BILL NUMBER: SB 54 INTRODUCED
BILL TEXT
INTRODUCED BY Senator Leno
JANUARY 15, 2009
An act to amend Section 1365.5 of the Health and Safety Code, and
to amend Section 10140 of the Insurance Code, relating to health care
coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 54, as introduced, Leno. Health care coverage: pricing.
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 willful
violation of that act a crime. Existing law prohibits health care
service plans from charging premium, price, or charge differentials
because of the sex of any individual, but makes an exception for
differentials based on specified statistical and actuarial data.
This bill would eliminate that exception.
Because a willful violation of this provision by a health care
service plan would be a crime, this bill would impose a
state-mandated local program.
Existing law provides for the regulation of life and disability
insurers by the Department of Insurance. Existing law prohibits life
and disability insurers from engaging in certain discriminatory
practices, but specifies that premium, price, or charge differentials
because of the sex of any individual are not prohibited when based
on specified statistical or actuarial data or sound underwriting
practices.
This bill would prohibit a health insurance policy from being
subject to premium, price, or charge differentials because of the sex
of any individual.
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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1365.5 of the Health and Safety Code is amended
to read:
1365.5. (a) No health care service plan or specialized health
care service plan shall refuse to enter into any contract or shall
cancel or decline to renew or reinstate any contract because of the
race, color, national origin, ancestry, religion, sex, marital
status, sexual orientation, or age of any contracting party,
prospective contracting party, or person reasonably expected to
benefit from that contract as a subscriber, enrollee, member, or
otherwise.
(b) The terms of any contract shall not be modified, and the
benefits or coverage of any contract shall not be subject to any
limitations, exceptions, exclusions, reductions, copayments,
coinsurance, deductibles, reservations, or premium, price, or charge
differentials, or other modifications because of the race, color,
national origin, ancestry, religion, sex, marital status, sexual
orientation, or age of any contracting party, potential contracting
party, or person reasonably expected to benefit from that contract as
a subscriber, enrollee, member, or otherwise; except that premium,
price, or charge differentials because of the sex or
age of any individual when based on objective, valid, and
up-to-date statistical and actuarial data are not prohibited.
Nothing in this section shall be construed to permit a
health care service plan to charge different premium rates to
individual enrollees within the same group solely on the basis of the
enrollee's sex.
(c) It shall be deemed a violation of subdivision (a) for any
health care service plan to utilize marital status, living
arrangements, occupation, sex, beneficiary designation, ZIP Codes or
other territorial classification, or any combination thereof for the
purpose of establishing sexual orientation. Nothing in this section
shall be construed to alter in any manner the existing law
prohibiting health care service plans from conducting tests for the
presence of human immunodeficiency virus or evidence thereof.
(d) This section shall not be construed to limit the authority of
the director to adopt or enforce regulations prohibiting
discrimination because of sex, marital status, or sexual orientation.
(e) "Sex" as used in this section shall have the same meaning as
"gender," as defined in Section 422.56 of the Penal Code.
SEC. 2. Section 10140 of the Insurance Code is amended to read:
10140. (a) No admitted insurer, licensed to issue life or
disability insurance, shall fail or refuse to accept an application
for that insurance, to issue that insurance to an applicant therefor,
or issue or cancel that insurance, under conditions less favorable
to the insured than in other comparable cases, except for reasons
applicable alike to persons of every race, color, religion, sex,
national origin, ancestry, or sexual orientation. Race, color,
religion, national origin, ancestry, or sexual orientation shall not,
of itself, constitute a condition or risk for which a higher rate,
premium, or charge may be required of the insured for that insurance.
Unless otherwise prohibited by law and except as provided in
subdivision (b) , premium, price, or charge differentials
because of the sex of any individual when based on objective, valid,
and up-to-date statistical and actuarial data or sound underwriting
practices are not prohibited.
(b) A health insurance policy shall not be subject to premium,
price, or charge differentials because of the sex of any individual.
(b)
(c) Except as otherwise permitted by law, no admitted
insurer, licensed to issue disability insurance policies for
hospital, medical, and surgical expenses, shall fail or refuse to
accept an application for that insurance, fail or refuse to issue
that insurance to an applicant therefor, cancel that insurance,
refuse to renew that insurance, charge a higher rate or premium for
that insurance, or offer or provide different terms, conditions, or
benefits, or place a limitation on coverage under that insurance, on
the basis of a person's genetic characteristics that may, under some
circumstances, be associated with disability in that person or that
person's offspring.
(c)
(d) No admitted insurer, licensed to issue disability
insurance for hospital, medical, and surgical expenses, shall seek
information about a person's genetic characteristics for any
nontherapeutic purpose.
(d)
(e) No discrimination shall be made in the fees or
commissions of agents or brokers for writing or renewing a policy of
disability insurance, other than disability income, on the basis of a
person's genetic characteristics that may, under some circumstances,
be associated with disability in that person or that person's
offspring.
(e)
(f) It shall be deemed a violation of subdivision (a)
for any insurer to consider sexual orientation in its underwriting
criteria or to utilize marital status, living arrangements,
occupation, sex, beneficiary designation, ZIP Codes or other
territorial classification within this state, or any combination
thereof for the purpose of establishing sexual orientation or
determining whether to require a test for the presence of the human
immunodeficiency virus or antibodies to that virus, where that
testing is otherwise permitted by law. Nothing in this section shall
be construed to alter, expand, or limit in any manner the existing
law respecting the authority of insurers to conduct tests for the
presence of human immunodeficiency virus or evidence thereof.
(f)
(g) This section shall not be construed to limit the
authority of the commissioner to adopt regulations prohibiting
discrimination because of sex, marital status, or sexual orientation
or to enforce these regulations, whether adopted before or on or
after January 1, 1991.
(g)
(h) "Genetic characteristics" as used in this section
shall have the same meaning as defined in Section 10123.3.
(h)
(i) "Sex" as used in this section shall have the same
meaning as "gender," as defined in Section 422.56 of the Penal Code.
SEC. 3. (a) The amendments made by this act to Section 1365.5 of
the Health and Safety Code shall apply to health care service plan
contracts issued, amended, or renewed on or after January 1, 2010.
(b) The amendments made by this act to Section 10140 of the
Insurance Code shall apply to health insurance policies issued,
amended, or renewed on or after January 1, 2010.
SEC. 4. 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.