1. (a) This article applies to a health insurance policy as defined by Insurance Code section 106, and to an insurer that provides coverage under such a policy, as follows:

   1. (1) This article applies to a specialized health insurance policy, except for a dental- only or vision-only policy.
   2. (2) This article applies to student health insurance coverage as defined by Insurance Code section 10965.03.
   3. (3) This article applies regardless of the market segment in which a health insurance policy is offered, or whether it is a grandfathered health plan under Section 1251 of the Patient Protection and Affordable Care Act (42 U.S.C. Sec. 18011).
   4. (4) This article does not apply to Medicare supplement insurance.
2. (b) A specialized behavioral health insurer, third-party administrator, contracting provider, or any other entity that performs utilization review or utilization management functions, or otherwise administers health care benefits that are subject to this article on an insurer's behalf, shall comply with this article in the performance of those duties.
3. (c) An insurer that delegates responsibility for performing utilization review or utilization management functions, or administering health care benefits that are subject to this article, to a third-party administrator, contracting provider, another insurer, or any other entity shall maintain written policies and procedures describing the insurer's oversight and monitoring process for assuring the contractor or administrator complies with the requirements set forth in Insurance Code sections 10144.4, 10144.5, 10144.51, 10144.52, 10144.53, 10144.57, and this article.
4. (d) The provisions of this article are severable. If any provision of this article or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application.

Note: Authority cited: Sections 10144.5, 10144.52 and 10144.57, Insurance Code. Reference: Sections 106, 10123.135, 10144.4, 10144.5, 10144.51, 10144.52, 10144.53, 10144.57 and 10965.03, Insurance Code.

History

1. Amendment of article heading and new section filed 6-26-2025; operative 6-26-2025 pursuant to Government Code section 11343.4(b)(3) (Register 2025, No. 26).