BILL NUMBER: AB 314 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Pan
FEBRUARY 12, 2013
An act to amend Section 1367.001 of the Health and Safety Code,
and to amend Section 10112.1 of the Insurance Code, relating to
health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
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 1. Section 1367.001 of the Health and Safety Code is
amended to read:
1367.001. (a) To the extent required by federal law, every health
care service plan that issues, sells, renews, or offers contracts
for health care coverage in this state shall comply with the
requirements of Section 2711 of the federal Public Health Service Act
(42 U.S.C. Sec. 300gg-11) and any rules or regulations issued under
that section, in addition to any state laws or regulations that do
not prevent the application of those requirements.
(b) Notwithstanding Section 1343, this section shall 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.
(b)
(c) Nothing in this section shall be construed to apply
to a health care service plan contract or insurance policy issued,
sold, renewed, or offered for health care services or coverage
provided in the Medi-Cal program (Chapter 7 (commencing with Section
14000) of Part 3 of Division 9 of the Welfare and Institutions Code),
the Healthy Families Program (Part 6.2 (commencing with Section
12693) of Division 2 of the Insurance Code), the Access for Infants
and Mothers Program (Part 6.3 (commencing with Section 12695) of
Division 2 of the Insurance Code), the California Major Risk Medical
Insurance Program (Part 6.5 (commencing with Section 12700) of
Division 2 of the Insurance Code), or the Federal Temporary High Risk
Insurance Pool (Part 6.6 (commencing with Section 12739.5) of
Division 2 of the Insurance Code), to the extent consistent with the
federal Patient Protection and Affordable Care Act (Public Law
111-148).
SEC. 2. Section 10112.1 of the Insurance Code is amended to read:
10112.1. (a) To the extent required by federal law, every health
insurer that issues, sells, renews, or offers policies for health
care coverage in this state shall comply with the requirements of
Section 2711 of the federal Public Health Service Act (42 U.S.C. Sec.
300gg-11) and any rules or regulations issued under that section, in
addition to any state laws or regulations that do not prevent the
application of those requirements.
(b) Notwithstanding any other law, this section shall apply to a
health insurance policy directly offered by a bona fide public or
private institution of higher learning only to its students, faculty,
staff, administration, and their respective dependents.
(b)
(c) Nothing in this section shall be construed to apply
to a health care service plan contract or insurance policy issued,
sold, renewed, or offered for health care services or coverage
provided in the Medi-Cal program (Chapter 7 (commencing with Section
14000) of Part 3 of Division 9 of the Welfare and Institutions Code),
the Healthy Families Program (Part 6.2 (commencing with Section
12693)), the Access for Infants and Mothers Program (Part 6.3
(commencing with Section 12695)), the California Major Risk Medical
Insurance Program (Part 6.5 (commencing with Section 12700)), or the
Federal Temporary High Risk Insurance Pool (Part 6.6 (commencing with
Section 12739.5)), to the extent consistent with the federal Patient
Protection and Affordable Care Act (Public Law 111-148).
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.