Section § 1759

Explanation

This section defines who qualifies as an 'administrator' related to life or health insurance coverage in California. An 'administrator' is someone who collects charges or settles claims for insurance, except for specific exceptions. The list of exceptions includes employers, unions, licensed insurance companies and agents, creditors, certain trusts, banks, credit card companies, attorneys, licensed adjusters, nonprofit agricultural associations, and certain regulated entities under the Health and Safety Code. These exceptions are not considered administrators for the purpose of this law.

For purposes of this chapter, “administrator” means any person who collects any charge or premium from, or who adjusts or settles claims on, residents of this state in connection with life or health insurance coverage or annuities or coverage described in Section 740 other than any of the following:
(a)CA Insurance Code § 1759(a) An employer on behalf of its employees or the employees of one or more subsidiary or affiliated corporations of that employer.
(b)CA Insurance Code § 1759(b) A union on behalf of its members.
(c)CA Insurance Code § 1759(c) An insurance company which is either licensed in this state or acting as an insurer with respect to a policy lawfully issued and delivered by it in and pursuant to the laws of a state in which the insurer was authorized to do an insurance business or prepaid hospital or health care service plan (including their sales representatives licensed in this state when engaged in the performance of their duties).
(d)CA Insurance Code § 1759(d) A life or health agent or broker licensed in this state, whose activities are limited exclusively to the sale of insurance.
(e)CA Insurance Code § 1759(e) A creditor on behalf of its debtors with respect to insurance covering a debt between the creditor and its debtors.
(f)CA Insurance Code § 1759(f) A trust, its trustees, agents, and employees acting thereunder, established in conformity with 29 U.S.C. Sec. 186.
(g)CA Insurance Code § 1759(g) A trust exempt from taxation under Section 501(a) of the Internal Revenue Code, its trustees, and employees acting thereunder, or a custodian, its agents and employees acting pursuant to a custodian account which meets the requirements of Section 401(f) of the Internal Revenue Code.
(h)CA Insurance Code § 1759(h) A bank, credit union or other financial institution which is subject to supervision or examination by federal or state regulatory authorities.
(i)CA Insurance Code § 1759(i) A company which advances for and collects any premium or charge from its credit card holders who have authorized it to do so, provided the company does not adjust or settle claims.
(j)CA Insurance Code § 1759(j) A person who adjusts or settles claims in the normal course of his or her practice or employment as an attorney at law, and who does not collect any charge or premium in connection with life or health insurance coverage or annuities.
(k)CA Insurance Code § 1759(k) An adjuster licensed by the Insurance Commissioner when engaged in the performance of his or her duties.
(l)CA Insurance Code § 1759(l) A nonprofit agricultural association.
(m)CA Insurance Code § 1759(m) Any person or entity subject to regulation under Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code.

Section § 1759.1

Explanation

This law states that administrators must have a written agreement with insurers before they can act in their role. This agreement should be kept as an official record by both the insurer and the administrator for the length of the agreement, plus five more years. The agreement must include specific requirements outlined in related sections, unless they're not relevant to the administrator's tasks.

If a policy is issued to a trustee, the administrator must provide the insurer with a copy of the trust agreement, including any changes. This documentation should also be kept on file by both parties for the policy's duration and for an additional five years.

No administrator shall act as such without a written agreement between the administrator and the insurer, and such written agreement shall be retained as part of the official records of both the insurer and the administrator for the duration of the agreement and five years thereafter. Such written agreement shall contain provisions which include the requirements of Sections 1759.2 to 1759.8, inclusive, except insofar as those requirements do not apply to the functions performed by the administrator.
Where a policy is issued to a trustee or trustees, a copy of the trust agreement and any amendments thereto shall be furnished to the insurer by the administrator and shall be retained as part of the official records of both the insurer and the administrator for the duration of the policy and five years thereafter.

Section § 1759.2

Explanation

This law explains how payments work when an insurance company hires an administrator to manage its policies. If you pay your insurance premium through an administrator, it counts as paid directly to the insurance company. However, when the insurance company sends money back for things like refunds or claims, it's not considered paid to you until you actually receive it. Also, if the administrator doesn't pass on payments properly, the insurance company can still take action against them.

Whenever an insurer utilizes the services of an administrator under the terms of a written contract as required in Section 1759.1, the payment to the administrator of any premiums or charges for insurance by or on behalf of the insured shall be deemed to have been received by the insurer, and the payment of return premiums or claims by the insurer to the administrator shall not be deemed payment to the insured or claimant until such payments are received by the insured or claimant. Nothing herein shall limit any right of the insurer against the administrator resulting from its failure to make payments to the insurer, insureds or claimants.

Section § 1759.3

Explanation

This law requires insurance administrators to maintain thorough and accurate records of all transactions with insurers and insured parties. These records must be kept for the duration of any agreements and for five years after, and must meet standard insurance recordkeeping practices.

Insurers have the right to access these records to fulfill their obligations, while the commissioner can access them for audits or inspections. The information in the records is confidential but can be used in proceedings against an administrator if necessary.

The commissioner can also set rules about how these records should be kept. If an administrator fails to maintain the required records, they risk losing their registration certificate after due process.

(a)CA Insurance Code § 1759.3(a) Every administrator shall maintain at its principal administrative office for the duration of the written agreement referred to in Section 1759.1 and five years thereafter adequate books and records of all transactions between it, and insurers and insured persons. The books and records shall be maintained in accordance with prudent standards of insurance recordkeeping. The insurer shall retain the right to continuing access to the books and records of the administrator sufficient to permit the insurer to fulfill all of its contractual obligations to insured persons, subject to any restrictions in the written agreement between the insurer and administrator on the proprietary rights of the parties in the books and records.
(b)CA Insurance Code § 1759.3(b) The commissioner shall have access to the books and records for the purpose of examination, audit, and inspection. Any information contained in the books and records, including, but not limited to, the identity and addresses of policyholders and certificateholders, shall be confidential, except the commissioner may use the information in any proceedings instituted against the administrator.
(c)CA Insurance Code § 1759.3(c) The commissioner may, after notice and hearing, promulgate reasonable rules and regulations specifying the manner and type of records to be maintained by administrators.
(d)CA Insurance Code § 1759.3(d) Every administrator shall keep and maintain the books and records required by this section and the regulations promulgated pursuant to this section. Failure to keep or maintain the books and records as required shall be grounds for the suspension or revocation of the certificate of registration of the administrator. The proceeding 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.

Section § 1759.4

Explanation

In California, if you manage or run insurance programs, you can only use advertisements that the insurance company has looked at and approved before you use them. This means any ad you want to release must first be checked and accepted by the insurer who underwrites the business.

An administrator may use only such advertising pertaining to the business underwritten by an insurer as has been approved by such insurer in advance of its use.

Section § 1759.5

Explanation

This law section says that an agreement must include details about the guidelines or standards used by an insurance company for accepting or refusing insurance business.

The agreement shall make provision with respect to the underwriting or other standards pertaining to the business underwritten by such insurer.

Section § 1759.6

Explanation

When insurance premiums and charges are collected by an administrator (a person or company handling insurance tasks), they must be kept safe in a fiduciary (trust-based) manner. These funds should be sent immediately to the rightful owner or deposited in a special bank account set up by the administrator. If the funds are for multiple insurers, the administrator must keep detailed records for each insurer's money.

The administrator needs to maintain copies of these records and provide them to insurers if requested. The money in this fiduciary account cannot be used to pay claims. Instead, withdrawals must follow a written agreement with the insurer and can include remitting money to the insurer, depositing it for the insurer, transferring it to a claims-paying account, or paying the administrator's own fees. Return premiums (refunds) should also be given back to the rightful parties.

All insurance charges or premiums collected by an administrator on behalf of or for an insurer or insurers, and return premiums received from such insurer or insurers, shall be held by the administrator in a fiduciary capacity. Such funds shall be immediately remitted to the person or persons entitled thereto, or shall be deposited promptly in a fiduciary bank account established and maintained by the administrator. If charges or premiums so deposited have been collected on behalf of or for more than one insurer, the administrator shall keep records clearly recording the deposits in and withdrawals from such account on behalf of or for each insurer. The administrator shall keep copies of all such records and, upon request of an insurer, shall furnish such insurer with copies of such records pertaining to deposits and withdrawals on behalf of or for such insurer. The administrator shall not pay any claim on behalf of or for such insurer by withdrawals from such fiduciary account. Withdrawals from such account shall be made, as provided in the written agreement between the administrator and the insurer, for (1) remittance to an insurer entitled thereto; (2) deposit in an account maintained in the name of such insurer; (3) transfer to and deposit in a claims paying account, with claims on behalf of or for such insurer to be paid as provided in Section 1759. 7; (4) payment to a group policyholder for remittance to the insurer entitled thereto; (5) payment to the administrator of its commission, fees or charges; or (6) remittance of return premiums to the person or persons entitled thereto.

Section § 1759.7

Explanation

Under this law, any claims that are paid out by an administrator from the money collected for an insurer must be done so through checks or drafts that are approved by the insurer. Alternatively, with the insured person's permission, the payment can be made via electronic funds transfer authorized by the insurer.

All claims paid by the administrator from funds collected on behalf of the insurer shall be paid only on checks or drafts of, or, with the consent of the insured, by an electronic funds transfer from, and as authorized by the insurer.

Section § 1759.8

Explanation

This law states that when an administrator is responsible for adjusting or settling claims on insurance policies, their pay cannot be influenced by how the claims turn out. In simpler terms, they shouldn't be paid more or less depending on the claim results.

With respect to any policies where an administrator adjusts or settles claims, the compensation to the administrator with regard to such policies shall in no way be contingent on claim experience.

Section § 1759.9

Explanation

If an administrator is handling your insurance, they must give you a notice, approved by the insurance company, explaining who they are and how they are connected to the insurance company and policyholder. When the administrator collects money, they must clearly separate and specify in writing any insurance charges or premiums.

Where the services of an administrator are utilized, the administrator shall provide a written notice approved by the insurer, to insured individuals, advising them of the identity of and relationship among the administrator, the policyholder and the insurer. Where an administrator collects funds, it must identify and state separately in writing to the person paying to the administrator any charge or premium for insurance coverage the amount of any such charge or premium specified by the insurer for such insurance coverage.

Section § 1759.10

Explanation

If you want to work as an insurance administrator in this state and you're not already a licensed adjuster, you need a registration certificate from the commissioner. This certificate must meet specific rules and fees similar to those for life insurance agents, but with some exceptions. Additionally, all administrators need to follow certain requirements in Section 1724.5.

A person shall not act as, or hold himself or herself out to be, an administrator in this state, other than an adjuster licensed in this state for the kinds of business for which he or she is acting as an administrator, unless he or she holds a certificate of registration as an administrator issued by the commissioner. The certificate shall be issued, renewed, and held in accordance with, and subject to, all the provisions applicable to a life agent contained in Article 6 (commencing with Section 1666), excluding Section 1672, Article 10 (commencing with Section 1708), Article 11 (commencing with Section 1716), and Article 13 (commencing with Section 1737), excluding Section 1741, of, and subject to the fees applicable to resident life agents as set forth in Article 14 (commencing with Section 1750) of, Chapter 5. Every administrator shall also comply with Section 1724.5.