BILL NUMBER: AB 1825 AMENDED
BILL TEXT
AMENDED IN SENATE AUGUST 20, 2010
INTRODUCED BY Assembly Member De La Torre
FEBRUARY 11, 2010
An act to add Section 10123.865 to , and to add and repeal
Section 10123.866 of, the Insurance Code, relating to health
care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 1825, as amended, De La Torre. Maternity services.
Existing law provides for the regulation of health insurers by the
Department of Insurance. Under existing law, a health insurer that
provides maternity coverage may not restrict inpatient hospital
benefits, as specified, and is required to provide notice of the
maternity services coverage.
This bill would require new forms for health
insurance policies submitted to the department
issued, amended, or renewed on or after January
July 1, 2011, and prior to January 1, 2014,
to provide coverage for maternity services, as defined
and would require health insurance policies issued, amended, or
renewed on or after January 1, 2014, to provide coverage for
maternity services consistent with the federal Patient Protection and
Affordable Care Act, as specified . With respect to
policy forms on file with the department as of January 1, 2011, the
bill would require health insurers to submit to the department, on or
before March 1, 2011, revised policy forms that provide coverage for
maternity services and would require insurers to include that
coverage in the corresponding policies that are issued, amended, or
renewed following the department's approval of the revised forms, as
specified. The bill would also, until
January 1, 2014, to the extent permitted under federal law, authorize
certain individual health insurance policies to include an
exclusionary period of up to 12 months on maternity services, as
specified, and would require the insurer to provide a specified
notice regarding that exclusionary period at the time of solicitation
for the policy.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares the following:
(a) In actual practice, health care service plans have been
required by the Knox-Keene Health Care Service Plan Act of 1975
(Chapter 2.2 (commencing with Section 1340) of Division 2 of the
Health and Safety Code) to provide maternity services as a basic
health care benefit.
(b) At the same time, existing law does not require health
insurers to provide designated basic health care services and,
therefore, health insurers are not required to provide coverage for
maternity services.
(c) Therefore, it is essential to clarify that all health care
coverage made available to California consumers, whether issued by
health care service plans regulated by the Department of Managed
Health Care or by health insurers regulated by the Department of
Insurance, must include maternity services.
SEC. 2. Section 10123.865 is added to the Insurance Code, to read:
10123.865. (a) With respect to a pending or approved
individual or group health insurance policy form on file with the
department as of January 1, 2011, a health insurer shall submit to
the department, on or before March 1, 2011, a revised policy form
that provides coverage for maternity services. The corresponding
policy issued, amended, or renewed on or after 30 days following the
department's approval of the revised form shall include coverage for
maternity services.
(b) New forms for
individual or group policies of health insurance submitted to the
department after January 1, 2011, shall provide coverage for
maternity services. (1) A group
or individual health insurance policy that is issued, amended, or
renewed on or after July 1, 2011, and on or before December 31, 2013,
shall provide coverage for maternity services. The policy shall also
comply with any other maternity coverage requirement imposed under
federal law or regul ation.
(c)
(2) For purposes of this section
subdivision , "maternity services" include prenatal care,
ambulatory care maternity services, involuntary complications of
pregnancy, neonatal care, and inpatient hospital maternity care,
including labor and delivery and postpartum care.
(b) To the extent required under federal law, a group or
individual health insurance policy issued, amended, or renewed, on or
after January 1, 2014, shall cover maternity services consistent
with the rules and regulations issued by the United States Secretary
of Health and Human Services pursuant to subdivision (b) of Section
1302 of the federal Patient Protection and Affordable Care Act
(Public Law 111-148).
(d)
(c) This section shall not apply to specialized health
insurance, Medicare supplement insurance, short-term limited duration
health insurance, CHAMPUS-supplement insurance, or TRI-CARE
supplement insurance, or to hospital indemnity, accident-only, or
specified disease insurance.
SEC. 3. Section 10123.866 is added to the
Insurance Code , to read:
10123.866. (a) To the extent permitted under federal law, an
individual health insurance policy that is issued, amended, or
renewed on or after July 1, 2011, and that applies a preexisting
condition provision, a waiting or affiliation period, or a waivered
condition provision may include an exclusionary period of up to 12
months for maternity services, except for those services required to
be covered under federal law and those services covered under the
policy prior to July 1, 2011. An insurer shall credit the time an
individual was covered under creditable coverage against the 12-month
exclusionary period, provided that the individual becomes eligible
for coverage under the succeeding insurance policy within 62 days of
termination of prior coverage, exclusive of any waiting or
affiliation period, and applies for coverage under the succeeding
insurance policy within the applicable enrollment period.
(b) A health insurer that offers an individual health insurance
policy with an exclusionary period for maternity services as
described in subdivision (a) shall make available, at the time of
solicitation and as part of the sales material for the policy, the
following notice in 12-point type:
"IMPORTANT NOTICE: PLEASE BE AWARE THAT YOU MAY BE ENROLLING IN A
POLICY THAT DOES NOT COVER OR PROVIDE BENEFITS FOR MATERNITY CARE FOR
UP TO TWELVE MONTHS IMMEDIATELY FOLLOWING ENROLLMENT. NO BENEFITS
WILL BE PAID FOR MATERNITY SERVICES DURING THIS PERIOD, AS DESCRIBED
IN THE CERTIFICATE OF INSURANCE."
(c) For purposes of this section, "maternity services" has the
same meaning as that term is defined in Section 10123.865.
(d) This section shall not apply to specialized health insurance,
Medicare supplement insurance, short-term limited duration health
insurance, CHAMPUS-supplement insurance, or TRI-CARE supplement
insurance, or to hospital indemnity, accident-only, or specified
disease insurance.
(e) This section shall remain in effect only until January 1,
2014, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2014, deletes or extends
that date.