BILL NUMBER: AB 314 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 9, 2013
INTRODUCED BY Assembly Member Pan
FEBRUARY 12, 2013
An act to amend Section 1367.001 of add
Section 1367.004 to 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 amended, 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 prohibit
a plan directly operated by a bona fide public or private
institution of higher learning college or
university 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 from
establishing an annual limit or a lifetime limit on the dollar value
of benefits for any participant or beneficiary . 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 1367.004 is added to the
Health and Safety Code , to read:
1367.004. (a) Notwithstanding Section 1343, a plan directly
operated by a public or private college or university that directly
provides health care services only to its students, faculty, staff,
administration, and their respective dependents shall not establish
any of the following:
(1) A lifetime limit on the dollar value of benefits for any
participant or beneficiary.
(2) An annual limit on the dollar value of benefits for any
participant or beneficiary.
(b) This section does not establish any other requirements under
this chapter upon a plan described in subdivision (a).
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.
(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.
(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. SEC. 2. 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.