Section 1389.4 Of Article 7.5. Underwriting Practices From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 7.5.
1389.4
. (a) A full service health care service plan that renews
individual grandfathered health benefit plans shall be subject to
this section.
(b) A health care service plan subject to this section shall have
written policies, procedures, or underwriting guidelines establishing
the criteria and process whereby the plan makes its decision to
provide or to deny coverage to dependents applying for an individual
grandfathered health plan and sets the rate for that coverage. These
guidelines, policies, or procedures shall ensure that the plan rating
and underwriting criteria comply with Sections 1365.5 and 1389.1 and
all other applicable provisions of state and federal law.
(c) On or before the June 1 next following the operative date of
this section, and annually thereafter, every health care service plan
shall file with the department a general description of the
criteria, policies, procedures, or guidelines the plan uses for
rating and underwriting decisions related to individual grandfathered
health plans, 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 coverage or severely
limit the plan products for which they would be eligible. A plan may
comply with this section by submitting to the department underwriting
materials or resource guides provided to plan solicitors or
solicitor firms, provided that those materials include the
information required to be submitted by this section.
(d) This section does not authorize public disclosure of company
specific rating and underwriting criteria and practices submitted to
the director.
(e) For purposes of this section, the following definitions shall
apply:
(1) "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.
(2) "Grandfathered health plan" has the same meaning as that term
is defined in Section 1251 of PPACA.
(f) (1) This section shall become operative on November 1, 2013,
or the 91st calendar day following the adjournment of the 2013-14
First Extraordinary Session, whichever date is later.
(2) If Section 5000A of the Internal Revenue Code, as added by
Section 1501 of PPACA, is repealed or amended to no longer apply to
the individual market, as defined in Section 2791 of the federal
Public Health Service Act (42 U.S.C. Sec. 300gg-91), this section
shall become inoperative 12 months after the date of that repeal or
amendment.