Cal. Code Regs. tit. 10 § 2274.70

Current through Register 2024 Notice Reg. No. 45, November 8, 2024

Section 2274.70 - Purpose

The purpose of this article is to:

(a) Clarify and make specific the application of the following statutes to the medical underwriting process and the permissibility of rescission by insurers: Insurance Code sections 10113, 10119.3, 10380, 10381.5 and 10384 and related insurance policy provisions;

(b) Set forth standards for determining whether questions used to ascertain the health condition or history of an applicant for health insurance coverage are clear and unambiguous pursuant to Insurance Code section 10291.5(c)(1);

(c) Identify bases on which the Commissioner may find that provisions in a health insurance policy containing a health history questionnaire which the insurer makes part of the contract between the insurer and the insured are unintelligible, uncertain, ambiguous, abstruse or likely to mislead an applicant pursuant to Insurance Code section 10291.5(b)(1);

(d) Set forth standards for determining whether questions on a health history questionnaire, supplemental questionnaire or script used during pre-issuance underwriting are reasonable and necessary for medical underwriting purposes as required by Insurance Code section 10291.5(c)(2);

(e) Set forth requirements for the pre-issuance medical underwriting process pursuant to Insurance Code section 10384;

(f) Set forth attestation requirements for agents assisting insureds in the submission of health insurance applications; and

(g) Set forth requirements for the conduct of post-issuance rescission investigations where a claim has been submitted or the insurer has received notice of a claim.

Cal. Code Regs. Tit. 10, § 2274.70

1. New article 11 (sections 2274.70-2274.78) and section filed 7-19-2010; operative 8-18-2010 (Register 2010, No. 30).
2. Change without regulatory effect amending NOTE filed 9-23-2010 pursuant to section 100, title 1, California Code of Regulations (Register 2010, No. 39).

Note: Authority cited: Sections 790.10, 10291.5, 10384, 12921 and 12926, Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989); and 20th Century Ins. Co. v. Garamendi, 8 Cal. 4th 216 (1994). Reference: Sections 106, 380, 730, 733, 734, 790.03, 796.04, 10113, 10291.5, 10380, 10381.5 and 10384, Insurance Code.

1. New article 11 (sections 2274.70-2274.78) and section filed 7-19-2010; operative 8-18-2010 (Register 2010, No. 30).
2. Change without regulatory effect amending Note filed 9-23-2010 pursuant to section 100, title 1, California Code of Regulations (Register 2010, No. 39).