BILL ANALYSIS
AB 1825
Page 1
ASSEMBLY THIRD READING
AB 1825 (De La Torre)
As Introduced February 11, 2010
Majority vote
HEALTH 12-6 APPROPRIATIONS 12-5
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|Ayes:|Monning, Ammiano, Carter, |Ayes:|Fuentes, Ammiano, |
| |Caballero, Eng, Hayashi, | |Bradford, Charles |
| |Hernandez, Jones, Bonnie | |Calderon, Coto, Davis, |
| |Lowenthal, Nava, | |Monning, Ruskin, Skinner, |
| |V. Manuel Perez, Salas | |Solorio, Torlakson, |
| | | |Torrico |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Fletcher, Conway, |Nays:|Conway, Harkey, Miller, |
| |Emmerson, Gaines, Smyth, | |Nielsen, Norby |
| |Audra Strickland | | |
| | | | |
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SUMMARY : Requires every individual or group health insurance
policy, as specified, to cover maternity services, as defined.
Specifically, this bill :
1)Requires a health insurer with respect to a pending or
approved individual or group health insurance policy form on
file with the California Department of Insurance (CDI) as of
January 1, 2011, to submit to CDI, on or before March 1, 2011,
a revised policy form that provides coverage for maternity
services.
2)Requires that the corresponding policy issued, amended, or
renewed on or after 30 days following CDI's approval of the
revised form to include coverage for maternity services.
3)Defines "maternity services" to include prenatal care,
ambulatory care maternity services, involuntary complications
of pregnancy, neonatal care, and inpatient hospital maternity
care, including labor and delivery and postpartum care.
4)Exempts from the provisions of this bill specialized health
insurance, Medicare supplement insurance, short-term limited
duration health insurance, Civilian Health and Medical Program
AB 1825
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of the Uniformed Services (CHAMPUS)-supplement insurance, or
TRI-CARE supplemental insurance, or hospital indemnity,
accident-only, or specified disease insurance.
EXISTING LAW :
1)Provides for the regulation of health plans by the Department
of Managed Health Care (DMHC) under the Knox-Keene Health Care
Service Plan Act of 1975 (Knox-Keene) and for the regulation
of health insurers by CDI under the Insurance Code.
2)Requires health plans under Knox-Keene to cover a number of
basic health care services and permits DMHC to define the
scope of the services and to exempt plans from the requirement
for good cause.
3)Provides, under Knox-Keene, that "basic health care services"
include: a) physician services, including consultation and
referral; b) hospital inpatient services and ambulatory care
services; c) diagnostic laboratory and diagnostic and
therapeutic radiological services; d) home health services; e)
preventive health services; f) emergency health care services,
including ambulance and ambulance transport services and
out-of-area coverage; and, g) hospice care.
4)Provides, under Knox-Keene, that health plans must provide all
medically necessary basic health care services, including
maternity services necessary to prevent serious deterioration
of the health of the enrollee or the enrollee's fetus, and
preventive health care services, specifically including
prenatal care.
5)Prohibits health plans and health insurers from issuing
contracts and policies that contain a copayment or deductible
for inpatient hospital or ambulatory care maternity services
that exceed the most common amount charged for the same type
of care and services provided for other covered medical
conditions.
6)Prohibits health plans and health insurers providing maternity
benefits for a person covered continuously from conception
from attaching any exclusions, reductions, or limitations to
coverage for involuntary complications of pregnancy unless
those provisions apply to all of the benefits paid by the plan
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or insurer.
FISCAL EFFECT : According to the Assembly Appropriations
Committee and the California Health Benefits Review Program,
this bill will have the following fiscal impact:
1)No direct state fiscal impact for publicly supported health
coverage provided through Medi-Cal, CalPERS, or Healthy
Families.
2)Increased premium costs in the individual insurance market of
$120 million. Increased premium costs are largely offset by a
reduction in out-of-pocket costs for women who would otherwise
pay for a variety of services not covered by insurance in the
absence of this mandate.
COMMENTS : The author asserts that one of the latest trends in
the individual market is for insurers to exclude maternity care
from their basic plan benefits to sell cheaper products to
target populations. As more employers are dropping employee
health coverage, the author contends that insurance companies
are increasingly targeting the young, uninsured population of
the market with non-maternity products, even though 25% of these
individuals are women of childbearing age. The author argues
that these types of non-maternity products delay and restrict
access to prenatal care, which can lead to serious health
complications for both the mother and the baby, and force more
women into state-funded programs, such as Medi-Cal or Access for
Infants and Mothers.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097
FN: 0004601