BILL NUMBER: SB 155 AMENDED
AMENDED IN ASSEMBLY JUNE 28, 2011
AMENDED IN SENATE MAY 4, 2011
INTRODUCED BY Senator Evans
( Coauthor: Senator de León
( Coauthors: Assembly Members
Alejo, Ammiano, Blumenfield,
Huffman, and Bonnie Lowenthal )
FEBRUARY 2, 2011
An act to add Section 10123.865 to the Insurance Code, relating to
health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 155, as amended, Evans. 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.
would require new forms for health insurance
policies submitted to the department after January 1, 2012, to
provide coverage for maternity services, as defined. With respect to
policy forms on file with the department as of January 1, 2012, the
bill would require health insurers to submit to the department, on or
before March 1, 2012, 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 , commencing July 1, 2012, would
require every individual and group health insurance policy to provide
coverage for maternity services for all insureds covered under the
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
(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, 2012, a health insurer shall submit to
the department, on or before March 1, 2012, 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
(b) New forms for individual or group policies of health insurance
submitted to the department after January 1, 2012, shall provide
coverage for maternity services.
Commencing no later than July 1, 2012, every individual and group
health insurance policy shall provide coverage for maternity services
for all insureds covered under the policy.
(b) For purposes of this section, "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. This definition of "maternity services" shall remain in effect
until such time as federal regulations and guidance issued pursuant
to the federal Patient Protection and Affordable Care Act (Public Law
111-148) define the scope of benefits to be provided under the
maternity benefit requirement of that act, after which time the
definition of that term under the federal act and associated
regulations and guidance shall apply for purposes of this section.
(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.