California Senate Bill SB353 Amended / Bill

 BILL NUMBER: SB 353AMENDED BILL TEXT AMENDED IN ASSEMBLY SEPTEMBER 4, 2013 AMENDED IN ASSEMBLY AUGUST 14, 2013 AMENDED IN ASSEMBLY AUGUST 5, 2013 AMENDED IN SENATE APRIL 16, 2013 INTRODUCED BY Senator Lieu FEBRUARY 20, 2013 An act to add Section 1367.041 to the Health and Safety Code, and to add  Sections 10127.45 and   Section  10133.10 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGEST SB 353, as amended, Lieu. Health care coverage: language assistance. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. A willful violation of the act is a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires the departments to adopt regulations establishing standards and requirements to provide enrollees and insureds with access to language assistance in obtaining health care services. Existing law requires health care service plans and health insurers, if they exceed certain enrollment thresholds, to implement programs to assess the needs of enrollees and insureds, and to provide translation and interpretation for medical services and translation of vital documents, as defined, to enrollees and insureds, and to report to the respective departments regarding internal policies and procedures related to cultural appropriateness. Existing law provides that a health care service plan is in compliance with the requirements if it is required to meet and meets the same or similar standards, as imposed by the Medi-Cal program. This bill would require a health care service plan, as specified, that advertises or markets products in the individual or small group health care service plan markets, or that allows others to market or advertise on its behalf  in those markets  , in a non-English language, as provided, and that does not meet certain requirements, to translate into that language specified documents.  This   The  bill would also require an insurer, as specified, that markets, advertises, or allows others to market or advertise on its behalf, or produces educational materials for health insurance policies, in the individual or small group health insurance markets  ,  in a non-English language, as provided, and that does not meet certain requirements, to translate into that language specified documents.  This   The  bill would require both those health care service plans and insurers to use trained and qualified translators.  Existing law prohibits a health care service plan, except as provided, from publishing or distributing, or allowing to be published or distributed on its behalf, any advertisement unless a true copy of the advertisement has first been filed with the Director of the Department of Managed Health Care at least 30 days, or any shorter period of time by the director's rule or order, prior to its use and the director, by notice, has not found the advertisement, wholly or in part, to be untrue, misleading, deceptive, or otherwise not in compliance with the applicable provisions, and specified the deficiencies, within the 30 days, or any shorter period of time by the director's rule or order. The director, by rule or order, may classify plans and advertisements and exempt certain classes, wholly or in part, either unconditionally or upon specified terms and conditions, or for specified periods, from these requirements.   This bill would extend the approval requirements and exemptions to health insurers, as specified, and require the Department of Insurance to perform the related functions. The bill would prohibit the department from exempting certain classes of policies and advertisements from the requirements where it concerns new products or products offered by health insurers with a record, in the past 5 years, of violations of these provisions.  By placing additional requirements on health care service plans, the  willful  violation of which would be a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 1367.041 is added to the Health and Safety Code, to read: 1367.041. (a) A health care service plan that advertises or markets products in the individual or small group health care service plan markets, or allows any other person or business to market or advertise on its behalf  in the individual or small group health care service plan markets  , in a non-English language that does not meet the requirements set forth in Sections 1367.04 and 1367.07, shall provide the following documents in the same non-English language: (1) Welcome letters or notices of initial coverage, if provided. (2) Applications for enrollment and any information pertinent to eligibility or participation. (3) Notices advising limited-English-proficient persons of the availability of no-cost translation and interpretation services. (4) Notices pertaining to the right and instructions on how an enrollee may file a grievance. (5)  Uniform summaries   The uniform summary  of benefits  of   and coverage required  by Section 2715 of the federal Public Health Service Act (42 U.S.C. Sec. 300gg-11) and any rules or regulations promulgated thereunder.   pursuant to subparagraph (A) of paragraph (3) of subdivision (b) of Section 1363.  (b) A health care service plan shall use a trained and qualified translator for all written translations of marketing and advertising materials relating to health care service plan products, and for all  of  the documents specified in subdivision (a). (c)  This section shall apply to any specialized health care service plan that offers an essential health benefit as defined in subdivision (a) of Section 1367.005.  This section shall not apply to a specialized health care service plan that does not offer an essential health benefit as defined in Section 1367.005.  SEC. 2.   Section 10127.45 is added to the Insurance Code, to read: 10127.45. (a) Except as provided in subdivision (b), a health insurer offering policies of health insurance, as defined in Section 106, shall not publish or distribute, or allow to be published or distributed on its behalf, any advertisement unless both the following conditions are met at least 30 days prior to the publishing or distribution, or any shorter period as the department may allow by regulation: (1) A true copy of the advertisement has first been filed with the department. (2) The department, by notice, has not found the advertisement, wholly or in part, to be untrue, misleading, deceptive, or otherwise not in compliance with this code or the rules thereunder, and has specified any deficiencies within the 30 days or any shorter time as the commissioner by rule or order may allow. (b) Except as provided in subdivision (c), a health insurer that has been admitted to transact health insurance under this part continuously licensed under this chapter for the preceding 18 months may publish or distribute, or allow to be published or distributed on its behalf, an advertisement without having filed that advertisement with the department for prior approval, if the insurer and the material comply with each of the following conditions: (1) The advertisement or a material provision thereof has not been previously disapproved by the department by written notice to the insurer and the insurer reasonably believes that the advertisement does not violate any requirement of this code or the rules thereunder. (2) The insurer files a true copy of each new or materially revised advertisement, used by it or by any person acting on behalf of the insurer, with the department not later than 10 business days after publication or distribution of the advertisement or within such additional period as the department may allow by regulation. (c) (1) If the department finds that any advertisement of a health insurer has materially failed to comply with this code or the rules thereunder, the department may, by order, require the insurer to publish, in the same or similar medium, an approved correction or retraction of any untrue, misleading, or deceptive statement contained in the advertising, and may prohibit the insurer from publishing or distributing, or allowing to be published or distributed on its behalf, the advertisement or any new materially revised advertisement without first having filed a copy thereof with the department, 30 days prior to the publication or distribution thereof, or any shorter period specified in the order. (2) An order issued under this subdivision shall be effective for 12 months from its issuance and may be renewed by order if the advertisements submitted under this subdivision indicate difficulties of voluntary compliance with the applicable provisions of this code and the rules thereunder. (d) A health insurer, insurance agent, or other person regulated under this code may, within 30 days after receipt of any notice or order under this section, file a written request for a hearing with the department. (e) The department, by regulation, may classify plans and advertisements and exempt certain classes, wholly or in part, either unconditionally or upon specified terms and conditions or for specified periods, from the application of subdivisions (a) and (b). In no instance shall the department exempt new products or products offered by health insurers with a record within the past five years of violations of this section.   SEC. 3.   SEC. 2.  Section 10133.10 is added to the Insurance Code, to read: 10133.10. (a) An insurer that markets, advertises, or produces educational materials for a health insurance policy, as defined in Section 106, in the individual or small group health insurance markets, or allows any other person or business to market or advertise on its behalf  in the individual or small group health insurance markets  , in a non-English language that does not meet the requirements set forth in Sections 10133.8 and 10133.9, shall provide the following documents in the same non-English language: (1) Welcome letters or notices of initial coverage, if applicable. (2) Applications for health insurance and any information pertinent to eligibility or participation. (3) Notices advising limited-English-proficient persons of the availability of no-cost translation and interpretation services. (4) Notices pertaining to the right and instructions on how an insured may file a grievance. (5)  A matrix of the categories of health insurance benefits outlined in the insurance policy including copayments and coinsurance, exclusions, and limitations in the following sequence: deductibles, lifetime maximums, professional services, outpatient services, hospitalization services, diagnostic and therapeutic radiological services, preventative health services, emergency health care coverage including ambulance services, prescription drug coverage, durable medical equipment, mental health services, chemical dependency services, home health services, other services or the   The  uniform summary of benefits  of   and  coverage required  by   pursuant to paragraph (2) of subdivision (a) of  Section  2715 of the federal Public Health Service Act (42 U.S.C. Sec. 300gg-11) and any rules or regulations promulgated thereunder.   10603.  (b) An insurer shall use trained and qualified translators for the translation of all marketing and advertising materials relating to health insurance products and for all  of  the documents specified in subdivision (a). (c)  This section shall apply to a specialized health insurance policy that offers an essential health benefit as defined in subdivision (a) of Section 10112.27.  This section shall not apply to a specialized health insurance policy that does not offer an essential health benefit as defined in Section 10112.27.  SEC. 4.   SEC. 3.  No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.