BILL NUMBER: SB 746	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Leno

                        FEBRUARY 22, 2013

   An act to amend Section 1385.04 of the Health and Safety Code,
relating to health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 746, as introduced, Leno. Health care coverage: premium rates.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
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 health care
service plans, for large group plan contracts, at least 60 days in
advance of a rate change, to file with the department all specified
rate information for unreasonable rate increases and, with that
filing, to disclose specified aggregate data.
   This bill would instead require the plans to file all specified
rate information for rate increases that exceed the Consumer Price
Index as published by the United States Bureau of Labor Statistics.
The bill would also require a health plan that exclusively contracts
with no more than 2 medical groups in the state to disclose the
amount of its actual trend experience for the prior contract year by
aggregate benefit category, using benefit categories that are, to the
maximum extent possible, the same or similar to those used for the
individual and small group markets as well as those used by that plan
for the individual and small group markets.
   Because a willful violation of the bill's requirements would be a
crime, this bill would impose a state-mandated local program.
   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 1385.04 of the Health and Safety Code is
amended to read:
   1385.04.  (a) For large group health care service plan contracts,
all health plans shall file with the department at least 60 days
prior to implementing any rate change all required rate information
for  unreasonable  rate increases  that exceed
the Consumer Price Index as published by the United States Bureau of
Labor Statistics  . This filing shall be concurrent with the
written notice described in subdivision (a) of Section 1374.21.
   (b) For large group rate filings, health plans shall submit all
information that is required by PPACA. A plan shall also submit any
other information required pursuant to any regulation adopted by the
department to comply with this article.
   (c) A health care service plan subject to subdivision (a) shall
also disclose the following aggregate data for all rate filings
submitted under this section in the large group health plan market:
   (1) Number and percentage of rate filings reviewed by the
following:
   (A) Plan year.
   (B) Segment type.
   (C) Product type.
   (D) Number of subscribers.
   (E) Number of covered lives affected.
   (2) The plan's average rate increase by the following categories:
   (A) Plan year.
   (B) Segment type.
   (C) Product type.
   (3) Any cost containment and quality improvement efforts since the
plan's last rate filing for the same category of health benefit
plan. To the extent possible, the plan shall describe any significant
new health care cost containment and quality improvement efforts and
provide an estimate of potential savings together with an estimated
cost or savings for the projection period. 
   (4) A health care service plan that exclusively contracts with no
more than two medical groups in the state to provide or arrange for
professional medical services for the enrollees of the plan shall
disclose both of the following:  
    (A) The amount of its actual trend experience for the prior
contract year by aggregate benefit category, using benefit categories
that are, to the maximum extent possible, the same or similar to
those used for the individual and small group markets.  
   (B) The amount of its actual trend experience for the prior
contract year by aggregate benefit category, using benefit categories
that are, to the maximum extent possible, the same or similar to
those used by it for the individual and small group markets. 
   (d) The department may require all health care service plans to
submit all rate filings to the National Association of Insurance
Commissioners' System for Electronic Rate and Form Filing (SERFF).
Submission of the required rate filings to SERFF shall be deemed to
be filing with the department for purposes of compliance with this
section.
  SEC. 2.  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.