AB 1018, as introduced, Conway. Health care service plans: transfers to different individual plans.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (the Knox-Keene Act), provides for the licensure and 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 requires a health care service plan to permit an individual who has been covered for at least 18 months under an individual plan contract to transfer, without medical underwriting, as defined, to another individual plan contract offered by the same health care service plan, that provides equal or lesser benefits.
This bill would make technical, nonsubstantive changes to these provisions.
Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 1389.5 of the Health and Safety Code is
2amended to read:
(a) This section shall apply to a health care service
2plan that provides coverage under an individual plan contract that
3is issued, amended, delivered, or renewed on or after January 1,
42007.
5(b) At least once each year, the health care service plan shall
6permit an individual who has been covered for at least 18 months
7under an individual plan contract to transfer, without medical
8underwriting, to any other individual plan contract offered by that
9same health care service plan that provides equal or lesser benefits,
10as determined by the plan.
11“Without medical underwriting” means that the health care
12service plan shall not decline to offer coverage to, or deny
13enrollment of, the
individual or imposebegin delete anyend deletebegin insert aend insert preexisting condition
14exclusion on the individual who transfers to another individual
15plan contract pursuant to this section.
16(c) The plan shall establish, for the purposes of subdivision (b),
17a ranking of the individual plan contracts it offers to individual
18purchasers andbegin insert eitherend insert post the ranking on its Internet Web site or
19make the ranking available upon request. The plan shall update
20the ranking whenever a new benefit design for individual
21purchasers is approved.
22(d) The plan shall notify in writing all enrollees of the right to
23transfer to another
individual plan contract pursuant to this section,
24at a minimum, when the plan changes the enrollee’s premium rate.
25Posting this information on the plan’s Internet Web site shall not
26constitute notice for purposes of this subdivision. The notice shall
27adequately inform enrollees of the transfer rights provided under
28this section, including information on the process to obtain details
29about the individual plan contracts available to that enrollee and
30advising that the enrollee may be unable to return to his or her
31current individual plan contract if the enrollee transfers to another
32individual plan contract.
33(e) The requirements of this section shall not apply to the
34following:
35(1) A federally eligible defined individual, as defined in
36subdivision (c) of Section 1399.801, who is enrolled in an
37individual health benefit plan contract offered pursuant to Section
381366.35.
39(2) An individual offered conversion coverage pursuant to
40Section 1373.6.
P3 1(3) Individual coverage under a specialized health care service
2plan contract.
3(4) An individual enrolled in the Medi-Cal program pursuant
4to Chapter 7 (commencing with Section 14000) of Division 9 of
5Part 3 of the Welfare and Institutions Code.
6(5) An individual enrolled in the Access for Infants and Mothers
7Program pursuant to Part 6.3 (commencing with Section 12695)
8of Division 2 of the Insurance Code.
9(6) An individual enrolled in the Healthy Families Program
10pursuant to Part 6.2 (commencing with Section 12693) of Division
112 of the Insurance Code.
12(f) It is the intent of the Legislature that individualsbegin delete shallend delete have
13more choice in their health coverage when health care service plans
14guarantee the right of an individual to transfer to another product
15based on the plan’s own ranking system. The Legislature does not
16intend for the department to review or verify the plan’s ranking
17for actuarial or other purposes.
O
99