Section 2240.6 - Notice and Information to Covered Persons(a) Network provider directories shall be updated pursuant to the requirements set forth in this section and shall be offered to accommodate individuals with limited English proficiency or disabilities.(b) An insurer shall post its current network provider directory on its internet web site and inform its covered persons of the availability of the internet network provider directory through its coverage materials. The network provider information provided on the website shall be updated weekly. The network provider directory shall be available online to both covered persons and consumers shopping for coverage without requirements to log on or enter a password or a policy number.(c) An insurer shall maintain accurate provider directories for its networks as to the information referenced in subdivisions (g) and (h), below, as applicable, and shall demonstrate the accuracy of its directories at the request of the Department.(d) In addition to providing the network provider directory on its internet web site, the insurer shall also inform its covered persons of the availability of a paper copy of the network provider directory at no cost in its coverage material and on its internet web site. (1) The paper copy of the network provider directory shall be updated quarterly during the calendar year.(2) An insurer may satisfy this quarterly update requirement by providing a paper copy insert or addendum to any existing paper copy network provider directory.(e) If an insurer has more than one provider network, its provider directories shall make it reasonably clear to a covered person which network applies to each insurance product.(f) The network provider directory shall inform covered persons regarding the availability of translations and interpreter services in languages other than English pursuant to section 10133.8 of the Insurance Code.(g) No later than July 1, 2016, the network provider directory shall include the information required by subdivisions (g) and (h) of Insurance Code section 10133.15.(h) No later than July 1, 2016, an insurer that issues vision-only, dental-only, or other specialized health insurance policies shall include in its provider directory the information required by subdivisions (g) and (i) of Insurance Code section 10133.15 with respect to those policies. However, an insurer that issues specialized mental health insurance policies shall provide in its provider directory the information required by subdivision (g) of this section with respect to those policies, in lieu of the information required by the immediately preceding sentence. For purposes of this subdivision (h), the term "specialized mental health insurance policies" includes behavioral health-only policies.(i) The network provider directories, both printed and online, shall also inform consumers of the requirements of this article regarding the insurer's obligation to offer consumers primary care and specialty care within the specified time frames.(j) The directory shall clearly explain out-of-network options and cost-sharing tiers.(k) The directory shall comply with Insurance Code section 10604.1.(l) The network provider directories, both printed and online, shall identify those contracting providers who are themselves multilingual or who employ other multilingual providers and/or office staff, based on language capability disclosure statements signed by the multilingual providers and/or office staff, attesting to their fluency in languages other than English; changes to this information shall be reflected in provider directory updates.(m) An insurer shall promptly notify those patients seen by a provider within the past year when the provider, for any reason, leaves the insurer's network. This may include, but is not limited to, the provider's decision to retire or stop practicing medicine for other reasons, relocating to an area outside the service area, leaving a group practice that is included as a participant in the network, or withdrawing from a network for any other reason.(n) Provider directories shall include a description of a process whereby inaccurate provider listings can be reported to the insurer in compliance with the requirements of Insurance Code section 10133.15.(o) The insurer shall ensure the accuracy of its provider directories in compliance with the requirements of Insurance Code section 10133.15.(p) An insurer's provider directory, both online and print, shall include prominent disclosure of the requirements of subdivision (e) of Section 2240.1.Cal. Code Regs. Tit. 10, § 2240.6
1. New section filed 1-30-2015 as an emergency; operative 1-30-2015 (Register 2015, No. 5). A Certificate of Compliance must be transmitted to OAL by 7-29-2015 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 7-27-2015 as an emergency; operative 7-27-2015 (Register 2015, No. 31). A Certificate of Compliance must be transmitted to OAL by 10-26-2015 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 10-26-2015 as an emergency; operative 10-26-2015 (Register 2015, No. 44). A Certificate of Compliance must be transmitted to OAL by 1-25-2016 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 10-26-2015 order, including amendment of section and NOTE, transmitted to OAL 1-25-2016 and filed 3-8-2016; amendments operative 3-8-2016 pursuant to Government Code section 11343.4(b)(3) (Register 2016, No. 11). Note: Authority cited: Section 10133.5, Insurance Code. Reference: Sections 10133, 10133.15, 10133.5 and 10133.8, Insurance Code.
1. New section filed 1-30-2015 as an emergency; operative 1-30-2015 (Register 2015, No. 5). A Certificate of Compliance must be transmitted to OAL by 7-29-2015 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 7-27-2015 as an emergency; operative 7-27-2015 (Register 2015, No. 31). A Certificate of Compliance must be transmitted to OAL by 10-26-2015 or emergency language will be repealed by operation of law on the following day.
3. New section refiled 10-26-2015 as an emergency; operative 10-26-2015 (Register 2015, No. 44). A Certificate of Compliance must be transmitted to OAL by 1-25-2016 or emergency language will be repealed by operation of law on the following da
4. Certificate of Compliance as to 10-26-2015 order, including amendment of section and Note, transmitted to OAL 1-25-2016 and filed 3-8-2016; amendments operative 3/8/2016 pursuant to Government Code section 11343.4(b)(3) (Register 2016, No. 11).