BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
AB 460 (Ammiano) - Health care coverage: infertility.
Amended: June 5, 2013 Policy Vote: Health 7-2
Urgency: No Mandate: Yes
Hearing Date: August 12, 2013
Consultant: Brendan McCarthy
This bill does not meet the criteria for referral to the
Suspense File.
Bill Summary: AB 460 would add non-discrimination language to
the existing mandate that health insurers and health plans offer
coverage for the treatment of infertility.
Fiscal Impact:
Minor costs to both the Department of Insurance and
Department of Managed Health Care to enforce the
requirements of the bill (Insurance Fund and Managed Care
Fund). Both departments have indicated that health insurers
and health plans are already subject to general provisions
in law against discrimination by sex or gender in the
provision of benefits. Therefore this bill clarifies
existing law and does not create a new obligation that must
be enforced.
No anticipated costs to the Medi-Cal program (General Fund
and federal funds). Medi-Cal generally does not provide
coverage for infertility services (unless infertility is a
secondary diagnosis to another medical condition, for which
treatment is covered). Therefore, there is no anticipated
additional cost to Medi-Cal.
No anticipated costs to CalPERS (General Fund and special
funds). CalPERS health plans are subject to regulation by
the Department of Insurance or the Department of Managed
Health care. As noted above, those carriers are already
subject to non-discrimination requirements.
Background: Under current law, health insurers are regulated by
the Department of Insurance and health plans are regulated by
the Department of Managed Health Care (collectively referred to
AB 460 (Ammiano)
Page 1
as "carriers).
Current law requires carriers in the group market to offer
coverage for infertility services (except for in vitro
fertilization). Carriers do not have to provide coverage, simply
to offer it to purchasers (typically employers who are
purchasing coverage on behalf of their employees).
Current law generally prohibits carriers from discriminating in
the provision of benefits based on race, color, national origin,
sex, marital status, or sexual orientation.
Proposed Law: AB 460 would add non-discrimination language to
the existing mandate that health insurers and health plans offer
coverage for the treatment of infertility.
Specifically, the bill would require coverage for infertility to
be offered, and if purchased, to be provided without
discrimination with regard to age, ancestry, color, disability,
domestic partner status, gender, gender expression, gender
identity, genetic information, marital status, national origin,
race, religion, sex, or sexual orientation. The bill specifies
that it shall not be construed to interfere with the clinical
judgment of a physician and surgeon.
Related Legislation:
AB 219 (Perea) would set maximum cost-sharing amounts for
oral anticancer drugs. That bill will be heard in this
committee.
AB 889 (Frazier) would limit the ability of health insurers
and health plans to use step therapy protocols for
prescription drugs. That bill will be heard in this
committee.
AB 912 (Quirk-Silva) would require every health insurance
policy and health plan contract to provide coverage for
medically necessary fertility preservation services when
medical treatment may cause infertility. That bill will be
heard in this committee.
Staff Comments: Under the federal Affordable Care Act, states
are authorized to designate the essential health benefits
benchmark plan. Under federal law, non-grandfathered plans in
the small group and individual markets are required to provide
at least the same level of benefits as is provided in the
AB 460 (Ammiano)
Page 2
benchmark plan. The state has selected the Kaiser Small Group
HMO as the state's benchmark plan. Under federal law, if a state
mandates any new benefits to be covered, any costs for
subsidizing those benefits in a state or federal health benefit
exchange would be the financial responsibility of the state.
Because the current infertility mandate only requires carriers
to offer to cover infertility treatments, this is not considered
a benefit mandate under federal law. Therefore, the changes to
that mandate in this bill would not expand the state's essential
health benefits and would not require any state subsidy in the
California Health Benefit Exchange.
The only costs that may be incurred by a local government under
the bill relate to crimes and infractions. Under the California
Constitution, such costs are not reimbursable by the state.