California Legislature—2013–14 Regular Session

Assembly BillNo. 460


Introduced by Assembly Member Ammiano

February 19, 2013


An act to amend Section 1374.55 of the Health and Safety Code, and to amend Section 10119.6 of the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

AB 460, as introduced, Ammiano. Health care coverage: infertility.

(1) Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the 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 provides for the regulation of health insurers by the Department of Insurance. Existing law also imposes various requirements and restrictions on health care service plans and health insurers, including, among other things, a requirement that every health care service plan contract or health insurance policy that is issued, amended, or renewed on or after January 1, 1990, offer coverage for the treatment of infertility, except in vitro fertilization, under those terms and conditions as may be agreed upon between the group subscriber or the group policyholder and the plan or the insurer, except as provided.

This bill would require that the coverage for the treatment of infertility be offered and provided without discrimination on the basis of age, ancestry, color, disability, domestic partner status, gender, gender expression, gender identity, genetic information, marital status, national origin, race, religion, sex, or sexual orientation. Because a willful violation of the bill’s provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.

(2) 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:

P2    1

SECTION 1.  

Section 1374.55 of the Health and Safety Code
2 is amended to read:

3

1374.55.  

(a)  On and after January 1, 1990, every health care
4service plan contractbegin delete whichend deletebegin insert thatend insert is issued, amended, or renewed
5that covers hospital, medical, or surgical expenses on a group basis,
6where the plan is not a health maintenance organization as defined
7in Section 1373.10, shall offer coverage for the treatment of
8infertility, except in vitro fertilization, under those terms and
9conditions as may be agreed upon between the group subscriber
10and the plan. Every plan shall communicate the availability of that
11coverage to all group contractholders and to all prospective group
12contractholders with whom they are negotiating.

13(b)  For purposes of this section, “infertility” means either (1)
14the presence of a demonstrated condition recognized by a licensed
15physician and surgeon as a cause of infertility, or (2) the inability
16to conceive a pregnancy or to carry a pregnancy to a live birth after
17a year or more of regular sexual relations without contraception.
18“Treatment for infertility” means procedures consistent with
19established medical practices in the treatment of infertility by
20licensed physicians and surgeons including, but not limited to,
21diagnosis, diagnostic tests, medication, surgery, and gamete
22intrafallopian transfer. “In vitro fertilization” means the laboratory
23medical procedures involving the actual in vitro fertilization
24process.

25(c)  On and after January 1, 1990, every health care service plan
26begin delete whichend deletebegin insert thatend insert is a health maintenance organization, as defined in
27Section 1373.10, andbegin delete whichend deletebegin insert thatend insert issues, renews, or amends a health
28care service plan contract that provides group coverage for hospital,
P3    1medical, or surgical expenses shall offer the coverage specified in
2subdivision (a), according to the terms and conditions that may be
3agreed upon between the group subscriber and the plan to group
4contractholders with at least 20 employees to whom the plan is
5offered. The plan shall communicate the availability of the
6coverage to those group contractholders and prospective group
7contractholders with whom the plan is negotiating.

8(d)  begin deleteNothing in this end deletebegin insertThis end insertsection shallbegin insert notend insert be construed to deny
9or restrict in any way any existing right or benefit to coverage and
10treatment of infertility under an existing law, planbegin insert,end insert or policy.

11(e)  begin deleteNothing in this end deletebegin insertThis end insertsection shallbegin insert notend insert be construed to require
12any employer that is a religious organization to offer coverage for
13forms of treatment of infertility in a manner inconsistent with the
14religious organization’s religious and ethical principles.

15(f)  begin deleteNothing in this end deletebegin insertThis end insertsection shallbegin insert notend insert be construed to require
16any plan, which is a subsidiary of an entity whose owner or
17corporate member is a religious organization, to offer coverage
18for treatment of infertility in a manner inconsistent with that
19religious organization’s religious and ethical principles.

20For purposes of this subdivision, “subsidiary” of a specified
21corporation means a corporation more than 45 percent of the voting
22power of which is owned directly, or indirectly through one or
23more subsidiaries, by the specified corporation.

begin insert

24(g) Coverage for the treatment of infertility shall be offered and
25provided without discrimination on the basis of age, ancestry,
26color, disability, domestic partner status, gender, gender
27expression, gender identity, genetic information, marital status,
28national origin, race, religion, sex, or sexual orientation.

end insert
29

SEC. 2.  

Section 10119.6 of the Insurance Code is amended to
30read:

31

10119.6.  

(a) On and after January 1, 1990, every insurer
32issuing, renewing, or amending a policy of disability insurance
33begin delete whichend deletebegin insert thatend insert covers hospital, medical, or surgical expenses on a
34group basis shall offer coverage of infertility treatment, except in
35vitro fertilization, under those terms and conditions as may be
36agreed upon between the group policyholder and the insurer. Every
37insurer shall communicate the availability of that coverage to all
38group policyholders and to all prospective group policyholders
39with whom they are negotiating.

P4    1(b) For purposes of this section, “infertility” means either (1)
2the presence of a demonstrated condition recognized by a licensed
3physician and surgeon as a cause of infertility, or (2) the inability
4to conceive a pregnancy or to carry a pregnancy to a live birth after
5a year or more of regular sexual relations without contraception.
6“Treatment for infertility” means procedures consistent with
7established medical practices in the treatment of infertility by
8licensed physicians and surgeonsbegin insert,end insert including, but not limited to,
9diagnosis, diagnostic tests, medication, surgery, and gamete
10intrafallopian transfer. “In vitro fertilization” means the laboratory
11medical procedures involving the actual in vitro fertilization
12process.

13(c) begin deleteNothing in this end deletebegin insertThis end insertsection shallbegin insert notend insert be construed to deny
14or restrict in any way any existing right or benefit to coverage and
15treatment of infertility under an existing law, planbegin insert,end insert or policy.

16(d) begin deleteNothing in this end deletebegin insertThis end insertsection shallbegin insert notend insert be construed to require
17any employer that is a religious organization to offer coverage for
18forms of treatment of infertility in a manner inconsistent with the
19religious organization’s religious and ethical principles.

20(e) begin deleteNothing in this section end deletebegin insertThis section end insertshallbegin insert notend insert be construed
21to require any insurer, which is a subsidiary of an entity whose
22owner or corporate member is a religious organization, to offer
23coverage for treatment of infertility in a manner inconsistent with
24that religious organization’s religious and ethical principles.

25For purposes of this subdivision, “subsidiary” of a specified
26corporation means a corporation more than 45 percent of the voting
27power of which is owned directly, or indirectly through one or
28more subsidiaries, by the specified corporation.

29(f) This section applies to every disability insurance policy
30begin delete whichend deletebegin insert thatend insert is issued, amended, or renewed to residents of this state
31regardless of the situs of the contract.

begin insert

32(g) Coverage for the treatment of infertility shall be offered and
33provided without discrimination on the basis of age, ancestry,
34color, disability, domestic partner status, gender, gender
35expression, gender identity, genetic information, marital status,
36national origin, race, religion, sex, or sexual orientation.

end insert
37

SEC. 3.  

No reimbursement is required by this act pursuant to
38Section 6 of Article XIII B of the California Constitution because
39the only costs that may be incurred by a local agency or school
40district will be incurred because this act creates a new crime or
P5    1infraction, eliminates a crime or infraction, or changes the penalty
2for a crime or infraction, within the meaning of Section 17556 of
3the Government Code, or changes the definition of a crime within
4the meaning of Section 6 of Article XIII B of the California
5Constitution.



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