BILL NUMBER: SB 51	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Alquist

                        DECEMBER 15, 2010

   An act to add Sections 1367.001 and 1367.003 to the Health and
Safety Code, and to add Sections 10112.1 and 10112.25 to the
Insurance Code, relating to health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 51, as introduced, Alquist. Health care coverage.
   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 the act a crime. Existing law prohibits a health care
service plan from expending for administrative costs, as defined, an
excessive amount of the payments the plan receives for providing
health care services to its subscribers and enrollees.
   Existing law provides for the regulation of health insurers by the
Department of Insurance. The Insurance Commissioner is required to
withdraw approval of an individual or mass-marketed policy of
disability insurance if the commissioner finds that the benefits
provided under the policy are unreasonable in relation to the premium
charged, as specified.
   The federal Patient Protection and Affordable Care Act prohibits a
health insurance issuer issuing health insurance coverage from
establishing lifetime limits or unreasonable annual limits on the
dollar value of benefits for any participant or beneficiary, as
specified. The act also requires a health insurance issuer issuing
health insurance coverage to provide an annual rebate to each
enrollee if the ratio of the amount of the revenue expended by the
issuer on costs to the total amount of premium revenue is less than a
certain percentage, as specified.
   This bill would require health care service plans and health
insurers to comply with the requirements imposed under those
provisions to the extent required under federal law.
   Because a willful violation of those requirements with respect to
health care service plans would be a crime, the 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.
   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 1367.001 is added to the Health and Safety
Code, to read:
   1367.001.  To the extent required by federal law, every health
care service plan that issues, sells, renews, or offers contracts for
health care coverage in this state shall comply with the
requirements of Section 2711 of the federal Public Health Service Act
(42 U.S.C. Sec. 300gg-11) and any rules or regulations issued under
that section, in addition to any state laws or regulations that do
not prevent the application of those requirements.
  SEC. 2.  Section 1367.003 is added to the Health and Safety Code,
to read:
   1367.003.  To the extent required by federal law, every health
care service plan that issues, sells, renews, or offers contracts for
health care coverage in this state shall comply with the
requirements of Section 2718 of the federal Public Health Service Act
(42 U.S.C. Sec. 300gg-18) and any rules or regulations issued under
that section.
  SEC. 3.  Section 10112.1 is added to the Insurance Code, to read:
   10112.1.  To the extent required by federal law, every health
insurer that issues, sells, renews, or offers policies for health
care coverage in this state shall comply with the requirements of
Section 2711 of the federal Public Health Service Act (42 U.S.C. Sec.
300gg-11) and any rules or regulations issued under that section, in
addition to any state laws or regulations that do not prevent the
application of those requirements.
  SEC. 4.  Section 10112.25 is added to the Insurance Code, to read:
   10112.25.  To the extent required by federal law, every health
insurer that issues, sells, renews, or offers policies for health
care coverage in this state shall comply with the requirements of
Section 2718 of the federal Public Health Service Act (42 U.S.C. Sec.
300gg-18) and any rules or regulations issued under that section.
  SEC. 5.  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.