BILL NUMBER: AB 2345 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 16, 2010
AMENDED IN ASSEMBLY APRIL 22, 2010
AMENDED IN ASSEMBLY APRIL 8, 2010
INTRODUCED BY Assembly Member De La Torre
FEBRUARY 19, 2010
An act to amend Section 10113.95 of the Insurance Code,
relating to health care coverage. An act to add
Section 1367.001 to the Health and Safety Code, and to add Section
10112.1 to the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 2345, as amended, De La Torre. Individual health care
coverage: health insurers. Health care coverage:
federal health care reform.
Existing law, the federal Patient Protection and Affordable Care
Act, enacts various health care coverage market reforms. With respect
to plan years beginning on and after September 23, 2010, the act
requires health insurance issuers to provide coverage, and not impose
cost-sharing requirements, for certain preventive services.
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 that act a crime. Existing law also provides for the
regulation of health insurers by the Department of Insurance.
This bill would require health care service plan contracts and
health insurance policies issued, amended, renewed, or delivered on
or after September 23, 2010, to provide coverage, and not impose
cost-sharing requirements, for certain preventive services. Because a
willful violation of this requirement by a health care service plan
would be a crime, the bill would impose a state-mandated local
program.
The bill would also state the intent of the Legislature to enact
legislation that would implement other provisions of the federal
Patient Protection and Affordable Care Act, including, among other
things, requiring plans and insurers to provide an internal claims
and appeals process that complies with the federal act and requiring
plans and insurers to comply with certain patient protections
specified in the federal act.
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.
Existing law provides for the regulation of health insurers by the
Department of Insurance and requires a health insurer to have
written policies, procedures, and underwriting guidelines
establishing the criteria and process whereby the insurer makes its
decision to provide or to deny coverage to individuals who apply for
coverage and sets the rate for that coverage. Existing law requires
an insurer to annually file with the commissioner a general
description of the criteria, policies, procedures, or guidelines that
the insurer uses for rating and underwriting decisions related to
individual health insurance policies, as specified.
This bill would additionally require an insurer to annually post
on its Internet Web site that information the insurer uses for rating
and underwriting decisions related to individual health insurance
policies, as specified.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no
yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1367.001 is added to the
Health and Safety Code , to read:
1367.001. (a) (1) Subject to the minimum interval established by
the United States Secretary of Health and Human Services pursuant to
subsection (b) of Section 2713 of the federal Public Health Service
Act, as added by Section 1001 of the federal Patient Protection and
Affordable Care Act (Public Law 111-148), a group or individual
health care service plan contract that is issued, amended, renewed,
or delivered on or after September 23, 2010, shall, at a minimum,
provide coverage for, and shall not impose any cost-sharing
requirements for, all of the following:
(A) Evidence-based items or services that have in effect a rating
of "A" or "B" in the current recommendations of the United States
Preventive Services Task Force.
(B) Immunizations that have in effect a recommendation from the
Advisory Committee on Immunization Practices of the federal Centers
for Disease Control and Prevention with respect to the individual
involved.
(C) With respect to infants, children, and adolescents,
evidence-informed preventive care and screenings provided for in the
comprehensive guidelines supported by the federal Health Resources
and Services Administration.
(D) With respect to women, any additional preventive care and
screenings not described in subparagraph (A) as provided for in the
comprehensive guidelines supported by the federal Health Resources
and Services Administration.
(2) For purposes of this subdivision, the current recommendations
of the United States Preventive Services Task Force regarding breast
cancer screening, mammography, and prevention shall be considered the
most current, other than recommendations issued by the task force in
November of 2009, or within 30 days of that month.
(3) Nothing in this subdivision shall be construed to prohibit a
plan from providing coverage for services in addition to those
recommended by the United States Preventive Services Task Force or to
deny coverage for services that are not recommended by the task
force.
(b) This section shall not apply to Medicare supplement plans or
to coverage offered by specialized health care service plans,
including, but not limited to, ambulance, dental, vision, behavioral
health, chiropractic, and naturopathic.
SEC. 2. Section 10112.1 is added to the
Insurance Code , to read:
10112.1. (a) (1) Subject to the minimum interval established by
the United States Secretary of Health and Human Services pursuant to
subsection (b) of Section 2713 of the federal Public Health Service
Act, as added by Section 1001 of the federal Patient Protection and
Affordable Care Act (Public Law 111-148), a group or individual
health insurance policy that is issued, amended, renewed, or
delivered on or after September 23, 2010, shall, at a minimum,
provide coverage for, and shall not impose any cost-sharing
requirements for, all of the following:
(A) Evidence-based items or services that have in effect a rating
of "A" or "B" in the current recommendations of the United States
Preventive Services Task Force.
(B) Immunizations that have in effect a recommendation from the
Advisory Committee on Immunization Practices of the federal Centers
for Disease Control and Prevention with respect to the individual
involved.
(C) With respect to infants, children, and adolescents,
evidence-informed preventive care and screenings provided for in the
comprehensive guidelines supported by the federal Health Resources
and Services Administration.
(D) With respect to women, any additional preventive care and
screenings not described in subparagraph (A) as provided for in the
comprehensive guidelines supported by the federal Health Resources
and Services Administration.
(2) For purposes of this subdivision, the current recommendations
of the United States Preventive Services Task Force regarding breast
cancer screening, mammography, and prevention shall be considered the
most current, other than recommendations issued by the task force in
November of 2009, or within 30 days of that month.
(3) Nothing in this subdivision shall be construed to prohibit a
health insurer from providing coverage for services in addition to
those recommended by the United States Preventive Services Task Force
or to deny coverage for services that are not recommended by the
task force.
(b) This section shall not apply to specialized health insurance
policies, Medicare supplement policies, CHAMPUS-supplement insurance
policies, TRICARE supplement insurance policies, accident-only
insurance policies, or insurance policies excluded from the
definition of "health insurance" under subdivision (b) of Section
106.
SEC. 3. It is the intent of the Legislature to
enact legislation that would do all of the following:
(a) Prohibit group health plans, other than self-insured plans,
from discriminating in favor of highly compensated individuals as to
eligibility to participate in the plan and benefits included in the
plan in a manner consistent with Section 2716 of the federal Public
Health Service Act (42 U.S.C. Sec. 300gg-16), as added by Section
1001 of, and amended by Section 10101 of, the federal Patient
Protection and Affordable Care Act (Public Law 111-148).
(b) Require health care service plans and health insurers to
provide an internal claims and appeals process that complies with
Section 2719 of the federal Public Health Service Act (42 U.S.C. Sec.
300gg-19), as added by Section 1001 of, and amended by Section 10101
of, the federal Patient Protection and Affordable Care Act (Public
Law 111-148).
(c) Require health care service plans and health insurers to
comply with the patient protections set forth in Section 2719A of the
federal Public Health Service Act (42 U.S.C. Sec. 300gg-19a), as
added by Section 10101 of the federal Patient Protection and
Affordable Care Act (Public Law 111-148).
(d) Require the Department of Managed Health Care and the
Department of Insurance to post a link on their respective Internet
Web sites to the Internet Web site of the federal Department of
Health and Human Services where consumers may easily obtain
information about affordable and comprehensive health care coverage
options under the federal Patient Protection and Affordable Care Act
(Public Law 111-148).
SEC. 4. 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.
SECTION 1. Section 10113.95 of the Insurance
Code is amended to read:
10113.95. (a) A health insurer that issues, renews, or amends
individual health insurance policies shall be subject to this
section.
(b) An insurer subject to this section shall have written
policies, procedures, or underwriting guidelines establishing the
criteria and process whereby the insurer makes its decision to
provide or to deny coverage to individuals applying for coverage and
sets the rate for that coverage. These guidelines, policies, or
procedures shall ensure that the plan rating and underwriting
criteria comply with Sections 10140 and 10291.5 and all other
applicable provisions.
(c) (1) On or before June 1, 2006, and annually thereafter, every
insurer shall file with the commissioner a general description of the
criteria, policies, procedures, or guidelines that the insurer uses
for rating and underwriting decisions related to individual health
insurance policies, which means automatic declinable health
conditions, health conditions that may lead to a coverage decline,
height and weight standards, health history, health care utilization,
lifestyle, or behavior that might result in a decline for coverage
or severely limit the health insurance products for which they would
be eligible.
(2) An insurer may comply with this section by submitting to the
department underwriting materials or resource guides provided to
agents and brokers, provided that those materials include the
information required to be submitted by this section.
(3) January 1, 2011, and annually thereafter, every insurer shall
post on its Internet Web site the information specified in paragraph
(1).
(d) Commencing September 1, 2006, the commissioner shall post on
the department's Web site, in a manner accessible and understandable
to consumers, general, noncompany specific information about rating
and underwriting criteria and practices in the individual market and
information about the Major Risk Medical Insurance Program. The
commissioner shall develop the information for the Web site in
consultation with the Department of Managed Health Care to enhance
the consistency of information provided to consumers. Information
about individual health insurance shall also include the following
notification:
"Please examine your options carefully before declining group
coverage or continuation coverage, such as COBRA, that may be
available to you. You should be aware that companies selling
individual health insurance typically require a review of your
medical history that could result in a higher premium or you could be
denied coverage entirely."
(e) Nothing in this section shall authorize public disclosure of
company-specific rating and underwriting criteria and practices
submitted to the commissioner.
(f) This section shall not apply to a closed block of business, as
defined in Section 10176.10.