California Code of Regulations
Title 10 - Investment
Chapter 5 - Insurance Commissioner
Subchapter 2 - Policy Forms and Other Documents
Article 11 - Standards for Health History Questionnaires in Health Insurance Applications, Pre-Issuance Medical Underwriting and Rescission of Health Insurance Policies
Section 2274.75 - Documentation Requirements and Examination by Commissioner

Universal Citation: 10 CA Code of Regs 2274.75

Current through Register 2024 Notice Reg. No. 38, September 20, 2024

(a) In order to complete medical underwriting and resolve all reasonable questions arising from written information submitted on or with an application pursuant to Insurance Code section 10384, the insurer shall document the following in writing and such documentation shall be subject to examination by the Commissioner pursuant to Sections 730, 733, 734, 790.04, 791.14, 12921.1, 12924 and 12926 of the Insurance Code and Title 10, Chapter 5, Section 2695.3 California Code of Regulations:

(1) The insurer's completion of medical underwriting;

(2) The insurer's identification and resolution of all reasonable questions arising from written information submitted on or with the application for health insurance coverage;

(3) The insurer's attempts to verify the accuracy and completeness of the application;

(4) All communications relating to the processes described in this article, including communications to and from the insured;

(5) All communications with the agent assisting the applicant regarding any aspect of (1) the application, (2) the submission of the application or any supplemental information to the insurer, or (3) the underwriting of the policy based on information in the application;

(6) All communications referred to in these regulations shall include electronic records as defined in Civil Code Section 1633.2(g).

1. New 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.

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