Final Guidance 2470:2

A PDF of this document is available

Guidance 2470: 2 Final release date: July 1, 2011

Pursuant to Assembly Bill 2470 (Chapter 658, Statutes 2010), the California Department of Insurance issues the following guidance regarding compliance. 

New Article 10. Guidance on Commissioner's Review of Complaints of Unlawful Cancellation, Rescission or Nonrenewal of Health Insurance Policies

Adopt Section 2274.50. Notice of the Right to Request Review by the Commissioner.

NOTICE OF RIGHT TO REVIEW BY THE CALIFORNIA INSURANCE COMMISSIONER

You may request a review by the California Insurance Commissioner if you believe your health insurance policy or coverage has been or will be wrongly canceled, rescinded or not renewed.  To do so, you must, as soon as possible, submit your request for review in writing to: California Department of Insurance, Consumer Communications Bureau, 300 S. Spring Street, South Tower, Los Angeles, California, 90013 or through this website. You may contact the California Insurance Commissioner's Consumer Communications Bureau at 1-800-927-HELP (4357) or TDD 1-800-482-4833 for information about how to request a review in writing.  Please provide the Department with your health insurance policy number, copies of any letters you have received from us or a copy of your health insurance card.

You have 30 days from the date we sent this notice to you to request a review by the commissioner in order to ensure that we are required to provide you health insurance coverage while your request for review is being evaluated.  To ensure that your coverage is continued without interruption, however, you must request a review by the commissioner before your coverage ends.  Even if more than 30 days have passed since we sent this notice, we must continue your coverage while your request is being evaluated, as long as you request the review by the commissioner at a time when your coverage is still in effect.   Regardless of whether or not we are required to provide you health insurance coverage while your request for review is being evaluated, the commissioner will order us to reinstate your coverage, retroactive to the time of cancellation, rescission or nonrenewal, if the commissioner determines that your request for review is a proper complaint and, ultimately, that the cancellation, rescission or nonrenewal was unlawful.

WARNING: You must continue to pay your insurance premiums on time in order to maintain coverage, and if your coverage is reinstated retroactively you will be responsible for paying insurance premiums corresponding to any gap in coverage between the time your coverage was terminated and the time it was continued or reinstated.

Adopt Section 2274.51. The Request for Review.

A request for review by the commissioner is any communication received from a policyholder, certificate holder or other insured by the Department of Insurance (the "Department") regarding an actual or impending nonrenewal, cancellation or rescission of health insurance coverage in connection with which communication the policyholder, certificate holder or other insured asserts that the termination of coverage was or would be wrongful.  The date of the request for review is the date the Department first receives the communication in writing, which for purposes of this Section 2274.51 shall include communications received via email.  The preceding sentence notwithstanding, in the event the Department first receives the communication orally, the date of the request for review shall be the date of that oral communication, provided that the Department receives written confirmation of the request for review, which may include confirmation by email, from the policyholder, certificate holder or other insured, no later than thirty days after the date of the oral communication.  However, in the event that the policyholder, certificate holder or other insured mistakenly directs his or her request for review by the commissioner to the Department of Managed Health Care (DMHC), the date of the request for review shall be the date upon which, according to DMHC, the request for review was received by DMHC, provided that the Department receives written confirmation of the request for review, which may include confirmation by email, from the policyholder, certificate holder or other insured.

Back to Top

Adopt Section 2274.52. The Proper Complaint.

Adopt Section 2274.53. Grace Period.

For purposes of Insurance Code sections 10273.4, 10273.6 and 10713:

Back to Top

Adopt Section 2274.54. Reinstatement and Continuation of Coverage.

Adopt Section 2274.55.  Submittal of Information by Insurers for Use in Determination by the Commissioner that a Cancellation, Rescission or Failure to Renew Is or Is not Contrary to Existing Law.

Legal Division, Health Enforcement Bureau California Department of Insurance 45 Fremont Street, 22nd Floor San Francisco CA 94105

California Department of Insurance Rating and Underwriting Services Bureau 300 South Spring Street, 11th Floor Los Angeles, California 90013

Back to Top

Adopt Section 2274.56.  Factual Showings Required of Insurers in order to Demonstrate that a Rescission or Cancellation Is Lawful under Insurance Code section 10384.

Back to Top

Adopt Section 2274.57. Miscellaneous Factual Showings Required of Insurers.

In addition to any other evidence required to be submitted pursuant to this article, the insurer shall submit:

Adopt Section 2274.58.  The Request for a Hearing pursuant to Insurance Code section 10273.7(c); Hearing Procedure.

Administrative Hearing Bureau California Department of Insurance 45 Fremont Street, 22nd Floor San Francisco CA 94105

Adopt Section 2274.59.  Affirmative Defense.

A policyholder, certificate holder or other insured shall be barred from requesting a review by the commissioner if the date of his or her request for review is more than 180 calendar days after the date the insurer sent the notice set forth in subdivision (b) of Section 2274.50, or the date coverage was terminated (if coverage was terminated), whichever is later in time.  The running of this 180-day period shall be tolled, however, during such period as the policyholder, certificate holder or other insured is unable, due to substantial health reasons or other incapacity, to understand or appreciate the significance of such notice, or termination of coverage, and act upon it.  The insurer shall have the burden to establish that the 180-day period had run, and had not been tolled, at the time of the policyholder's, certificate holder's or other insured's request for review by the commissioner.  The insurer must assert the affirmative defense described in this Section 2274.59, and include all evidence available to the insurer in support of that assertion, in the submittal required pursuant to paragraph (c)(1) of Section 2274.55 and in any submittal required pursuant to subdivision (a) of Section 2274.58.  In the event the insurer has not sent the notice set forth in subdivision (b) of Section 2274.50, the affirmative defense described in this section shall not obtain.

Back to Top

Adopt Section 2274.60.  Effect of Insurer's Failure to Make Timely Submittal.

In the event the insurer does not substantially comply with the information submittal requirements of paragraph (c)(1) of Section 2274.55, or of subdivision (a) of Section 2274.58, as the case may be, within the period of time within which the submittal in question is required to be made pursuant to that paragraph or subdivision, the insurer shall immediately reinstate the policyholder, certificate holder or other insured pursuant to subdivision (e) of Insurance Code section 10273.7.  No act of the commissioner shall be necessary in order for the requirement stated in the preceding sentence to become effective.

Adopt Section 2274.61. Role of Department Staff.

 Back to Top

Google™ Translation Disclaimer

This Google™ translation feature is provided for informational purposes only.

The Department of Insurance is unable to guarantee the accuracy of this translation and is therefore not liable for any inaccurate information resulting from the translation application tool.

The Department of Insurance is also unable to guarantee the same page layout for all the languages. Depending on the languages, the page layout may look strange from the original.

Please consult with a translator for accuracy if you are relying on the translation or are using this site for official business.

A copy of this disclaimer can also be found on our Disclaimer page.

Select a Language Below / Seleccione el Idioma Abajo

Close this box or use the [X]