Amended in Assembly April 12, 2016

California Legislature—2015–16 Regular Session

Assembly Bill No. 2752

Introduced by Assembly Member Nazarian

February 19, 2016

An act to add Section 1399.7 to the Health and Safety Code, and to add Section 10133.58 to the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

AB 2752, as amended, Nazarian. Health care coverage: continuity of care.

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 Insurance Commissioner.

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Existing law requires certain nongrandfathered health care service plan contracts and health insurance policies to provide for a limit on annual out-of-pocket expenses for covered benefits, as specified. Existing law requires a health care service plan to furnish services in a manner providing continuity of care. Existing law requires a health insurer covering hospital, medical, and surgical expenses on a group basis and that contracts with providers for alternative rates to file a written policy with the Department of Insurance describing how the insurer will facilitate the continuity of care for new insureds receiving services during a current episode of care for an acute condition from a noncontracting provider.

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This bill would declare the intent of the Legislature to enact legislation that would provide greater consumer protections regarding continuity of care for an enrollee or insured, and that would give relief to an enrollee or insured that would prevent an enrollee or insured from paying maximum out-of-pocket expenses twice in one year if the enrollee or insured involuntarily changes health plans or insurers.

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Existing law requires plans and insurers to annually issue specified notices pertaining to health care coverage to enrollees and insureds.

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This bill would require a health care service plan or a health begin delete insurer to annually, every October 1, end delete begin insert insurer, for a health care service plan contract or a health insurance policy that is issued, renewed, or amended on or after January 1, 2017, to end insert notify an enrollee or insured begin insert in annual renewal materials end insert that the begin delete enrollees’s end delete begin insert enrollee’s end insert or insured’s begin insert prescription end insert drug begin delete treatment end delete is no longer covered by the plan or begin delete policy, end delete begin insert policy or has changed tiers in the plan’s or insurer’s drug formulary, end insert if that is the begin delete case, and that the enrollee’s or insured’s provider is no longer part of the provider network, if that is the end delete case. begin insert The bill would exempt a specialized health care service plan that covers dental or vision services from that requirement. The bill would also require a health care service plan or health insurer, for a health care service plan contract or a health insurance policy that is issued, renewed, or amended on or after January 1, 2017, to include in annual renewal materials information regarding the plan’s provider directory or directories. end insert Because a willful violation of that requirement by a health care service plan would be a crime, the 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:

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SECTION 1.  

It is the intent of the Legislature to enact
legislation that would provide greater consumer protections
regarding continuity of care for an enrollee or insured, and that
would give relief to an enrollee or insured that would prevent him
or her from paying maximum out-of-pocket expense twice in one
year if he or she involuntarily changes health plans or health
insurers.

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begin delete SEC. 2. end delete

begin insert SECTION 1. end insert   

Section 1399.7 is added to the Health and Safety
Code, to read:

1399.7.  

(a)  begin delete Annually every October 1, a end delete begin insert (1) end insert begin insert   end insert begin insert A end insert health care
service begin delete plan end delete begin insert plan, for a health care service plan contract that is
issued, renewed, or amended on or after January 1, 2017, end insert shall
include in begin insert annual end insert renewal materials a notice to an enrollee that
the enrollee’s current begin insert prescription end insert drug begin delete treatment end delete is no longer
covered by the begin delete plan, end delete begin insert plan or has changed tiers in the plan’s drug
formulary, end insert if that is the case.

begin insert

(2) This subdivision does not apply to a specialized health care
service plan that covers dental or vision services.

end insert

(b)  begin delete Annually every October 1, a end delete begin insert A end insert health care service begin delete plan end delete begin insert plan,
for a health care service plan contract that is issued, renewed, or
amended on or after January 1, 2017, end insert shall include in begin insert annual end insert
renewal materials begin delete a notice to an enrollee that the enrollee’s current
provider is no longer part of the health care service plan’s provider
network, if that is the case. end delete begin insert information regarding the health care
service plan’s provider directory or directories. end insert

begin delete SEC. 3. end delete

begin insert SEC. 2. end insert   

Section 10133.58 is added to the Insurance Code, to
read:

10133.58.  

(a)  begin delete Annually every October 1, a end delete begin insert (1) end insert begin insert   end insert begin insert A end insert health begin delete insurer end delete
begin insert insurer, for a health insurance policy that is issued, renewed, or
amended on or after January 1, 2017, end insert shall include in begin insert annual end insert
renewal materials a notice to an insured that the insured’s current
begin insert prescription end insert drug begin delete treatment end delete is no longer covered by the begin delete policy, end delete
begin insert policy or has changed tiers in the insurer’s drug formulary, end insert if that
is the case.

begin insert

(2) This subdivision does not apply to a specialized health
insurance policy that covers dental or vision services.

end insert

(b)  begin delete Annually every October 1, a end delete begin insert A end insert health begin delete insurer end delete begin insert insurer, for a
health insurance policy that is issued, renewed, or amended on or
after January 1, 2017, end insert shall include in begin insert annual end insert renewal materials

begin delete a notice to an insured that the insured’s current provider is no
longer part of the health benefit plan’s provider network, if that is
the case. end delete begin insert information regarding the health insurer’s provider
directory or directories. end insert

begin delete SEC. 4. end delete

begin insert SEC. 3. end insert   

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.