Amended in Senate July 9, 2015

Amended in Assembly June 3, 2015

Amended in Assembly May 5, 2015

Amended in Assembly March 26, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 1102

Introduced by Assembly Member Santiago

February 27, 2015

An act to begin delete amend Section 1399.849 of the Health and Safety Code, and to amend Section 10965.3 of the Insurance Code, end delete begin insert add Section 15849 to the Welfare and Institutions Code, end insert relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

AB 1102, as amended, Santiago. Health care coverage: begin delete special enrollment periods: triggering event. end delete begin insert Medi-Cal Access Program: disclosures. end insert

begin insert

Existing federal law, the Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms as of January 1, 2014. Among other things, PPACA requires each state to establish an American Health Benefits Exchange and allows qualified individuals to obtain premium assistance for coverage purchased through the Exchange. PPACA specifies that this premium assistance is not available if the individual is eligible for affordable employer-sponsored coverage that provides minimum value, as specified.

end insert begin insert

Existing law establishes the Medi-Cal Access Program, administered by the State Department of Health Care Services. Existing law creates the California Major Risk Medical Insurance Program (MRMIP), which is administered by the Managed Risk Medical Insurance Board, to arrange for major risk medical coverage for eligible residents of the state who are unable to secure adequate private health care coverage.

end insert begin insert

This bill would require the State Department of Health Care Services to inform applicants who are rejected for Medi-Cal Access Program coverage of other coverage options through MRMIP and Covered California, and direct applicants how to receive more information on Covered California and MRMIP, as specified.

end insert begin delete

Existing federal law, the Patient Protection and Affordable Care Act (PPACA), enacts various health care coverage market reforms as of January 1, 2014. Among other things, PPACA requires each state, by January 1, 2014, to establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers, and requires each exchange to provide for an initial open enrollment period, annual open enrollment periods, and special enrollment periods.

end delete begin delete

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 also provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer, on and after October 1, 2013, to offer, market, and sell all of the plan’s or insurer’s health benefit plans that are sold in the individual market for policy years on or after January 1, 2014, to all individuals and dependents in each service area in which the plan or insurer provides or arranges for the provision of health care services, as specified, but requires plans and insurers to limit enrollment in individual health benefit plans to specified open enrollment and special enrollment periods. Existing law requires a health care service plan and health insurer to allow an individual to enroll in or change individual health benefit plans as a result of specified triggering events, including that he or she gains a dependent.

end delete begin delete

This bill would require, on and after January 1, 2017, and until October 1, 2020, a health care service plan or health insurer to allow an individual who does not have minimum essential coverage to enroll in an individual health benefit plan if the individual becomes pregnant. Because a willful violation of this requirement by a health care service plan would be a crime, this bill would impose a state-mandated local program.

end delete begin delete

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.

end delete begin delete

This bill would provide that no reimbursement is required by this act for a specified reason.

end delete

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program:  begin delete yes end delete begin insert no end insert .

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 15849 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

begin insert

begin insert 15849. end insert   

If an applicant is rejected for coverage, the department
shall inform the applicant about the California Major Risk Medical
Insurance Program (MRMIP) (Part 6.5 (commencing with Section
12700) of Division 2 of the Insurance Code) and about the
coverage options and the potential for subsidized coverage through
Covered California. The department shall direct persons seeking
more information to MRMIP, Covered California, plan or policy
representatives, insurance agents, or an entity paid by Covered
California to assist with health coverage enrollment, such as a
navigator or an assister.

end insert

All matter omitted in this version of the bill appears in the bill as amended in the Assembly, June 3, 2015. (JR11)