Section 2274.72 - DefinitionsFor purposes of this article,
(a) "Policy" or "policies" refers to the written instrument, which is a contract of insurance that puts insurance coverage into effect and includes group certificates and fraternal benefit society certificates.(b) "Reasonable layperson standard" means a method of evaluating health history information that recognizes and takes into account the level of understanding and appreciation of words and terms in a health history questionnaire by the average individual who lacks professional training and experience in medicine.(c) "Questions" means questions and all requests for information, including statements or disclosures requested of the applicant in a health history questionnaire that is part of an application for health insurance coverage.(d) "Personal Health Record" ("PHR") means a dynamic set of personal health history information derived from a private, secure database maintained by a health insurer or health plan and that contains medical claims and other information. A PHR may be "auto-populated" with medical and related information, including claims records reflecting diagnoses and procedure codes, dates of treatments, prescription records, medical testing and other allowed clinical information. A PHR is distinct from an electronic medical record, which is primarily intended for use by medical professionals. A PHR is designed primarily for use by the insured. As used in this article, a PHR refers exclusively to a record of health history information maintained by an insurer or health plan for use by its covered persons. An insurer may ignore any applicant-generated health information purporting to be part of a PHR.(e) "Material", when used to describe information relied on by an insurer, indicates specific information that would be a determining factor to the insurer in deciding whether to accept or reject a proposed insurance risk associated with a health insurance policy or in determining the rate that will be offered.(f) "Medical Underwriting" means the process of determining the relative risks of providing health insurance coverage to an individual by examining medical and other information and applying medical underwriting guidelines. The purpose of medical underwriting is to reject or accept the proposed insurance risk and, if accepted, to set the level of coverage and the rate that will be offered.Cal. Code Regs. Tit. 10, § 2274.72
1. New section filed 7-19-2010; operative 8-18-2010 (Register 2010, No. 30).
2. Change without regulatory effect amending NOTE filed 9-23-2010 pursuant to section 100, title 1, California Code of Regulations (Register 2010, No. 39). Note: Authority cited: Sections 790.10, 10291.5, 10384, 12921 and 12926, Insurance Code; CalFarm Ins. Co. v. Deukmejian, 48 Cal.3d 805 (1989); and 20th Century Ins. Co. v. Garamendi, 8 Cal. 4th 216 (1994). Reference: Sections 106, 380, 730, 733, 734, 790.03, 796.04, 10113, 10291.5, 10380, 10381.5 and 10384, Insurance Code.
1. New section filed 7-19-2010; operative 8-18-2010 (Register 2010, No. 30).
2. Change without regulatory effect amending Note filed 9-23-2010 pursuant to section 100, title 1, California Code of Regulations (Register 2010, No. 39).