BILL NUMBER: AB 460	INTRODUCED
	BILL TEXT


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:

  SECTION 1.  Section 1374.55 of the Health and Safety Code is
amended to read:
   1374.55.  (a)  On and after January 1, 1990, every health care
service plan contract  which   that  is
issued, amended, or renewed that covers hospital, medical, or
surgical expenses on a group basis, where the plan is not a health
maintenance organization as defined in Section 1373.10, shall 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 and the plan. Every plan shall
communicate the availability of that coverage to all group
contractholders and to all prospective group contractholders with
whom they are negotiating.
   (b)  For purposes of this section, "infertility" means either (1)
the presence of a demonstrated condition recognized by a licensed
physician and surgeon as a cause of infertility, or (2) the inability
to conceive a pregnancy or to carry a pregnancy to a live birth
after a year or more of regular sexual relations without
contraception. "Treatment for infertility" means procedures
consistent with established medical practices in the treatment of
infertility by licensed physicians and surgeons including, but not
limited to, diagnosis, diagnostic tests, medication, surgery, and
gamete intrafallopian transfer. "In vitro fertilization" means the
laboratory medical procedures involving the actual in vitro
fertilization process.
   (c)  On and after January 1, 1990, every health care service plan
 which   that  is a health maintenance
organization, as defined in Section 1373.10, and  which
  that  issues, renews, or amends a health care
service plan contract that provides group coverage for hospital,
medical, or surgical expenses shall offer the coverage specified in
subdivision (a), according to the terms and conditions that may be
agreed upon between the group subscriber and the plan to group
contractholders with at least 20 employees to whom the plan is
offered. The plan shall communicate the availability of the coverage
to those group contractholders and prospective group contractholders
with whom the plan is negotiating.
   (d)   Nothing in this   This   
section shall  not be construed to deny or restrict in any
way any existing right or benefit to coverage and treatment of
infertility under an existing law, plan  ,  or policy.
   (e)   Nothing in this   This  section
shall  not  be construed to require any employer that is a
religious organization to offer coverage for forms of treatment of
infertility in a manner inconsistent with the religious organization'
s religious and ethical principles.
   (f)   Nothing in this   This  section
shall  not  be construed to require any plan, which is a
subsidiary of an entity whose owner or corporate member is a
religious organization, to offer coverage for treatment of
infertility in a manner inconsistent with that religious organization'
s religious and ethical principles.
   For purposes of this subdivision, "subsidiary" of a specified
corporation means a corporation more than 45 percent of the voting
power of which is owned directly, or indirectly through one or more
subsidiaries, by the specified corporation. 
   (g) Coverage for the treatment of infertility shall 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. 
  SEC. 2.  Section 10119.6 of the Insurance Code is amended to read:
   10119.6.  (a) On and after January 1, 1990, every insurer issuing,
renewing, or amending a policy of disability insurance 
which   that  covers hospital, medical, or surgical
expenses on a group basis shall offer coverage of infertility
treatment, except in vitro fertilization, under those terms and
conditions as may be agreed upon between the group policyholder and
the insurer. Every insurer shall communicate the availability of that
coverage to all group policyholders and to all prospective group
policyholders with whom they are negotiating.
   (b) For purposes of this section, "infertility" means either (1)
the presence of a demonstrated condition recognized by a licensed
physician and surgeon as a cause of infertility, or (2) the inability
to conceive a pregnancy or to carry a pregnancy to a live birth
after a year or more of regular sexual relations without
contraception. "Treatment for infertility" means procedures
consistent with established medical practices in the treatment of
infertility by licensed physicians and surgeons  , 
including, but not limited to, diagnosis, diagnostic tests,
medication, surgery, and gamete intrafallopian transfer. "In vitro
fertilization" means the laboratory medical procedures involving the
actual in vitro fertilization process.
   (c)  Nothing in this   This   
section shall  not  be construed to deny or restrict in any
way any existing right or benefit to coverage and treatment of
infertility under an existing law, plan  ,  or policy.
   (d)  Nothing in this   This  section
shall  not  be construed to require any employer that is a
religious organization to offer coverage for forms of treatment of
infertility in a manner inconsistent with the religious organization'
s religious and ethical principles.
   (e)  Nothing in this section   This 
 section  shall  not  be construed to require any
insurer, which is a subsidiary of an entity whose owner or corporate
member is a religious organization, to offer coverage for treatment
of infertility in a manner inconsistent with that religious
organization's religious and ethical principles.
   For purposes of this subdivision, "subsidiary" of a specified
corporation means a corporation more than 45 percent of the voting
power of which is owned directly, or indirectly through one or more
subsidiaries, by the specified corporation.
   (f) This section applies to every disability insurance policy
 which   that  is issued, amended, or
renewed to residents of this state regardless of the situs of the
contract. 
   (g) Coverage for the treatment of infertility shall 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. 
  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.