Section 1373.620 Of Article 5. Standards From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 5.
1373.620
. (a) (1) At least 60 days prior to the plan renewal date,
a health care service plan that does not otherwise issue individual
health care service plan contracts shall issue the notice described
in paragraph (2) to any subscriber enrolled in an individual health
benefit plan contract issued pursuant to Section 1373.6 that is not a
grandfathered health plan.
(2) The notice shall be in at least 12-point type and shall
include all of the following:
(A) Notice that, as of the renewal date, the individual plan
contract will not be renewed.
(B) The availability of individual health coverage through Covered
California, including at least all of the following:
(i) That, beginning on January 1, 2014, individuals seeking
coverage may not be denied coverage based on health status.
(ii) That the premium rates for coverage offered by a health care
service plan or a health insurer cannot be based on an individual's
health status.
(iii) That individuals obtaining coverage through Covered
California may, depending upon income, be eligible for premium
subsidies and cost-sharing subsidies.
(iv) That individuals seeking coverage must obtain this coverage
during an open or special enrollment period, and a description of the
open and special enrollment periods that may apply.
(b) (1) At least 60 days prior to the plan renewal date, a health
care service plan that issues individual health care service plan
contracts shall issue the notice described in paragraph (2) to a
subscriber enrolled in an individual health benefit plan contract
issued pursuant to Section 1366.35 or 1373.6 that is not a
grandfathered health plan.
(2) The notice shall be in at least 12-point type and shall
include all of the following:
(A) Notice that, as of the renewal date, the individual plan
contract will not be renewed.
(B) Information regarding the individual health plan contract that
the health plan will issue as of January 1, 2014, which the health
plan has reasonably concluded is the most comparable to the
individual's current plan. The notice shall include information on
premiums for the possible replacement plan and instructions that the
individual can continue their coverage by paying the premium stated
by the due date.
(C) Notice of the availability of other individual health coverage
through Covered California, including at least all of the following:
(i) That, beginning on January 1, 2014, individuals seeking
coverage may not be denied coverage based on health status.
(ii) That the premium rates for coverage offered by a health care
service plan or a health insurer cannot be based on an individual's
health status.
(iii) That individuals obtaining coverage through Covered
California may, depending upon income, be eligible for premium
subsidies and cost-sharing subsidies.
(iv) That individuals seeking coverage must obtain this coverage
during an open or special enrollment period, and a description of the
open and special enrollment periods that may apply.
(c) No later than September 1, 2013, the department, in
consultation with the Department of Insurance, shall adopt uniform
model notices that health plans shall use to comply with subdivisions
(a) and (b) and Sections 1366.50, 1373.622, and 1399.861. Use of the
model notices shall not require prior approval by the department.
The model notices adopted by the department for purposes of this
section shall not be subject to the Administrative Procedure Act
(Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code). The director may modify the
wording of these model notices specifically for the purposes of
clarity, readability, and accuracy.
(d) The notices required in this section are vital documents,
pursuant to clause (iii) of subparagraph (B) of paragraph (1) of
subdivision (b) of Section 1367.04, and shall be subject to the
applicable requirements of that section.
(e) For purposes of this section, the following definitions shall
apply:
(1) "Covered California" means the California Health Benefit
Exchange established pursuant to Section 100500 of the Government
Code.
(2) "Grandfathered health plan" has the same meaning as that term
is defined in Section 1251 of PPACA.
(3) "PPACA" means the federal Patient Protection and Affordable
Care Act (Public Law 111-148), as amended by the federal Health Care
and Education Reconciliation Act of 2010 (Public Law 111-152), and
any rules, regulations, or guidance issued pursuant to that law.