BILL NUMBER: SB 961	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Hernandez
   (Principal coauthor: Assembly Member Monning)

                        JANUARY 10, 2012

   An act to add Section 1374.59 to the Health and Safety Code,
relating to health care service plans.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 961, as introduced, Hernandez. Health care service plans.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensing 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 provides for the licensing
and regulation of health insurers by the Insurance Commissioner. The
California Health Benefit Exchange is governed by a board and the
board is required to facilitate enrollment of qualified individuals
in qualified health plans.
   Existing federal law, the federal Patient Protection and
Affordable Care Act, commencing on and after January 1, 2014,
requires each health insurance issuer that offers health insurance
coverage in the individual or group market in a state to accept every
employer and individual in the state that applies for that coverage
and requires the issuer to renew that coverage. Existing federal law,
commencing on and after January 1, 2014, prohibits discriminatory
premium rates charged by a health insurance issuer for health
insurance coverage offered in the individual or small group market,
as specified, and also prohibits discrimination against individuals
based on health status. Existing federal law, commencing on and after
January 1, 2014, except as otherwise specified, prohibits a group
health plan and a health insurance issuer offering group or
individual health insurance coverage from imposing any preexisting
condition exclusion with respect to that plan or coverage.
   This bill would, to the extent requried by federal law, require a
health care service plan contract to comply with these federal
requirements. The bill would require the department to consult and
coordinate with the commissioner and the Exchange in carrying out
these provisions.
   Because a willful violation of these provisions would constitute 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 1374.59 is added to the Health and Safety Code,
to read:
   1374.59.  (a) To the extent required by federal law, every health
care service plan contract, except a specialized health care service
plan contract, shall comply with the following provisions related to
the offer, sale, issuance, and renewal of health care service plan
contracts, consistent with federal law and implementing rules,
regulations, and federal guidance:
   (1) Guaranteed availability of coverage pursuant to Section 2702
of the Public Health Service Act (42 U.S.C. Sec. 300gg-1).
   (2) Guaranteed renewability of coverage pursuant to Section 2703
of the Public Health Service Act (42 U.S.C. Sec. 300gg-2).
   (3) The portability and nondiscrimination provisions in Sections
2701, 2704, and 2705 of the Public Health Service Act (42 U.S.C.
Secs. 300gg, 300gg-3, and 300gg-4).
   (b) The department shall consult and coordinate with the Insurance
Commissioner in the implementation and enforcement of this section
to ensure uniform and consistent rules, regulations, guidance, and
enforcement for health care service plans sold to individuals in this
state.
   (c) In implementing this section, the department shall, in
addition to the requirements in subdivision (b), consult and
coordinate with the California Health Benefit Exchange established
pursuant to Section 100500 of the Government Code.
  SEC. 2.  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.