AB 314, as introduced, Pan. Health care coverage: self-funded student plans and policies.
Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms that take effect January 1, 2014. Among other things, PPACA prohibits a health insurance issuer issuing health insurance coverage from establishing lifetime limits or unreasonable annual limits on the dollar value of benefits for any participant or beneficiary, as specified.
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. That act does not apply to a plan directly operated by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents. Existing law also provides for the regulation of health insurers by the Department of Insurance.
Existing law requires every health care service plan or health insurer that issues, sells, renews, or offers contracts or policies for health care coverage in this state to comply, to the extent required by federal law, with the requirements of the above-described provision of PPACA and any rules or regulations issued under that provision.
This bill would additionally impose those requirements, to the extent required by federal law, on a plan directly operated by a bona fide public or private institution of higher learning that directly provides health care services only to its students, faculty, staff, administration, and their respective dependents or a health insurance policy directly offered by such an institution only to those persons. Because a willful violation of these requirements with respect to those 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 1367.001 of the Health and Safety Code
2 is amended to read:
(a) To the extent required by federal law, every
4health care service plan that issues, sells, renews, or offers contracts
5for health care coverage in this state shall comply with the
6requirements of Section 2711 of the federal Public Health Service
7Act (42 U.S.C. Sec. 300gg-11) and any rules or regulations issued
8under that section, in addition to any state laws or regulations that
9do not prevent the application of those requirements.
10(b) Notwithstanding Section 1343, this section shall apply to a
11plan directly operated by a bona fide public or private institution
12of higher learning that directly provides health care services only
13to its students, faculty, staff, administration,
and their respective
14dependents.
15(b)
end delete
16begin insert(c)end insert Nothing in this section shall be construed to apply to a health
17care service plan contract or insurance policy issued, sold, renewed,
18or offered for health care services or coverage provided in the
19Medi-Cal program (Chapter 7 (commencing with Section 14000)
20of Part 3 of Division 9 of the Welfare and Institutions Code), the
P3 1Healthy Families Program (Part 6.2 (commencing with Section
212693) of Division 2 of the Insurance Code), the Access for Infants
3and Mothers Program (Part 6.3 (commencing with Section 12695)
4of Division 2 of the Insurance Code),
the California Major Risk
5Medical Insurance Program (Part 6.5 (commencing with Section
612700) of Division 2 of the Insurance Code), or the Federal
7Temporary High Risk Insurance Pool (Part 6.6 (commencing with
8Section 12739.5) of Division 2 of the Insurance Code), to the extent
9consistent with the federal Patient Protection and Affordable Care
10Act (Public Law 111-148).
Section 10112.1 of the Insurance Code is amended to
12read:
(a) To the extent required by federal law, every health
14insurer that issues, sells, renews, or offers policies for health care
15coverage in this state shall comply with the requirements of Section
162711 of the federal Public Health Service Act (42 U.S.C. Sec.
17300gg-11) and any rules or regulations issued under that section,
18in addition to any state laws or regulations that do not prevent the
19application of those requirements.
20(b) Notwithstanding any other law, this section shall apply to
21a health insurance policy directly offered by a bona fide public or
22private institution of higher learning only to its students, faculty,
23staff, administration, and their respective dependents.
24(b)
end delete
25begin insert(c)end insert Nothing in this section shall be construed to apply to a health
26care service plan contract or insurance policy issued, sold, renewed,
27or offered for health care services or coverage provided in the
28Medi-Cal program (Chapter 7 (commencing with Section 14000)
29of Part 3 of Division 9 of the Welfare and Institutions Code), the
30Healthy Families Program (Part 6.2 (commencing with Section
3112693)), the Access for Infants and Mothers Program (Part 6.3
32(commencing with Section 12695)), the California Major Risk
33Medical Insurance Program (Part 6.5 (commencing with Section
3412700)), or the Federal Temporary High Risk Insurance Pool (Part
356.6 (commencing with Section 12739.5)), to the extent consistent
36with the federal Patient Protection and Affordable Care Act (Public
37Law 111-148).
No reimbursement is required by this act pursuant to
39Section 6 of Article XIII B of the California Constitution because
40the only costs that may be incurred by a local agency or school
P4 1district will be incurred because this act creates a new crime or
2infraction, eliminates a crime or infraction, or changes the penalty
3for a crime or infraction, within the meaning of Section 17556 of
4the Government Code, or changes the definition of a crime within
5the meaning of Section 6 of Article XIII B of the California
6Constitution.
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