BILL NUMBER: AB 219	AMENDED
	BILL TEXT

	AMENDED IN SENATE  AUGUST 20, 2013
	AMENDED IN SENATE  JULY 2, 2013
	AMENDED IN SENATE  JUNE 19, 2013
	AMENDED IN SENATE  JUNE 17, 2013

INTRODUCED BY   Assembly Member Perea
   (Coauthors: Assembly Members Olsen  , Wieckowski,  and
Williams)
   (Coauthor: Senator Wright)

                        FEBRUARY 4, 2013

   An act to add Section 1367.656 to the Health and Safety Code, and
to add Section 10123.206 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   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,  the cost-sharing
limit   this provision  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 1.  Section 1367.656 is added to the Health and Safety
Code, to read:
   1367.656.  (a) Notwithstanding any other law, a  large
group  health care service plan contract issued, amended, or
renewed on or after January 1,  2014,   2015,
 that provides coverage for prescribed, orally administered
anticancer medications shall not require an enrollee to pay a total
cost-sharing amount of more than one hundred dollars ($100) per
filled prescription. 
   (b) Notwithstanding any other law, an individual or small group
health care service plan contract issued, amended, or renewed on or
after January 1, 2015, that provides coverage for prescribed, orally
administered anticancer medications shall not require an enrollee to
pay a total cost-sharing amount of more than one hundred dollars
($100) per filled prescription.  
   (c) 
    (b)  The cost-sharing limit in this section shall not
apply to a health care service plan contract if the plan is a
 high-deductible   high deductible  health
plan, as defined in Section 223 of Title 26 of the United States
Code, and the plan deductible has not been satisfied.
  SEC. 2.  Section 10123.206 is added to the Insurance Code, to read:

   10123.206.  (a) Notwithstanding any other law, a  large
group  health insurance policy issued, amended, or renewed
on or after January 1,  2014,   2015,  that
provides coverage for prescribed, orally administered anticancer
medications shall not require an insured to pay a total cost-sharing
amount of more than one hundred dollars ($100) per filled
prescription. 
   (b) Notwithstanding any other law, an individual or small group
insurance policy issued, amended, or renewed on or after January 1,
2015, that provides coverage for prescribed, orally administered
anticancer medications shall not require an insured to pay a total
cost-sharing amount of more than one hundred dollars ($100) per
filled prescription.  
   (c) 
    (b)  The cost-sharing limit in this section shall not
apply to a health insurance policy if the policy is a 
high-deductible   high deductible  health plan, as
defined in Section 223 of Title 26 of the United States Code, and the
policy deductible has not been satisfied.
  SEC. 3.   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.