AB 219, as amended, Perea. Health care coverage: cancer treatment.
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 also provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plan contracts and health insurance policies to provide coverage for all generally medically accepted cancer screening tests and requires those contracts and policies to also provide coverage for the treatment of breast cancer. Existing law imposes various requirements on contracts and policies that cover prescription drug benefits.
This bill would prohibit abegin insert
large groupend insert health care service plan contractbegin delete and aend deletebegin insert orend insert health insurance policy issued, amended, or renewed on or after January 1, 2014,begin insert and an individual or small group health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2015,end insert that provides coverage for prescribed, orally administered anticancer medications from requiring an enrollee or insured to pay a total cost-sharing amount of more than $100 per filled prescription.begin insert The bill would provide that these provisions shall only apply to a high deductible health plan, as defined, linked to a
health savings account once an enrollee’s or insured’s deductible has been satisfied for the year.end insert
Because a willful violation of the bill’s requirements relative 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 1367.656 is added to the Health and
2Safety Code, to read:
(a) Notwithstanding any other law, abegin insert large groupend insert
4 health care service plan contract issued, amended, or renewed on
5or after January 1, 2014, that provides coverage for prescribed,
6orally administered anticancer medications shall not require an
7enrollee to pay a total cost-sharing amount of more than one
8hundred dollars ($100) per filled prescription.
9(b) Notwithstanding any other law, an individual or small group
10health care service plan contract issued, amended, or renewed on
11or after January 1, 2015, that provides coverage
for prescribed,
12orally administered anticancer medications shall not require an
13enrollee to pay a total cost-sharing amount of more than one
14hundred dollars ($100) per filled prescription.
15(c) This section shall only apply to a high deductible health plan
16linked to a health savings account once an enrollee’s deductible
17has been satisfied for the year. For purposes of this section, “high
18deductible health plan” shall have the meaning as that term is
19defined in Section 223(c)(2) of Title 26 of the United States Code.
Section 10123.206 is added to the Insurance Code, to
21read:
(a) Notwithstanding any other law, abegin insert large groupend insert
2 health insurance policy issued, amended, or renewed on or after
3January 1, 2014, that provides coverage for prescribed, orally
4administered anticancer medications shall not require an insured
5to pay a total cost-sharing amount of more than one hundred dollars
6($100) per filled prescription.
7(b) Notwithstanding any other law, an individual or small group
8insurance policy issued, amended, or renewed on or after January
91, 2015, that provides coverage for prescribed,
orally administered
10anticancer medications shall not require an insured to pay a total
11cost-sharing amount of more than one hundred dollars ($100) per
12filled prescription.
13(c) This section shall only apply to a high deductible health plan
14linked to a health savings account once an insured’s deductible
15has been satisfied for the year. For purposes of this section, “high
16deductible health plan” shall have the meaning as that term is
17defined in Section 223(c)(2) of Title 26 of the United States Code.
No reimbursement is required by this act pursuant to
19Section 6 of Article XIII B of the California Constitution because
20the only costs that may be incurred by a local agency or school
21district will be incurred because this act creates a new crime or
22infraction, eliminates a crime or infraction, or changes the penalty
23for a crime or infraction, within the meaning of Section 17556 of
24the Government Code, or changes the definition of a crime within
25the meaning of Section 6 of Article XIII B of the California
26Constitution.
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