SECTIONS 10199.1-10199.48

10199.1.  (a) No insurer or nonprofit hospital service plan oradministrator acting on its behalf shall terminate a group masterpolicy or contract providing hospital, medical, or surgical benefits,increase premiums or charges therefor, reduce or eliminate benefitsthereunder, or restrict eligibility for coverage thereunder withoutproviding prior notice of that action. No such action shall becomeeffective unless written notice of the action was delivered by mailto the last known address of the appropriate insurance producer andthe appropriate administrator, if any, at least 45 days prior to theeffective date of the action and to the last known address of thegroup policyholder or group contractholder at least 60 days prior tothe effective date of the action. If nonemployee certificate holdersor employees of more than one employer are covered under the policyor contract, written notice shall also be delivered by mail to thelast known address of each nonemployee certificate holder or affectedemployer or, if the action does not affect all employees anddependents of one or more employers, to the last known address ofeach affected employee certificate holder, at least 60 days prior tothe effective date of the action. (b) No holder of a master group policy or a master group nonprofithospital service plan contract or administrator acting on its behalfshall terminate the coverage of, increase premiums or charges for,or reduce or eliminate benefits available to, or restrict eligibilityfor coverage of a covered person, employer unit, or class ofcertificate holders covered under the policy or contract forhospital, medical, or surgical benefits without first providing priornotice of the action. No such action shall become effective unlesswritten notice was delivered by mail to the last known address ofeach affected nonemployee certificate holder or employer, or if theaction does not affect all employees and dependents of one or moreemployers, to the last known address of each affected employeecertificate holder, at least 60 days prior to the effective date ofthe action. (c) A health insurer that declines to offer coverage to or deniesenrollment for a large group applying for coverage or that offerssmall group coverage at a rate that is higher than the standardemployee risk rate shall, at the time of the denial or offer ofcoverage, provide the applicant with the specific reason or reasonsfor the decision in writing, in clear, easily understandablelanguage.10199.2.  (a)  The written notice described in subdivisions (a) and(b) of Section 10199.1 shall state in italics and in 12-point typethe actual dollar amount and the specific percentage of the premiumrate increase. Further, the notice shall describe in plainunderstandable English and highlighted in italics any changes in theplan design or change in benefits with reduction in benefits,waivers, exclusions, or conditions. (b) The written notice shall specify in a minimum of 10-point boldtypeface the reason or reasons for premium rate changes, plandesign, or plan benefit changes.10199.3.  There shall be no liability on the part of, and no causeof action of any nature shall arise against, any entity required toprovide the notice or its authorized representatives, or agents, forany statement made, unless shown to have been made with malice infact, by any of them in (a) any written notice or in any other oralor written communication specifying the reasons for the notice, (b)any communication providing information pertaining to such notice, or(c) evidence submitted at any court proceeding or informal inquiryin which such notice is at issue.10199.4.  Proof of mailing a notice and the reason therefor to theappropriate entity or individual at the last known mailing addressshall be sufficient proof of the notice required by this chapter.10199.44.  (a) On or after January 1, 1994, every insurer issuing,amending, or renewing group disability insurance which covershospital, medical, or surgical expenses shall notify the grouppolicyholders in writing of the cancellation of the group policy andshall include in their contract with group policyholders, regardlessof the situs of that contract, a provision requiring the grouppolicyholder to mail promptly to each person covered under the grouppolicy a legible, true copy of any notice of cancellation of thepolicy which may be received from the insurer and to provide promptlyto the insurer proof of that mailing and the date thereof. (b) The notice of cancellation required by subdivision (a) shallinclude information regarding the conversion rights of personscovered under the group policy upon termination of the group policy.This information shall be in clear and easily understandablelanguage.10199.46.  (a) On or after January 1, 1994, every nonprofit hospitalservice plan issued, amended, or renewed that covers hospital,medical, or surgical expenses on a group basis shall notify the groupcontractholders in writing of the cancellation of the plan contractand shall include in their contract with group contractholders aprovision requiring the group contractholder to mail promptly to eachsubscriber a legible, true copy of any notice of cancellation of theplan contract which may be received from the plan and to providepromptly to the plan proof of that mailing and the date thereof. (b) The notice of cancellation required by subdivision (a) shallinclude information regarding the conversion rights of personscovered under the plan contract upon termination of the plancontract. This information shall be in clear and easilyunderstandable language.10199.48.  (a) No health insurer shall, with regard to a groupcontract, change the premium rates or applicable copayments orcoinsurances or deductibles for the length of the contract, except asspecified in subdivision (b), during any of the following timeperiods: (1) After the group policyholder or group contractholder hasdelivered written notice of acceptance of the contract or policy. (2) After the start of the employer's annual open enrollmentperiod. (3) After the receipt of payment of the premium for the firstmonth of coverage in accordance with the contract or policy effectivedate. (b) Changes to the premium rates or applicable copayments orcoinsurances or deductibles of a contract or policy shall, subject tothe insurer meeting the requirements of this chapter, be allowed inany of the following circumstances: (1) When authorized or required in the group contract or policy. (2) When the contract or policy was agreed to under a preliminaryagreement that states that it is subject to execution of a definitiveagreement. (3) When the insurer and the policyholder or contractholdermutually agree in writing.