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Private Insurance Data Requirements in California

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An insurance company cannot disclose a patient’s medical information without prior written consent.1  Health plans are also required to provide a copy of their confidentiality notices to the Department of Managed Care, as well as to consumers, upon request.2  All licensed health insurance plans, except those that serve Medicaid recipients, must collect and document its enrollees’ demographic data and report it to State in order to improve language assistance and the quality of health care.3 The health plan must maintain patient confidentiality in the collection and reporting of this data.

 

Footnotes

  • 1. 10 CA ADC §2689.11
  • 2. Health & Safety Code §1364.5
  • 3. 28 CA ADC §1300.67.04

 

Private Insurance Data Requirements in California

Subtopic Statute/Regulation Description
Private Insurance Data Requirements Written Statement of Confidentiality to Patients for Health Service Plans – Cal. Health & Safety Code § 1364.5 All health service plans operating in the state of California must provide to the Director of the Department of Managed Care, a copy of their...
Language Assistance Programs for Health Insurance Plans Aside from Those That Serve Medicaid Beneficiaries – Cal. Code Regs. tit. 28 § 1300.67.04 All health insurance plans excluding those that serve Medicaid beneficiaries must collect, summarize and document enrolled members’ demographic...
Release of Health Information to Employers – Cal. Health & Safety Code § 1374.8 A health plan may not release to an employer any information showing that a covered employee has received services from a health care provider,...
Requirements for Medical Record Information Disclosure by Insurance Companies – Cal. Code Regs. tit. 10 § 2689.11 An insurance company cannot disclose a patient’s medical information to a third party without the consumer’s prior written consent.
Health plan required reporting Access To Language Assistance Programs and Linguistic Needs of Enrollees – Cal. Health & Safety Code § 1367.04 The Department of Managed Care must ensure that health plans provide enrollees access to language assistance programs.  Health service plans are...
Report By Health Care Service Plan Regarding Internal Policies On Cultural Appropriateness – Cal. Health & Safety Code § 1367.07 The Department of Managed Care must ensure that health plans provide services to those with language assistance needs.  In order to do this,...
Cost reporting by insurance companies (Cross reference Provider Resource Use) California Medicaid Plan Reporting Requirements – Cal. Code Regs. tit. 22 § 53862 California’s Medicaid plan is administered through a two plan mode, where one plan is a prepaid plan awarded by competitive bidding and the...
Disclosure of information held by health plan, including notice requirements Department of Insurance Reporting Requirements and Information Use – Cal. Code Regs. tit. 10 § 2538.8 The Department of Insurance must report biennially on insurance company compliance with standards requiring all health insurance companies to provide...
Access to individual’s own records (Cross reference Medical Records Collection) Patient Records: Confidentiality and Disclosure – Cal. Health & Safety Code § 11845.5. All substance abuse treatment records are confidential and privileged to the patient and may only be disclosed according to the statute, irrespective...
Grievance procedures Prepaid Health Plan Requirements and Compliance with Medi-Cal Standards – Cal. Welf. & Inst. Code § 14450 All prepaid health plans must comply with the state Medicaid (Medi-Cal) program standards for participation.  In addition, all prepaid health...
Click on the individual state law in the table above to see our summary of the individual law.


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