal regulations can request a waiver from these requirements, except for those offering mental health services. The department will provide details of any waivers on its website.

Starting January 1, 2027, or when new federal rules are set, California will require health insurance companies to create and maintain certain digital tools, called Application Programming Interfaces (APIs), which help share information between patients, healthcare providers, and insurance companies. The APIs include tools for patient access, provider access, healthcare provider to insurance company communication, and managing pre-setup conditions for medical treatments (prior authorization). These tools must follow federal standards and timelines. Until then, the insurance commissioner can guide insurers on how to comply, without following standard state procedural rules. These new requirements do not change any existing obligations insurers already have under previous laws.

This law requires health insurers in California to ensure that all staff interacting directly with insured individuals complete training on providing respectful and inclusive health care for transgender, gender diverse, and intersex (TGI) people. This training must cover TGI history, effective communication, understanding health disparities, and include insights from local TGI organizations.

Health insurers must follow the guidelines set by the department, which will also track complaints related to TGI care. If a staff member is found to have failed in providing inclusive care, they must complete a refresher course. Insurers can be penalized for non-compliance, with fines of up to $10,000 for willful violations.

By March 1, 2025, certain health insurers in California must update their provider directories to indicate which in-network providers offer gender-affirming services. This includes a wide range of services like surgeries, hormone therapy, and voice therapy related to gender identity or intersex conditions. This information should be accessible from the provider directory and the insurer’s call center, and it must be updated when providers request changes about their services. The law also reinforces that businesses can't discriminate based on sex or other protected traits while providing services, as per the Unruh Civil Rights Act.

This law, starting from July 1, 2016, mandates health insurers in California to maintain up-to-date online and printed directories of all healthcare providers they contract with. These directories must be easy to access and search on the insurer's website, requiring no personal information from the seeker. Insurers must consistently update these directories, removing providers who retire or no longer accept patients, and incorporate public reporting options for inaccuracies.

Directories must include essential details about each provider, like contact information, specialty, and whether they are accepting new patients. Insurers are also responsible for informing providers to update their information regularly and can delay payments if providers fail to comply. Insurers may have to compensate policyholders if inaccuracies in the directory cause them to inadvertently receive out-of-network services.

This section requires health insurance policies in California to provide information annually about the standards for timely access to care. Policies must inform insured individuals about appointment wait times, access to urgent and non-urgent care, and availability of interpreter services. This information should be readily accessible in multiple formats, including online and in written materials like newsletters. Insurers must communicate these requirements to their contracted healthcare providers, ensuring they know how to assist patients struggling to get timely care and where to direct complaints if needed.

This law mandates health insurers in California to provide timely access to covered health care services. Insurers must ensure their networks have enough providers to offer appointments within specific timeframes depending on the urgency and type of care needed. For instance, urgent care appointments without prior authorization must be available within 48 hours, while nonurgent primary care appointments must be within 10 business days.

The law also requires insurers to provide 24/7 phone-based triage or screening services. Specialized health insurance policies, such as those covering pediatric oral or vision care, must also adhere to specific appointment wait time standards.

Additionally, insurers cannot penalize providers or employees for informing patients about these requirements, and the law allows the Department of Insurance to impose penalties for noncompliance.

This law ensures that disability insurance companies in California, offering group coverage for hospital, medical, and surgical expenses, have a plan to help new enrollees continue their care when switching to new insurance. If a person is in the middle of treatment for an acute or mental health condition with a provider that doesn't contract with the insurer, the insurance company must have a written policy for transitioning care to a network provider.

The policy should allow a reasonable period for treatment to continue with the current non-network provider. However, the insurance company can require this provider to agree to certain terms, like reimbursement rates. The insurer is not responsible for malpractice by non-network providers. The rule doesn’t force coverage beyond the policy’s terms and doesn’t apply if an enrollee chose to switch from an out-of-network option. Additionally, this doesn't apply if the insurance includes out-of-network benefits or if the covered service isn't already included in the policy.

This law ensures that if you’re undergoing medical treatment and your healthcare provider’s contract ends, your insurance must help you complete your care with them for certain conditions. Specifically, if you’re dealing with an acute condition, a serious chronic condition, or have had recommended surgery, the insurer should let you continue treatment with the provider. They should also allow you to finish pregnancy care or care for a newborn up to 36 months, and stay with a provider if you have a terminal illness.

The provider must agree to previous contract terms for continued services, but insurers don't need to cover costs if the provider was terminated for disciplinary reasons. Insurers must inform you about these rights in coverage documents. If your new insurance starts while getting treatment from a non-participating provider, they must arrange for you to complete your care under similar terms.

This law states that any contract between a health insurer and a provider or supplier, issued from January 1, 2015, onwards, cannot stop the insurer from sharing information with consumers and purchasers about the cost and quality of healthcare services. Any contract clauses that try to do this are not valid. Insurers must give providers a 30-day heads-up to review the data used for these disclosures. If insurers share their own data on quality, they should adjust it for various factors that might affect the data. Insurers' websites must clearly state that there can be disagreements about cost and quality data, due to many influencing factors. Providers can respond to the insurer’s information by linking their website, and insurers must ensure this link is easily visible. Terms like 'consumers,' 'providers,' and 'suppliers' have specific meanings as defined in related sections.

This law, known as the Health Care Providers’ Bill of Rights, sets out rules for contracts between health insurers and healthcare providers. Contracts after January 1, 2003, cannot force providers to take more patients than they can handle, impose undisclosed rules for quality or utilization programs, conflict with insurance laws, or breach patient confidentiality.

If a health insurer wants to make significant changes to a contract, they must give providers 45 business days' notice, allowing the provider to end the contract if they disagree.

For dental insurance, insurers must notify dentists 45 days in advance of any substantial changes to contracting rules or payment systems, and provide updated contracts annually upon request. Any contract breaking these rules is void and unenforceable.

The Department of Insurance must report annually on provider complaints, and this section does not determine payment rates between insurers and providers.

This law requires health insurers to adhere to several guidelines when dealing with claims from providers. First, insurers can't require claims to be submitted earlier than 90 days for contracted providers and 180 days for non-contracted ones, except if other laws say otherwise. If a claim is denied due to late submission, but the provider has a good reason, the claim can still be processed.

Insurers can't request reimbursement for overpaid claims unless they notify providers within a year of payment, providing detailed explanations. However, fraud or misrepresentation by the provider can extend this time limit. All claims must be acknowledged within 15 working days, and providers should be able to check acknowledgment status easily.

For transparency, insurers must annually, and upon request, share detailed information on payments and policies with providers. This includes fee schedules and clear explanations of how services are reimbursed, especially for complex cases, while respecting trade secrets and copyrights. Insurers can use websites to disclose this information if they notify providers 45 days before posting changes.

This law allows the insurance commissioner to authorize payment directly to a healthcare provider for services covered by an insured person's health insurance policy when the provider submitted a claim.

This law prevents health insurers from terminating, not renewing, or penalizing healthcare providers based on certain judgments, convictions, or disciplinary actions from other states, if those actions interfere with lawful care in California. Providers can't be discriminated against for involvement with mifepristone or medication abortion lawful in California. The law doesn't cover actions that would be problematic under California law. Enforcement is under the commissioner's authority according to the Government Code.

This law requires the insurance commissioner to take specific actions by July 1, 2006, to help consumers with health insurance issues. The commissioner must announce the department's toll-free phone number for handling complaints and set up a dedicated web page for complaints and inquiries about health insurance. The web page should include the toll-free number, a list of licensed insurers, consumer rights guides, and a complaint form for healthcare providers.

People can file written complaints about how claims or policies are handled, or about misconduct by insurers. The department must acknowledge complaints within 10 business days, make a determination within 60 days, and notify the complainant of the final decision within 30 days of that decision. This notification should summarize the reasons for the decision.