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 delete large groupend delete
health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1,begin delete 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,end delete 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 the cost-sharing limitend deletebegin insert this provisionend insert applies only if the plan deductible has been satisfied.
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 delete large groupend delete
4 health care service plan contract issued, amended, or renewed on
5or after January 1,begin delete 2014,end deletebegin insert 2015,end insert that provides coverage for
6prescribed, orally administered anticancer medications shall not
7require an enrollee to pay a total cost-sharing amount of more than
8one hundred 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)
end delete
16begin insert(b)end insert The cost-sharing limit in this section shall not apply to a
17health care service plan contract if the plan is abegin delete high-deductibleend delete
P3 1begin insert high deductible end insert health plan, as defined in Section 223 of Title 26
2of the United States Code, and the plan deductible has not been
3satisfied.
Section 10123.206 is added to the Insurance Code, to
5read:
(a) Notwithstanding any other law, abegin delete large groupend delete
7 health insurance policy issued, amended, or renewed on or after
8January 1,begin delete 2014,end deletebegin insert 2015,end insert that provides coverage for prescribed, orally
9administered anticancer medications shall not require an insured
10to pay a total cost-sharing amount of more than one hundred dollars
11($100) per filled prescription.
12(b) Notwithstanding any other law, an individual or small group
13insurance policy issued, amended, or renewed on or after January
141, 2015, that provides coverage for prescribed, orally administered
15anticancer medications shall not require an insured to pay a total
16cost-sharing amount of more than one hundred dollars ($100) per
17filled
prescription.
18(c)
end delete
19begin insert(b)end insert The cost-sharing limit in this section shall not apply to a
20health insurance policy if the policy is abegin delete high-deductibleend deletebegin insert high
21deductibleend insert health plan, as defined in Section 223 of Title 26 of the
22United States Code, and the policy deductible has not been
23satisfied.
No reimbursement is required by this act pursuant to
25Section 6 of Article XIII B of the California Constitution because
26the only costs that may be incurred by a local agency or school
27district will be incurred because this act creates a new crime or
28infraction, eliminates a crime or infraction, or changes the penalty
29for a crime or infraction, within the meaning of Section 17556 of
30the Government Code, or changes the definition of a crime within
31the meaning of Section 6 of Article XIII B of the California
32Constitution.
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