(a) A life or disability income insurer shall not decline an application or an enrollment request for coverage under a policy or certificate for life insurance or disability income insurance based solely on the results of a positive HIV test, regardless of when or at whose direction the test was performed.

(b) Notwithstanding any other law, this article does not prevent or otherwise restrict a life or disability income insurer from refusing to insure an applicant that is HIV positive, limiting the amount, extent, or kind of coverage for an applicant that is HIV positive, or charging a different rate to an applicant that is HIV positive, if the refusal, limitation, or charge is based on sound actuarial principles and actual or reasonably anticipated experience.

Terms Used In California Insurance Code 799.02

  • Certificate: means a certificate of group life insurance or a certificate of group disability income insurance delivered in this state, regardless of the situs of the group master policy. See California Insurance Code 799.01
  • Disability income insurance: means insurance against loss of occupational earning capacity arising from injury, sickness, or disablement. See California Insurance Code 799.01
  • HIV test: means any clinical test, laboratory or otherwise, used to identify HIV, a component of HIV, or antibodies or antigens to HIV. See California Insurance Code 799.01
  • Life insurance: means the class of coverage described in Section 101, but, as used in this article, excludes annuities. See California Insurance Code 799.01
  • Life or disability income insurer: means an insurer licensed to transact life insurance or disability insurance in this state that is transacting life insurance or disability income insurance in this state, or a fraternal benefit society licensed in this state that is transacting life insurance or disability income insurance in this state. See California Insurance Code 799.01
  • Policy: means an individual life insurance policy or individual disability income insurance policy issued or delivered in this state, or a certificate of life insurance benefits or disability income insurance benefits issued or delivered in this state by a fraternal benefit society. See California Insurance Code 799.01

(c) Transferring an applicant from a simplified, expedited, accelerated, or algorithmic underwriting process to a traditional medical underwriting process, based solely on the results of a positive HIV test, does not constitute a denial of the application or a violation of this section.

(d) This section applies if coverage is contingent upon medical review for other diseases or medical conditions.

(Amended (as added by Stats. 2020, Ch. 184, Sec. 3) by Stats. 2022, Ch. 424, Sec. 11. (SB 1242) Effective January 1, 2023.)

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