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 a large group health care service plan contract or health
insurance policy issued, amended, or renewed on or after January 1, 2014, 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, 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. The bill would provide that, with respect to a high deductible health plan, as defined,begin delete linked to a health savings account, these provisions shall applyend deletebegin insert the cost-sharing limit appliesend insert only if thebegin delete enrollee’s or insured’send deletebegin insert planend insert
deductible has been satisfiedbegin delete for the yearend delete.
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, a large group
4health 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) With respect to a high deductible health plan linked to a
16health savings account, this section shall apply only if the enrollee’s
17deductible has been satisfied for the year. For purposes of this
18section, “high deductible health plan” shall have the meaning as
P3 1that term is defined in Section 223(c)(2) of Title 26 of the United
2States Code.
3(c) The cost-sharing limit in this section shall not apply to a
4health care service plan contract if the plan is a high-deductible
5health plan, as defined in Section 223 of
Title 26 of the United
6States Code, and the plan deductible has not been satisfied.
Section 10123.206 is added to the Insurance Code, to
8read:
(a) Notwithstanding any other law, a large group
10health insurance policy issued, amended, or renewed on or after
11January 1, 2014, that provides coverage for prescribed, orally
12administered anticancer medications shall not require an insured
13to pay a total cost-sharing amount of more than one hundred dollars
14($100) per filled prescription.
15(b) Notwithstanding any other law, an individual or small group
16insurance policy issued, amended, or renewed on or after January
171, 2015, that provides coverage for prescribed, orally administered
18anticancer medications shall not require an insured to pay a total
19cost-sharing amount of more than one hundred dollars ($100) per
20filled
prescription.
21(c) With respect to a high deductible health plan linked to a
22health savings account, this section shall apply only if the insured’s
23deductible has been satisfied for the year. For purposes of this
24section, “high deductible health plan” shall have the meaning as
25that term is defined in Section 223(c)(2) of Title 26 of the United
26States Code.
27(c) The cost-sharing limit in this section shall not apply to a
28health insurance policy if the policy is a high-deductible health
29plan, as defined in Section 223 of Title 26 of the United States
30Code, and the
policy deductible has not been satisfied.
No reimbursement is required by this act pursuant to
32Section 6 of Article XIII B of the California Constitution because
33the only costs that may be incurred by a local agency or school
34district will be incurred because this act creates a new crime or
35infraction, eliminates a crime or infraction, or changes the penalty
36for a crime or infraction, within the meaning of Section 17556 of
37the Government Code, or changes the definition of a crime within
P4 1the meaning of Section 6 of Article XIII B of the California
2Constitution.
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