CA SB1091

Defines "alternate plan of care" as a plan developed by a licensed health care practitioner specifying long-term care services required by an insured that are not covered under the policy, applicable to policies issued on or after January 1, 2017

Authorizes either the insured or insurer to propose an alternate plan of care, which must be agreed to by the insured, insurer, and an independent licensed health care practitioner

Prohibits the maximum benefit under a policy from changing based on use of an alternate plan of care, but allows reduction by the amount of benefits actually paid under the alternate plan

Requires that coverage for alternate plan of care services be in addition to, not instead of, services specifically defined as covered under the policy, with ability to switch between them with practitioner and insurer agreement

Mandates insurers provide written explanation to policyholders within 60 days if agreement on an alternate plan of care cannot be reached, specifying the specific reasons for denial