10199.1. (a) No insurer or nonprofit hospital service plan or
administrator acting on its behalf shall terminate a group master
policy or contract providing hospital, medical, or surgical benefits,
increase premiums or charges therefor, reduce or eliminate benefits
thereunder, or restrict eligibility for coverage thereunder without
providing prior notice of that action. No such action shall become
effective unless written notice of the action was delivered by mail
to the last known address of the appropriate insurance producer and
the appropriate administrator, if any, at least 45 days prior to the
effective date of the action and to the last known address of the
group policyholder or group contractholder at least 60 days prior to
the effective date of the action. If nonemployee certificate holders
or employees of more than one employer are covered under the policy
or contract, written notice shall also be delivered by mail to the
last known address of each nonemployee certificate holder or affected
employer or, if the action does not affect all employees and
dependents of one or more employers, to the last known address of
each affected employee certificate holder, at least 60 days prior to
the effective date of the action.
(b) No holder of a master group policy or a master group nonprofit
hospital service plan contract or administrator acting on its behalf
shall terminate the coverage of, increase premiums or charges for,
or reduce or eliminate benefits available to, or restrict eligibility
for coverage of a covered person, employer unit, or class of
certificate holders covered under the policy or contract for
hospital, medical, or surgical benefits without first providing prior
notice of the action. No such action shall become effective unless
written notice was delivered by mail to the last known address of
each affected nonemployee certificate holder or employer, or if the
action does not affect all employees and dependents of one or more
employers, to the last known address of each affected employee
certificate holder, at least 60 days prior to the effective date of
the action.
(c) A health insurer that declines to offer coverage to or denies
enrollment for a large group applying for coverage or that offers
small group coverage at a rate that is higher than the standard
employee risk rate shall, at the time of the denial or offer of
coverage, provide the applicant with the specific reason or reasons
for the decision in writing, in clear, easily understandable
language.
10199.2. (a) The written notice described in subdivisions (a) and
(b) of Section 10199.1 shall state in italics and in 12-point type
the actual dollar amount and the specific percentage of the premium
rate increase. Further, the notice shall describe in plain
understandable English and highlighted in italics any changes in the
plan 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 bold
typeface the reason or reasons for premium rate changes, plan
design, or plan benefit changes.
10199.3. There shall be no liability on the part of, and no cause
of action of any nature shall arise against, any entity required to
provide the notice or its authorized representatives, or agents, for
any statement made, unless shown to have been made with malice in
fact, by any of them in (a) any written notice or in any other oral
or 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 inquiry
in which such notice is at issue.
10199.4. Proof of mailing a notice and the reason therefor to the
appropriate entity or individual at the last known mailing address
shall 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 covers
hospital, medical, or surgical expenses shall notify the group
policyholders in writing of the cancellation of the group policy and
shall include in their contract with group policyholders, regardless
of the situs of that contract, a provision requiring the group
policyholder to mail promptly to each person covered under the group
policy a legible, true copy of any notice of cancellation of the
policy which may be received from the insurer and to provide promptly
to the insurer proof of that mailing and the date thereof.
(b) The notice of cancellation required by subdivision (a) shall
include information regarding the conversion rights of persons
covered under the group policy upon termination of the group policy.
This information shall be in clear and easily understandable
language.
10199.46. (a) On or after January 1, 1994, every nonprofit hospital
service plan issued, amended, or renewed that covers hospital,
medical, or surgical expenses on a group basis shall notify the group
contractholders in writing of the cancellation of the plan contract
and shall include in their contract with group contractholders a
provision requiring the group contractholder to mail promptly to each
subscriber a legible, true copy of any notice of cancellation of the
plan contract which may be received from the plan and to provide
promptly to the plan proof of that mailing and the date thereof.
(b) The notice of cancellation required by subdivision (a) shall
include information regarding the conversion rights of persons
covered under the plan contract upon termination of the plan
contract. This information shall be in clear and easily
understandable language.
10199.48. (a) No health insurer shall, with regard to a group
contract, change the premium rates or applicable copayments or
coinsurances or deductibles for the length of the contract, except as
specified in subdivision (b), during any of the following time
periods:
(1) After the group policyholder or group contractholder has
delivered written notice of acceptance of the contract or policy.
(2) After the start of the employer's annual open enrollment
period.
(3) After the receipt of payment of the premium for the first
month of coverage in accordance with the contract or policy effective
date.
(b) Changes to the premium rates or applicable copayments or
coinsurances or deductibles of a contract or policy shall, subject to
the insurer meeting the requirements of this chapter, be allowed in
any 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 preliminary
agreement that states that it is subject to execution of a definitive
agreement.
(3) When the insurer and the policyholder or contractholder
mutually agree in writing.
10199.1. (a) No insurer or nonprofit hospital service plan or
administrator acting on its behalf shall terminate a group master
policy or contract providing hospital, medical, or surgical benefits,
increase premiums or charges therefor, reduce or eliminate benefits
thereunder, or restrict eligibility for coverage thereunder without
providing prior notice of that action. No such action shall become
effective unless written notice of the action was delivered by mail
to the last known address of the appropriate insurance producer and
the appropriate administrator, if any, at least 45 days prior to the
effective date of the action and to the last known address of the
group policyholder or group contractholder at least 60 days prior to
the effective date of the action. If nonemployee certificate holders
or employees of more than one employer are covered under the policy
or contract, written notice shall also be delivered by mail to the
last known address of each nonemployee certificate holder or affected
employer or, if the action does not affect all employees and
dependents of one or more employers, to the last known address of
each affected employee certificate holder, at least 60 days prior to
the effective date of the action.
(b) No holder of a master group policy or a master group nonprofit
hospital service plan contract or administrator acting on its behalf
shall terminate the coverage of, increase premiums or charges for,
or reduce or eliminate benefits available to, or restrict eligibility
for coverage of a covered person, employer unit, or class of
certificate holders covered under the policy or contract for
hospital, medical, or surgical benefits without first providing prior
notice of the action. No such action shall become effective unless
written notice was delivered by mail to the last known address of
each affected nonemployee certificate holder or employer, or if the
action does not affect all employees and dependents of one or more
employers, to the last known address of each affected employee
certificate holder, at least 60 days prior to the effective date of
the action.
(c) A health insurer that declines to offer coverage to or denies
enrollment for a large group applying for coverage or that offers
small group coverage at a rate that is higher than the standard
employee risk rate shall, at the time of the denial or offer of
coverage, provide the applicant with the specific reason or reasons
for the decision in writing, in clear, easily understandable
language.
10199.2. (a) The written notice described in subdivisions (a) and
(b) of Section 10199.1 shall state in italics and in 12-point type
the actual dollar amount and the specific percentage of the premium
rate increase. Further, the notice shall describe in plain
understandable English and highlighted in italics any changes in the
plan 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 bold
typeface the reason or reasons for premium rate changes, plan
design, or plan benefit changes.
10199.3. There shall be no liability on the part of, and no cause
of action of any nature shall arise against, any entity required to
provide the notice or its authorized representatives, or agents, for
any statement made, unless shown to have been made with malice in
fact, by any of them in (a) any written notice or in any other oral
or 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 inquiry
in which such notice is at issue.
10199.4. Proof of mailing a notice and the reason therefor to the
appropriate entity or individual at the last known mailing address
shall 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 covers
hospital, medical, or surgical expenses shall notify the group
policyholders in writing of the cancellation of the group policy and
shall include in their contract with group policyholders, regardless
of the situs of that contract, a provision requiring the group
policyholder to mail promptly to each person covered under the group
policy a legible, true copy of any notice of cancellation of the
policy which may be received from the insurer and to provide promptly
to the insurer proof of that mailing and the date thereof.
(b) The notice of cancellation required by subdivision (a) shall
include information regarding the conversion rights of persons
covered under the group policy upon termination of the group policy.
This information shall be in clear and easily understandable
language.
10199.46. (a) On or after January 1, 1994, every nonprofit hospital
service plan issued, amended, or renewed that covers hospital,
medical, or surgical expenses on a group basis shall notify the group
contractholders in writing of the cancellation of the plan contract
and shall include in their contract with group contractholders a
provision requiring the group contractholder to mail promptly to each
subscriber a legible, true copy of any notice of cancellation of the
plan contract which may be received from the plan and to provide
promptly to the plan proof of that mailing and the date thereof.
(b) The notice of cancellation required by subdivision (a) shall
include information regarding the conversion rights of persons
covered under the plan contract upon termination of the plan
contract. This information shall be in clear and easily
understandable language.
10199.48. (a) No health insurer shall, with regard to a group
contract, change the premium rates or applicable copayments or
coinsurances or deductibles for the length of the contract, except as
specified in subdivision (b), during any of the following time
periods:
(1) After the group policyholder or group contractholder has
delivered written notice of acceptance of the contract or policy.
(2) After the start of the employer's annual open enrollment
period.
(3) After the receipt of payment of the premium for the first
month of coverage in accordance with the contract or policy effective
date.
(b) Changes to the premium rates or applicable copayments or
coinsurances or deductibles of a contract or policy shall, subject to
the insurer meeting the requirements of this chapter, be allowed in
any 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 preliminary
agreement that states that it is subject to execution of a definitive
agreement.
(3) When the insurer and the policyholder or contractholder
mutually agree in writing.
10199.1. (a) No insurer or nonprofit hospital service plan or
administrator acting on its behalf shall terminate a group master
policy or contract providing hospital, medical, or surgical benefits,
increase premiums or charges therefor, reduce or eliminate benefits
thereunder, or restrict eligibility for coverage thereunder without
providing prior notice of that action. No such action shall become
effective unless written notice of the action was delivered by mail
to the last known address of the appropriate insurance producer and
the appropriate administrator, if any, at least 45 days prior to the
effective date of the action and to the last known address of the
group policyholder or group contractholder at least 60 days prior to
the effective date of the action. If nonemployee certificate holders
or employees of more than one employer are covered under the policy
or contract, written notice shall also be delivered by mail to the
last known address of each nonemployee certificate holder or affected
employer or, if the action does not affect all employees and
dependents of one or more employers, to the last known address of
each affected employee certificate holder, at least 60 days prior to
the effective date of the action.
(b) No holder of a master group policy or a master group nonprofit
hospital service plan contract or administrator acting on its behalf
shall terminate the coverage of, increase premiums or charges for,
or reduce or eliminate benefits available to, or restrict eligibility
for coverage of a covered person, employer unit, or class of
certificate holders covered under the policy or contract for
hospital, medical, or surgical benefits without first providing prior
notice of the action. No such action shall become effective unless
written notice was delivered by mail to the last known address of
each affected nonemployee certificate holder or employer, or if the
action does not affect all employees and dependents of one or more
employers, to the last known address of each affected employee
certificate holder, at least 60 days prior to the effective date of
the action.
(c) A health insurer that declines to offer coverage to or denies
enrollment for a large group applying for coverage or that offers
small group coverage at a rate that is higher than the standard
employee risk rate shall, at the time of the denial or offer of
coverage, provide the applicant with the specific reason or reasons
for the decision in writing, in clear, easily understandable
language.
10199.2. (a) The written notice described in subdivisions (a) and
(b) of Section 10199.1 shall state in italics and in 12-point type
the actual dollar amount and the specific percentage of the premium
rate increase. Further, the notice shall describe in plain
understandable English and highlighted in italics any changes in the
plan 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 bold
typeface the reason or reasons for premium rate changes, plan
design, or plan benefit changes.
10199.3. There shall be no liability on the part of, and no cause
of action of any nature shall arise against, any entity required to
provide the notice or its authorized representatives, or agents, for
any statement made, unless shown to have been made with malice in
fact, by any of them in (a) any written notice or in any other oral
or 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 inquiry
in which such notice is at issue.
10199.4. Proof of mailing a notice and the reason therefor to the
appropriate entity or individual at the last known mailing address
shall 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 covers
hospital, medical, or surgical expenses shall notify the group
policyholders in writing of the cancellation of the group policy and
shall include in their contract with group policyholders, regardless
of the situs of that contract, a provision requiring the group
policyholder to mail promptly to each person covered under the group
policy a legible, true copy of any notice of cancellation of the
policy which may be received from the insurer and to provide promptly
to the insurer proof of that mailing and the date thereof.
(b) The notice of cancellation required by subdivision (a) shall
include information regarding the conversion rights of persons
covered under the group policy upon termination of the group policy.
This information shall be in clear and easily understandable
language.
10199.46. (a) On or after January 1, 1994, every nonprofit hospital
service plan issued, amended, or renewed that covers hospital,
medical, or surgical expenses on a group basis shall notify the group
contractholders in writing of the cancellation of the plan contract
and shall include in their contract with group contractholders a
provision requiring the group contractholder to mail promptly to each
subscriber a legible, true copy of any notice of cancellation of the
plan contract which may be received from the plan and to provide
promptly to the plan proof of that mailing and the date thereof.
(b) The notice of cancellation required by subdivision (a) shall
include information regarding the conversion rights of persons
covered under the plan contract upon termination of the plan
contract. This information shall be in clear and easily
understandable language.
10199.48. (a) No health insurer shall, with regard to a group
contract, change the premium rates or applicable copayments or
coinsurances or deductibles for the length of the contract, except as
specified in subdivision (b), during any of the following time
periods:
(1) After the group policyholder or group contractholder has
delivered written notice of acceptance of the contract or policy.
(2) After the start of the employer's annual open enrollment
period.
(3) After the receipt of payment of the premium for the first
month of coverage in accordance with the contract or policy effective
date.
(b) Changes to the premium rates or applicable copayments or
coinsurances or deductibles of a contract or policy shall, subject to
the insurer meeting the requirements of this chapter, be allowed in
any 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 preliminary
agreement that states that it is subject to execution of a definitive
agreement.
(3) When the insurer and the policyholder or contractholder
mutually agree in writing.
