California Code of Regulations
Title 10 - Investment
Chapter 5 - Insurance Commissioner
Subchapter 2 - Policy Forms and Other Documents
Article 1.5 - Standards for Determining Conformity of Individual Disability Policies with the Provisions of Paragraph (7) of Subdivision (b) of Section 10291.5 of the Insurance Code
Subarticle 4 - Basic Medical Benefits
Section 2220.16 - Basic Miscellaneous Hospital Services Benefits
Current through Register 2024 Notice Reg. No. 38, September 20, 2024
Except to the extent provided otherwise in Section 2220.20, a benefit covering miscellaneous hospital services (other than a benefit described in Sections 2220.19 and 2220.22) shall be deemed not sufficient to be of real economic value to the insured if.
(a) When the benefit specifies a blanket amount for miscellaneous hospital services for unnamed items, such blanket amount is less than five times the largest daily hospital benefit of the policy; or
(b) When the benefit specifies a blanket amount for miscellaneous hospital services for a number of named items, such blanket amount is less than five times the largest daily hospital benefit of the policy, or the items named are less than six in number; or
(c) When the benefit specifies a separate limiting amount per separate item named, the amount per item is less than $15.00 and the aggregate limiting amount for all such items is less than $150 or the items named are less than seven in number and the amounts are not reasonably related; or
(d) Less than six of such items if separately named are of a reasonably normal frequency or occurrence; and
(e) It does not provide benefits under either (a) or (b) or (c) above for diagnostic X-rays, laboratory tests and electrocardiograms on an in-patient basis and also on an out-patient basis for preadmission hospital testing when the procedures are performed within 72 hours of admission to the hospital.
A policy or rider which contains the benefits of this section and Section 2220.15 may be subject to a combined deductible not in excess of $100.00, except that if the miscellaneous hospital service benefits are not less than ten times the daily hospital benefit, the combined deductible may be not in excess of $150.00. This section shall not prohibit a miscellaneous hospital services benefit which, in the opinion of the Commissioner is not less than the actuarial equivalent of one of the specified benefits in this section.
