Section 1352.1 Of Article 3. Licensing And Fees From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 3.
1352.1
. (a) Except as provided in subdivision (b), no plan shall
enter into any new or modified plan contract or publish or
distribute, or allow to be published or distributed on its behalf,
any disclosure form or evidence of coverage, unless (1) a true copy
thereof has first been filed with the director, at least 30 days
prior to any such use, or any shorter period as the director by rule
or order may allow, and (2) the director by notice has not found the
plan contract, disclosure form, or evidence of coverage, wholly or in
part, to be untrue, misleading, deceptive, or otherwise not in
compliance with this chapter or the rules thereunder, and specified
the deficiencies, within at least 30 days or any shorter time as the
director by rule or order may allow.
(b) Except as provided in subdivision (c), a licensed plan which
has been continuously licensed under this chapter for the preceding
18 months and which has had group contracts in effect at all times
during that period may enter a new or modified group contract or may
publish or distribute, or allow to be published or distributed on its
behalf, any group disclosure form or evidence of coverage without
having filed the same for the director's prior approval, if the plan
and the materials comply with each of the following conditions:
(1) The contract, disclosure form, or evidence of coverage, or any
material provision thereof, has not been previously disapproved by
the director by written notice to the plan and the plan reasonably
believes that the contract, disclosure form, and evidence of coverage
do not violate any requirements of this chapter or the rules
thereunder.
(2) The plan files the contract and any related disclosure form
and evidence of coverage with the director not later than 10 business
days after entering the contract, or within any additional period as
the director by rule or order may provide.
(3) If the person or group entering into the contract with the
plan is not an employee welfare benefit plan, as defined in the
Employee Retirement Income Security Act of 1974 (29 U.S.C. Sec. 1001
et seq.), the person or group is not organized solely or principally
for the purpose of providing health benefits to members of the group.
(c) The director by order may require a plan which has entered any
group contract or published or distributed, or allowed to be
published or distributed on its behalf, any disclosure form or
evidence of coverage in violation of this chapter or the rules
thereunder to comply with subdivision (a) prior to entering group
contracts, or a specified class of group contracts, and prior to
publishing or distributing, or allowing to be published or
distributed on its behalf, related disclosure forms and evidences of
coverage. An order issued pursuant to this subdivision shall be
effective for 12 months from its issuance, and may be renewed by
order if the contracts, disclosure forms, or evidences of coverage
submitted under this subdivision indicate difficulties of voluntary
compliance with the applicable provisions of this chapter and the
rules thereunder.
(d) A licensed plan or other person regulated under this chapter
may, within 30 days after receipt of any notice or order under this
section, file a written request for a hearing with the director.