Amended in Senate June 5, 2013

California Legislature—2013–14 Regular Session

Assembly BillNo. 460


Introduced by Assembly Member Ammiano

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(Coauthor: Assembly Member Atkins)

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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 amended, 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 andbegin insert, if purchased,end insert 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:

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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 contract that is issued, amended, or renewed that
5covers 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
26 that is a health maintenance organization, as defined in Section
271373.10, and that issues, renews, or amends a health care service
P3    1plan contract that provides group coverage for hospital, medical,
2or surgical expenses shall offer the coverage specified in
3subdivision (a), according to the terms and conditions that may be
4agreed upon between the group subscriber and the plan to group
5contractholders with at least 20 employees to whom the plan is
6offered. The plan shall communicate the availability of the
7coverage to those group contractholders and prospective group
8contractholders with whom the plan is negotiating.

9(d)  This section shall not be construed to deny or restrict in any
10way any existing right or benefit to coverage and treatment of
11infertility under an existing law, plan, or policy.

12(e)  This section shall not be construed to require any employer
13that is a religious organization to offer coverage for forms of
14treatment of infertility in a manner inconsistent with the religious
15organization’s religious and ethical principles.

16(f)  begin insert(1)end insertbegin insertend insert This section shall not be construed to require any plan,
17which is a subsidiary of an entity whose owner or corporate
18member is a religious organization, to offer coverage for treatment
19of infertility in a manner inconsistent with that religious
20organization’s religious and ethical principles.

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21 For

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22begin insert(2)end insertbegin insertend insertbegin insertForend insert purposes of this subdivision, “subsidiary” of a specified
23corporation means a corporation more than 45 percent of the voting
24power of which is owned directly, or indirectly through one or
25more subsidiaries, by the specified corporation.

26(g) Coverage for the treatment of infertility shall be offered andbegin insert,
27if purchased, end insert
provided without discrimination on the basis of age,
28ancestry, color, disability, domestic partner status, gender, gender
29expression, gender identity, genetic information, marital status,
30national origin, race, religion, sex, or sexual orientation.begin insert Nothing
31in this subdivision shall be construed to interfere with the clinical
32judgment of a physician and surgeon.end insert

33

SEC. 2.  

Section 10119.6 of the Insurance Code is amended to
34read:

35

10119.6.  

(a) On and after January 1, 1990, every insurer
36issuing, renewing, or amending a policy of disability insurance
37that covers hospital, medical, or surgical expenses on a group basis
38shall offer coverage of infertility treatment, except in vitro
39fertilization, under those terms and conditions as may be agreed
40upon between the group policyholder and the insurer. Every insurer
P4    1shall communicate the availability of that coverage to all group
2policyholders and to all prospective group policyholders with
3whom they are negotiating.

4(b) For purposes of this section, “infertility” means either (1)
5the presence of a demonstrated condition recognized by a licensed
6physician and surgeon as a cause of infertility, or (2) the inability
7to conceive a pregnancy or to carry a pregnancy to a live birth after
8a year or more of regular sexual relations without contraception.
9“Treatment for infertility” means procedures consistent with
10established medical practices in the treatment of infertility by
11licensed physicians and surgeons, including, but not limited to,
12diagnosis, diagnostic tests, medication, surgery, and gamete
13intrafallopian transfer. “In vitro fertilization” means the laboratory
14medical procedures involving the actual in vitro fertilization
15process.

16(c) This section shall not be construed to deny or restrict in any
17way any existing right or benefit to coverage and treatment of
18infertility under an existing law, plan, or policy.

19(d) This section shall not be construed to require any employer
20that is a religious organization to offer coverage for forms of
21treatment of infertility in a manner inconsistent with the religious
22organization’s religious and ethical principles.

23(e) begin insert(1)end insertbegin insertend insert This section shall not be construed to require any
24insurer, which is a subsidiary of an entity whose owner or corporate
25member is a religious organization, to offer coverage for treatment
26of infertility in a manner inconsistent with that religious
27organization’s religious and ethical principles.

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28 For

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29begin insert(2)end insertbegin insertend insertbegin insertForend insert purposes of this subdivision, “subsidiary” of a specified
30corporation means a corporation more than 45 percent of the voting
31power of which is owned directly, or indirectly through one or
32more subsidiaries, by the specified corporation.

33(f) This section applies to every disability insurance policy that
34is issued, amended, or renewed to residents of this state regardless
35of the situs of the contract.

36(g) Coverage for the treatment of infertility shall be offered andbegin insert,
37if purchased, end insert
provided without discrimination on the basis of age,
38ancestry, color, disability, domestic partner status, gender, gender
39expression, gender identity, genetic information, marital status,
40national origin, race, religion, sex, or sexual orientation.begin insert Nothing
P5    1in this subdivision shall be construed to interfere with the clinical
2judgment of a physician and surgeon.end insert

3

SEC. 3.  

No reimbursement is required by this act pursuant to
4Section 6 of Article XIII B of the California Constitution because
5the only costs that may be incurred by a local agency or school
6district will be incurred because this act creates a new crime or
7infraction, eliminates a crime or infraction, or changes the penalty
8for a crime or infraction, within the meaning of Section 17556 of
9the Government Code, or changes the definition of a crime within
10the meaning of Section 6 of Article XIII B of the California
11Constitution.



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