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Summary:

Every professional liability insurer, self-insured governmental agency, or licensee (or counsel) must file a complete report of any settlement or arbitration award over $30,000 emanating from a claim for death or personal injury caused by the licensee's alleged negligence, error, or omission in practice, or by his or her rendering of unauthorized professional services, if the license was granted by either the Medical Board of California, the Osteopathic Medical Board of California, or the California Board of Podiatric Medicine.

Summary:

Every professional liability insurer, self-insured governmental agency, or licensee or his or her counsel that has received a copy of a patient's medical or hospital records must include with the liability settlement report (to be sent to the Board that licensed the licensee, i.e. the Medical Board of California, the Osteopathic Medical Board of California, or the California Board of Podiatric Medicine) copies of the records and depositions. The records include those prepared by the treating physician and surgeon or podiatrist, or hospital, describing the medical condition, history, care, or treatment of the person whose death or injury is the subject of the report, or a copy of any deposition in the matter that discusses the care, treatment, or medical condition of the person. If confidentiality is required by court order and, as a result, the reporter is unable to provide the records and depositions, documentation to that effect must accompany the original report. A professional liability insurer, self-ins

Summary:

The parent or person having custody of the child may contact the insurer, by telephone or in writing, and request information about the health insurance coverage for the child. The insurer shall provide the requested information that is specific to the health insurance coverage for the child.

Summary:

(d) Insurance coverage of the subscriber’s dependent child will terminate upon attainment of the specified limiting age, unless the dependent is (1) incapable of self-sustaining employment due to a physically or mentally disabling injury, illness, or condition; or (2) chiefly dependent upon the subscriber for support. In either case, the subscriber must submit proof of the dependent’s condition to the plan within 60 days of receipt of the plan’s notification that coverage will terminate once the child attains the limiting age. If the plan determines that coverage may continue, after two years the plan may annually request information about a dependent child whose coverage is continued beyond the limiting age. If the subscriber changes carriers to another plan or to a health insurer, the new plan or insurer shall continue to provide coverage for the dependent child. The new plan or insurer may request information about the dependent child initially and annually thereafter to determine if the child continues to satisfy the criteria.

Summary:

An insurer shall pay a provider reasonable costs for duplicating all information it requests in connection with a contested claim, including patient records. Insurers must only request information that is reasonably necessary to determine liability for payment of a claim.

Summary:

If a disability insurer requests medical information from health care service providers in order to determine whether to approve, modify, or deny requests for authorization, the insurer shall request only the information reasonably necessary to make the determination.

Summary:

When requested by an insured or contracting health professional who is treating an insured, a disability insurer that covers hospital, medical, or surgical expenses shall authorize a second opinion by an appropriately qualified health care professional. The insurer shall require the second opinion health professional to provide the insured and the initial health professional with a consultation report, including any recommended procedures or tests that the second opinion health professional believes appropriate. Nothing in this section shall be construed to prevent the insurer from authorizing, based on its independent determination, additional medical opinions concerning the medical condition of an insured.

Summary:

Disability insurers may establish reasonable requirements for the participating obstetrician and gynecologist or the family practice physician and surgeon, to communicate with the policyholder's primary care physician regarding the policyholder's condition, treatment, and any need for followup care.

Summary:

Any data submitted by a health insurer to the United States Secretary of Health and Human Services for purposes of the risk adjustment program under the Patient Protection and Affordable Care Act shall be concurrently submitted to the Department of Insurance, and in the same format. The department shall use the information to ensure that insurers are in compliance with federal requirements related to risk adjustment.

Summary:

This provision enumerates prohibited terms in a contract between insurers and health care providers. One such prohibited term is (b)(4) a requirement to permit access to patient information in violation of federal or state laws concerning the confidentiality of patient information.

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