Cal. Code Regs. tit. 10 § 2562.3

Current through Register 2025 Notice Reg. No. 2, January 10, 2025

Section 2562.3 - Prohibited Limitations on Coverage

For purposes of Insurance Code section 10144.5,

(a) If treatment or services are

(1) Medically necessary,

(2) Rendered to an individual diagnosed with a health condition indicated in subdivision (d)(7) of Insurance Code section 10144.5, and

(3) Rendered for the purpose of treating that condition;

(b) Then an insurer shall not impose

(1) An annual visit limit, or

(2) An annual dollar limit, a copayment, a deductible, or any other financial term, when the same term or limit is not equally applicable to all benefits under the policy.

(c) For purposes of subdivision (a) of this section 2562.3, "treatment or services" includes but is not limited to speech therapy, occupational therapy and behavioral health treatment.

Cal. Code Regs. Tit. 10, § 2562.3

1. New section filed 3-11-2013 as an emergency; operative 3-11-2013 (Register 2013, No. 11). A Certificate of Compliance must be transmitted to OAL by 9-9-2013 or emergency language will be repealed by operation of law on the following day.
2. New section refiled 9-9-2013 as an emergency; operative 9-9-2013 (Register 2013, No. 37). A Certificate of Compliance must be transmitted to OAL by 12-9-2013 or emergency language will be repealed by operation of law on the following day.
3. New section filed 11-20-2013 as an emergency; operative 12-9-2013 pursuant to Government Code section 11346.1(d) (Register 2013, No. 47). A Certificate of Compliance must be transmitted to OAL by 3-10-2014 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 11-20-2013 order, including amendment of section heading and section, transmitted to OAL 3-7-2014 and filed 4-10-2014; amendments effective 4-10-2014 pursuant to Government Code section 11343.4(b)(3) (Register 2014, No. 15).

Note: Authority cited: Sections 10144.5, 10144.51, 12921 and 12926, Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989); 20th Century Ins. Co. v. Garamendi, 8 Cal.4th 216 (1994). Reference: Sections 10144.5 and 10144.51, Insurance Code; Harlick v. Blue Shield of California, 686 F.3d 699 (2012).