BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          AB 1305 (Bonta) - Limitations on cost sharing:  family coverage
          
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          |Version: June 25, 2015          |Policy Vote: HEALTH 8 - 0       |
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          |Urgency: No                     |Mandate: Yes                    |
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          |Hearing Date: August 17, 2015   |Consultant: Brendan McCarthy    |
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          This bill meets the criteria for referral to the Suspense File.


          Bill  
          Summary:  AB 1305 would require out-of-pocket expenditure limits  
          and deductibles for family health plan or health insurance  
          coverage to include out-of-pocket expenditure limits and  
          deductibles for each individual member of the family that are no  
          more than the amounts allowed for individual coverage.


          Fiscal  
          Impact:  
           One-time costs of about $440,000 for policy development and  
            adopting regulations and ongoing costs of about $340,000 per  
            year for the Department of Managed Health Care to update  
            policies and respond to public information requests (Managed  
            Care Fund).

           One-time costs of about $40,000 in 2015-16 and $45,000 in  
            2016-17 to review plan filings for compliance by the  
            Department of Insurance (Insurance Fund). Ongoing costs are  
            expected to be minor.








          AB 1305 (Bonta)                                        Page 1 of  
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           No significant costs to the Medi-Cal program or for health  
            care coverage provided by CalPERS are anticipated. According  
            to the California Health Benefits Review Program, health plans  
            and health insurance policies provided by Medi-Cal and CalPERS  
            are already compliant with the requirements of the bill and  
            therefore would not experience any increased costs.


          Background:  Beginning in 2014, under the federal Patient Protection and  
          Affordable Care Act (Affordable Care Act), total annual  
          out-of-pocket expenditures for health care coverage in the  
          individual, small group, and health benefit exchange markets is  
          limited to roughly $6,000 for an individual and $13,000 for a  
          family. In addition, annual deductibles in the small group  
          market are generally limited to $2,000 for an individual and  
          $4,000 for a family.

          Under current practice, health plans and health insurance  
          products can include both individual out-of-pocket maximums and  
          deductibles as well as family out-of-pocket maximums and  
          deductibles. For example, a health plan for a family of four  
          could have individual deductibles of $1,500 as well as an  
          aggregated family deductible of $3,000. The family's health plan  
          could require both the individual deductible and the family  
          deductible to be met before the health plan coverage begins. For  
          example, if only one member of the family needed significant  
          medical care, that individual could need to pay for medical  
          services up to $3,000 (the family deductible) before coverage  
          began. Whereas, if that member of the family purchased similar  
          coverage as an individual, he or she may only have to pay $1,500  
          before coverage began.

          According to the California Health Benefit Review Program, about  
          98% of health care coverage in the state is already compliant  
          with the requirements of the bill. There are a small number of  
          high-deductible health plans that have aggregated deductibles or  
          out-of-pocket maximums for family members.


          Proposed Law:  
            AB 1305 would require out-of-pocket expenditure limits and  
          deductibles for family health plan or health insurance coverage  
          to include out-of-pocket expenditure limits and deductibles for  
          each individual member of the family that are no more than the  








          AB 1305 (Bonta)                                        Page 2 of  
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          amounts allowed for individual coverage.
          Implementation of the bill's provisions relating to deductibles  
          in large group coverage would go into effect on July 1, 2016.




          Related  
          Legislation:  
           AB 339 (Gordon) would restrict outpatient prescription drug  
            cost-sharing, require coverage for specified drugs under  
            certain circumstances, and standardize tiers for prescription  
            drug coverage. That bill will be heard in this committee.
           SB 639 (Hernandez, Statutes of 2014) codified federal  
            requirements relating to out-of-pocket maximum cost-sharing.




          Staff  
          Comments:  The only costs that may be incurred by a local agency  
          relate to crimes and infractions. Under the California  
          Constitution, such costs are not reimbursable by the state.


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