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Code · California · Insurance Code

§ 10181.31

379 words·~2 min read·/ca/insurance-code/10181-31

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)Upon receiving notice of a rate change, a large group contractholder that has coverage that is experience rated in whole or blended and that meets the criteria in subdivision (e), may apply within 60 days to have the department review the rate change to determine whether the rate change is unreasonable or not justified, consistent with this article.
(b)Upon receiving an application, the department shall notify the health insurer of the application, and the insurer shall provide the information required by the department to complete the department’s review of the proposed rate within five business days of the department’s request or as otherwise required by the department.
(c)The department shall use reasonable efforts to complete its review of the rate change within 60 days of receiving all the information the department requires to make its determination, and shall notify the health insurer and the large group contractholder of its determination.
(d)A rate change under review by the department shall not be imposed before a determination is made by the department pursuant to subdivision
(c)or within 60 days following receipt by the department of all information the department requires to make its determination, whichever occurs earlier.
(e)To apply for a review of a rate change for a particular group, at least one of the following shall apply:
(1)The contractholder has more than 2,000 total insureds.
(2)The insurer failed to provide the information required by this article or Section 10181.10.
(f)To facilitate review, the department may group appeals that apply to the same health insurer and that raise similar questions about rates, methodology, assumptions, or factors.
(g)The department may contract with a consultant or consultants with expertise to assist the department in its review. Contracts entered into pursuant to the authority in this article shall be exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Article 4 (commencing with Section 19130) of Chapter 5 of Part 2 of Division 5 of Title 2 of the Government Code, and the State Contract Act (Chapter 1 (commencing with Section 10100) of Part 2 of Division 2 of the Public Contract Code).
(h)This section shall become operative on July 1, 2021.
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