Vote to concur with Senate amendments and pass a bill that modifies the California insurance code.

-Prohibits the cancellation or non-renewal of enrollment in a health care service plan except in, but not limited to, the following cases (Sec. 4):
        -For non-payment of the required premiums by an individual, an employer, or contractholder, provided that a notified 30-day grace period has passed;
        -Fraud or misrepresentation is demonstrated as having been purported by the individual contract holder;
        -An individual subscriber no longer lives or works in the plan's area; or
        -If an employer or contractholder violates a material contract provision relating to employer contribution or group participation rates.

-Requires any decisions to approve, modify, or deny coverage based on "medical necessity' to be made in a timely fashion, within 5 days of receiving the relevant information, appropriate for the patient's condition, or within 30 days if the review is retrospective (Sec. 5):
        -If the condition of an enrollee is one of serious and imminent threat to the enrollee's health, or if the normal timeframe for decision-making would be detrimental to the enrollee's health, then an exception to the time frame will be made.

-Requires all health care service plans to do, but not be limited to, the following (Sec. 7):
        -Establish and maintain a grievance system, and provide reasonable procedures that shall ensure consideration of enrollee grievances;
        -Inform enrollees of the procedure of processing and resolving grievances;
        -Provide enrollees with clear and concise responses to any grievances written or received; and
        -Provide continuing coverage for grievances involving the cancellation of coverage until a final determination has been made relating to such cancellation.

-Prohibits the practice of postclaims underwriting (Sec. 9):
        -Defines "postclaims underwriting" as the "rescinding, canceling, or limiting of a plan contract due to the plan's failure to complete medical underwriting and resolve all reasonable questions arising from written information submitted on or with an application before issuing the plan contract".

-Requires insurers of disabilities to have written policies that establish how the insurer reviews and either approves, modifies, delays, or denies requests by providers of health care services for those insured (Sec. 10).

-Prohibits any individual who is not a licensed physician or licensed health care professional to deny or modify any request for authorization of services for reasons of medical necessity (Sec. 10).

-Authorizes individuals who believe their coverage is about to be canceled, not renewed, or rescinded to request a review by the commissioner to determine whether or not a complaint, or cancellation, is justified (Sec. 13).

Vote pass a bill that modifies the California insurance code.

-Prohibits the cancellation or non-renewal of enrollment in a health care service plan except in, but not limited to, the following cases (Sec. 4):
        -For non-payment of the required premiums by an individual, an employer, or contractholder, provided that a notified 30-day grace period has passed;
        -Fraud or misrepresentation is demonstrated as having been purported by the individual contract holder;
        -An individual subscriber no longer lives or works in the plan's area; or
        -If an employer or contractholder violates a material contract provision relating to employer contribution or group participation rates.

-Requires any decisions to approve, modify, or deny coverage based on "medical necessity' to be made in a timely fashion, within 5 days of receiving the relevant information, appropriate for the patient's condition, or within 30 days if the review is retrospective (Sec. 5):
        -If the condition of an enrollee is one of serious and imminent threat to the enrollee's health, or if the normal timeframe for decision-making would be detrimental to the enrollee's health, then an exception to the time frame will be made.

-Requires all health care service plans to do, but not be limited to, the following (Sec. 7):
        -Establish and maintain a grievance system, and provide reasonable procedures that shall ensure consideration of enrollee grievances;
        -Inform enrollees of the procedure of processing and resolving grievances;
        -Provide enrollees with clear and concise responses to any grievances written or received; and
        -Provide continuing coverage for grievances involving the cancellation of coverage until a final determination has been made relating to such cancellation.

-Prohibits the practice of postclaims underwriting (Sec. 9):
        -Defines "postclaims underwriting" as the "rescinding, canceling, or limiting of a plan contract due to the plan's failure to complete medical underwriting and resolve all reasonable questions arising from written information submitted on or with an application before issuing the plan contract".

-Requires insurers of disabilities to have written policies that establish how the insurer reviews and either approves, modifies, delays, or denies requests by providers of health care services for those insured (Sec. 10).

-Prohibits any individual who is not a licensed physician or licensed health care professional to deny or modify any request for authorization of services for reasons of medical necessity (Sec. 10).

-Authorizes individuals who believe their coverage is about to be canceled, not renewed, or rescinded to request a review by the commissioner to determine whether or not a complaint, or cancellation, is justified (Sec. 13).

Vote to pass a bill that amends current state health care guidelines for individual health care plans and insurers.

-There was a material misrepresentation or omission in the information submitted by the applicant in the written application to the health care service plan prior to the issuance of the health care service plan contract which would have prevented an accurate representation of the applicant; -The health care service plan completed medical underwriting before the issuance of the health care service plan contract; -The health care service plan demonstrates that the applicant intentionally misrepresented or intentionally omitted material information on the application before the plan contract was issued in order to obtain health care coverage; -The department approved the application form; -The health care service plan sent a copy of the complete written application and health care service plan contract to the applicant along with the written notice; -Failure to pay the charge for coverage.

-The total number of individual health care service plan contracts issued; -Those health care service plan contracts that had a cancellation or rescission initiated; -Or, those that were completed based on the provisions of the intended article in the previous calendar year; and -The department will publish the information on or before March 31, 2011 on its website.