BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
AB 912 (Quirk-Silva) - Health care coverage: fertility
preservation.
Amended: July 2, 2013 Policy Vote: Health 7-2
Urgency: No Mandate: Yes
Hearing Date: August 12, 2013
Consultant: Brendan McCarthy
This bill meets the criteria for referral to the Suspense File.
Bill Summary: AB 912 would require large group health plans or
health insurance policies to provide coverage for fertility
preservation services when a necessary medical treatment may
cause infertility in the patient.
Fiscal Impact:
Increased health care costs to CalPERS of about $70,000 per
year (various funds) based on an analysis by the California
Health Benefits Review Program. However, CalPERS indicates
that their costs from the bill could be higher, depending on
the demand for fertility preservation services related to
infertility caused by medications and procedures other than
those used to treat cancer.
No anticipated costs to the Medi-Cal program. Under the
law, Medi-Cal managed care plans are not considered "large
group" plans and thus are not impacted by this benefit
mandate.
No anticipated costs to the state to pay for the cost of
subsidizing benefits in the California Health Benefit
Exchange. See below.
One-time costs of about $20,000 for the review of plan
filings by the Department of Managed Health Care (Managed
Care Fund).
Ongoing costs of about $10,000 per year for review of
insurance policy filings by the Department of Insurance
(Insurance Fund).
AB 912 (Quirk-Silva)
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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
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).
Under the federal Patient Protection and Affordable Care Act,
health coverage provided in the small group or individual market
(including through health exchanges) must provide essential
health benefits. The Affordable Care Act specifies the general
categories of benefits that must be provided, which includes
prescription drugs. Under federal guidance, the states will be
able to select an essential health benefits benchmark plan.
After 2014, all coverage provided in the small group and
individual markets must provide coverage equal to or greater
than the coverage provided by the benchmark plan. The state has
selected the Kaiser Small Group HMO as the state's essential
health benefits benchmark plan.
Under federal law, individuals purchasing coverage through
health benefit exchanges will be eligible for subsidies, based
on income, paid by the federal government. Under federal law, if
a state imposes a benefit mandate after January 1, 2012 that
exceeds the benefits provided by the essential health benefits
benchmark plan, the state is responsible for providing the
subsidies for coverage of that mandated benefit.
Certain medical interventions may lead to infertility in the
patient (this is referred to as "iatrogenic infertility"). Most
commonly, anti-cancer treatments such as surgical removal of
reproductive organs, radiation therapy, or chemotherapy can
render a patient infertile. In such cases, some patients elect
to receive fertility preservation treatments before undergoing
treatment for their illness. For example, a male patient may
elect to have sperm frozen or a female patient may elect to have
either unfertilized eggs or a fertilized embryo frozen. These
services are not typically covered by health insurance policies
or health plans. Even if the patient's health insurance policy
or health plan provides coverage for infertility, the patient
AB 912 (Quirk-Silva)
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may not qualify for that coverage because the patient is not
infertile before medical treatment has begun.
Proposed Law: AB 912 would require large group health plans or
health insurance policies to provide coverage for fertility
preservation services when a necessary medical treatment may
cause infertility in the patient.
Related Legislation:
AB 428 (Portantino, 2011) was substantially similar to this
bill. That bill was held on the Assembly Appropriations
Committee's Suspense File.
AB 219 (Perea) would set maximum cost-sharing amounts for
oral anticancer drugs. That bill will be heard in this
committee.
AB 460 (Ammiano) would add non-discrimination language to
the current mandate to offer infertility treatment. 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.
Staff Comments: Because the benefit mandate in this bill is
limited to the large group market and does not impact the small
group or individual markets, this bill does not expand the
state's essential health benefits. Therefore, the bill will not
require health insurers or health plans selling policies in the
California Health Benefit Exchange to provide this mandated
benefit and there will be no state obligation to subsidize such
a mandated benefit.
The only costs to local governments under the bill relate to
crimes and infractions. Under the California Constitution, such
costs are not reimbursable by the state.