BILL NUMBER: AB 2345	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 8, 2010

INTRODUCED BY   Assembly Member De La Torre

                        FEBRUARY 19, 2010

   An act to  amend Section 10113.95 of   add
Section 1342.1 to the Health and Safety Code, and to add Section
10121.8 to  the Insurance Code, relating to health care
coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 2345, as amended, De La Torre.  Individual health care
coverage: health insurers.   Health care.  
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care and makes a violation
of the act a crime. Existing law also provides for the regulation of
health insurers by the Department of Insurance.  
   This bill would, on and after January 1, 2011, require health care
service plans and health insurers that issue, sell, renew, or offer
contracts or group policies for health care coverage in this state to
meet the requirements of specified provisions of the federal Public
Health Service Act.  
   Because a violation of these provisions by a health care service
plan would be a crime, this bill would impose a state-mandated local
program.  
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.  
   This bill would provide that no reimbursement is required by this
act for a specified reason.  
   Existing law provides for the regulation of health insurers by the
Department of Insurance and requires a health insurer to have
written policies, procedures, and underwriting guidelines
establishing the criteria and process whereby the insurer makes its
decision to provide or to deny coverage to individuals who apply for
coverage and sets the rate for that coverage. Existing law requires
an insurer to annually file with the commissioner a general
description of the criteria, policies, procedures, or guidelines that
the insurer uses for rating and underwriting decisions related to
individual health insurance policies, as specified, and requires the
commissioner to make specified information available on its Internet
Web site regarding rating, underwriting criteria, and practices in
the individual market.  
   This bill would make technical, nonsubstantive changes to those
provisions.
   Vote: majority. Appropriation: no. Fiscal committee:  no
  yes  . State-mandated local program:  no
  yes  .


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Section 1342.1 is added to the 
 Health and Safety Code   , to read:  
   1342.1.  On and after January 1, 2011, every health care service
plan that issues, sells, renews, or offers contracts for health care
coverage in this state in the small or large group markets shall meet
the requirements of Part A (commencing with Section 300gg) of
Subchapter XXV of Chapter 6A of Title 42 of the United States Code.

   SEC. 2.    Section 10121.8 is added to the  
Insurance Code   , to read:  
   10121.8.  On and after January 1, 2011, every health insurer that
issues, sells, or offers group policies for health care coverage in
this state in the small or large group markets shall meet the
requirements of Part A (commencing with Section 300gg) of Subchapter
XXV of Chapter 6A of Title 42 of the United States Code. 
   SEC. 3.    No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution.  
  SECTION 1.    Section 10113.95 of the Insurance
Code is amended to read:
   10113.95.  (a) A health insurer that issues, renews, or amends
individual health insurance policies shall be subject to this
section.
   (b) An insurer subject to this section shall have written
policies, procedures, or underwriting guidelines establishing the
criteria and process whereby the insurer makes its decision to
provide or to deny coverage to individuals applying for coverage and
sets the rate for that coverage. These guidelines, policies, or
procedures shall assure that the plan rating and underwriting
criteria comply with Sections 10140 and 10291.5 and all other
applicable provisions.
   (c) On or before June 1, 2006, and annually thereafter, every
insurer shall file with the commissioner a general description of the
criteria, policies, procedures, or guidelines that the insurer uses
for rating and underwriting decisions related to individual health
insurance policies, which means automatic declinable health
conditions, health conditions that may lead to a coverage decline,
height and weight standards, health history, health care utilization,
lifestyle, or behavior that might result in a decline of coverage or
severely limit the health insurance products for which an individual
would be eligible. An insurer may comply with this section by
submitting to the department underwriting materials or resource
guides provided to agents and brokers, provided that those materials
include the information required to be submitted by this section.
   (d) Commencing September 1, 2006, the commissioner shall post on
the department's Internet Web site, in a manner accessible and
understandable to consumers, general, noncompany specific information
about rating and underwriting criteria and practices in the
individual market and information about the California Major Risk
Medical Insurance Program. The commissioner shall develop the
information for the Internet Web site in consultation with the
Department of Managed Health Care to enhance the consistency of
information provided to consumers. Information about individual
health insurance shall also include the following notification:
   "Please examine your options carefully before declining group
coverage or continuation coverage, such as COBRA, that may be
available to you. You should be aware that companies selling
individual health insurance typically require a review of your
medical history that could result in a higher premium or you could be
denied coverage entirely."
   (e) Nothing in this section shall authorize public disclosure of
company-specific rating and underwriting criteria and practices
submitted to the commissioner.
   (f) This section shall not apply to a closed block of business, as
defined in Section 10176.10.