Sec. 2594.1 - Scope of Article

§ 2594.1. Scope of Article

(a) This article shall apply to the following:

(1) An individual or small group health insurance policy which is issued, amended, or renewed on or after January 1, 2017, regardless of whether the health insurance policy is sold on the Exchange or outside of the Exchange.

(2) To the extent applicable, an individual or small group specialized health insurance policy that covers the pediatric oral essential health benefit which is issued, amended, or renewed on or after January 1, 2017, regardless of whether it is an excepted benefit policy under subdivision (b)(2) of this section.

(b) This article shall not apply to the following:

(1) An individual or small group health insurance policy that is a grandfathered health plan.

(2) An individual or group disability insurance policy that covers excepted benefits in accordance with subsections (b) and (c) of section 2722 of the Public Health Service Act (42 U.S.C. § 300gg-21(b), (c)), and any rules, regulations, or guidance issued pursuant to that section.

(c) The sections of the Health and Safety Code enumerated in subdivisions (a)(2)(A)(ii) and (a)(2)(A)(iv) of section 10112.27 of the Insurance Code shall apply only to a health insurance policy subject to section 10112.27 of the Insurance Code.

(d) Nothing in section 10112.27 of the Insurance Code or this article exempts a health insurer or health insurance policy from complying with other applicable requirements of law, including Chapter 5 of Title 10 of the California Code of Regulations.

(e) A small group health insurance policy subject to section 10112.27 of the Insurance Code shall comply with the following sections of the Insurance Code:

(1) Section 10119.6.

(2) Section 10123.141.

(1. New section filed 6-13-2013 as an emergency; operative 6-13-2013 (Register 2013, No. 24). A Certificate of Compliance must be transmitted to OAL by 12-10-2013 or emergency language will be repealed by operation of law on the following day. 2. New section refiled 12-9-2013 as an emergency; operative 12-9-2013 (Register 2013, No. 50). Pursuant to Insurance Code section 10112.27(o)(2) a Certificate of Compliance must be transmitted to OAL by 6-9-2014 or emergency language will be repealed by operation of law on the following day. 3. Certificate of Compliance as to 12-9-2013 order, including amendment of section and Note, transmitted to OAL 1-15-2014 and filed 2-24-2014; amendments effective 2-24-2014 pursuant to Government Code section 11343.4(b)(3)(Register 2014, No. 9). 4. Change without regulatory effect amending subsections (a)(1)-(2) filed 1-3-2017 pursuant to section 100, title 1, California Code of Regulations (Register 2017, No. 1).)

Note: Authority cited: Sections 10112.27, 10112.295, 10112.297, 12921 and 12926, Insurance Code. Reference: Sections 10112.27, 10112.295, 10112.297, 10119.6 and 10123.141, Insurance Code.

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