BILL NUMBER: SB 1471	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Padilla

                        FEBRUARY 19, 2010

   An act to amend Section 10123.7 of the Insurance Code, relating to
health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1471, as introduced, Padilla. Insurers: orthotic and prosthetic
devices and services.
   Existing law provides for the regulation of health insurers by the
Department of Insurance. Existing law requires health insurers to
provide coverage for orthotic and prosthetic devices and services
under terms and conditions that may be agreed upon between the
policyholder and insurer, and requires that the device be prescribed
by a physician and surgeon or doctor of podiatric medicine acting
within the scope of his or her license or ordered by a licensed
health care provider acting within the scope of his or her license.
   This bill would make a technical, nonsubstantive change to the
above-described provisions.
   Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 10123.7 of the Insurance Code is amended to
read:
   10123.7.  (a) On or after January 1, 1986, every insurer issuing
group health insurance shall offer coverage for orthotic and
prosthetic devices and services under the terms and conditions that
may be agreed upon between the  group policyholder 
 insurer  and the  insurer   group
policyholder  . Every insurer shall communicate the availability
of that coverage to all group policyholders and to all prospective
group policyholders with whom they are negotiating. Any coverage for
prosthetic devices shall include original and replacement devices, as
prescribed by a physician and surgeon or doctor of podiatric
medicine acting within the scope of his or her license. Any coverage
for orthotic devices shall provide for coverage when the device,
including original and replacement devices, is prescribed by a
physician and surgeon or doctor of podiatric medicine acting within
the scope of his or her license, or is ordered by a licensed health
care provider acting within the scope of his or her license. Every
insurer  shall have  has  the right to
conduct a utilization review to determine medical necessity prior to
authorizing these services.
   (b) Notwithstanding subdivision (a), on and after July 1, 2007,
the amount of the benefit for orthotic and prosthetic devices and
services shall be no less than the annual and lifetime benefit
maximums applicable to all benefits in the policy. Any copayment,
coinsurance, deductible, and maximum out-of-pocket amount applied to
the benefit for orthotic and prosthetic devices and services shall be
no more than the most common amounts contained in the policy.
   (c) This section shall not apply to Medicare supplement,
short-term limited duration health insurance, vision-only,
dental-only, or CHAMPUS supplement insurance, or to hospital
indemnity, hospital-only, accident-only, or specified disease
insurance that does not pay benefits on a fixed benefit, cash payment
only basis.