BILL NUMBER: AB 792 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 30, 2011
AMENDED IN ASSEMBLY MAY 27, 2011
AMENDED IN ASSEMBLY MAY 10, 2011
AMENDED IN ASSEMBLY APRIL 14, 2011
INTRODUCED BY Assembly Member Bonilla
(Coauthor: Assembly Member Huffman)
FEBRUARY 17, 2011
An act to add Sections 2024.7 and 8613.7 to the Family Code, to
add Sections 1366.50 and 1366.51 to the Health and Safety Code, to
add Sections 10786 and 10787 to the Insurance Code, to amend Section
2800.2 of the Labor Code, and to add Sections 1342.5 and 2706.5 to
the Unemployment Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 792, as amended, Bonilla. Health care coverage: California
Health Benefit Exchange.
Existing law, the federal Patient Protection and Affordable Care
Act, requires each state to, by January 1, 2014, establish an
American Health Benefit Exchange that makes available qualified
health plans to qualified individuals and employers. Existing state
law establishes the California Health Benefit Exchange within state
government, specifies the powers and duties of the board governing
the Exchange relative to determining eligibility for enrollment in
the Exchange and arranging for coverage under qualified health plans,
and requires the board to facilitate the purchase of qualified
health plans through the Exchange by qualified individuals and small
employers by January 1, 2014.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the 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 provides for the regulation of health
insurers by the Department of Insurance. Existing law imposes
specified requirements on health care service plans and health
insurers that provide medical and hospital coverage under an
employer-sponsored group plan for an employer, employee association,
or other entity subject to requirements under COBRA or Cal-COBRA, as
defined, and imposes specified requirements on those employers,
employee associations, or other entities to notify its current and
former employees or members and dependents of continuation coverage
and conversion coverage options upon specified events. Existing law
regulates the distribution of unemployment compensation or disability
benefits by the Employment Development Department. Existing law
, under the Family Code, sets forth procedures
related to a petition for dissolution of marriage, nullity of
marriage, or legal separation, or a petition for adoption.
This bill would require the disclosure of information on health
care coverage through the California Health Benefit Exchange, under
specified circumstances, by health care service plans, health
insurers, employers, employee associations or other entities, the
Employment Development Department, upon an initial claim for
disability benefits, or, on and after January 1, 2013, by the court,
upon the filing of a petition for dissolution of marriage, nullity of
marriage, legal separation, or adoption.
On and after January 1, 2014, this bill would also require
specified health care service plans and health insurers to, upon the
failure of an enrollee or insured to renew his or her health
coverage, as specified, or upon termination of coverage under an
employer-sponsored group plan, and the Employment Development
Department with regard to an applicant for unemployment compensation,
transfer specified information to the California Health Benefit
Exchange for purposes of enrolling those individuals or applicants in
the Exchange. The bill would make the automatic enrollment of those
individuals in the Exchange subject to the plan or insurer, or
employer, employee association, or other entity, obtaining the
written consent of the individual at the time the individual or
employer-sponsored group plan contract or policy is issued, amended,
delivered, or renewed, as specified , or upon a qualifying
event, as defined . The bill would make the automatic
enrollment of those individuals by the Employment Development
Department subject to the Exchange receiving approval from the United
States Department of Health and Human Services to transfer the
minimum information necessary to initiate an application for
enrollment, as specified, and provide that enrollment by the
department is only operative to the extent that it is funded out of
non-General Fund moneys. The bill would require the Employment
Development Department to maintain a link on its Internet Web site to
the Internet Web site of the Exchange and information on the
Exchange. The bill would allow an individual who is
enrolled in whose information has been transferred to
the Exchange under those provisions to opt out of that
coverage in writing to discontinue his or her
application for enrollment with the Exchange, as specified.
Because a willful violation of the bill's provisions relative to
health care service plans 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:
SECTION 1. Section 2024.7 is added to the Family Code, to read:
2024.7. On and after January 1, 2013, upon the filing of a
petition for dissolution of marriage, nullity of marriage, or legal
separation, the court shall provide to the petitioner and the
respondent the following notice:
"If you do not have affordable health care coverage, effective
January 1, 2014, you may obtain health care coverage through the
California Health Benefit Exchange. What you pay for coverage through
the Exchange will depend on how much you make. If your income is
low, you may qualify for no-cost coverage through Medi-Cal. For more
information, check www.healthcare.ca.gov or call 1-888-Healthhelp
(insert telephone number)."
"In March of 2010, the federal government passed national health
care reform. Because of this, effective January 1, 2014, you may
become eligible for reduced-cost comprehensive health care coverage
through the California Health Benefit Exchange. To learn more, visit
www.healthexchange.ca.gov or call 1-888-(insert telephone number)."
SEC. 2. Section 8613.7 is added to the Family Code, to read:
8613.7. On and after January 1, 2013, upon the filing of a
petition for adoption pursuant to this part, the court shall provide
to the petitioner the following notice:
"If you do not have affordable health care coverage, effective
January 1, 2014, you may obtain health care coverage through the
California Health Benefit Exchange. What you pay for coverage through
the Exchange will depend on how much you make. If your income is
low, you may qualify for no-cost coverage through Medi-Cal. For more
information, check www.healthcare.ca.gov or call 1-888-Healthhelp
(insert telephone number)."
"In March of 2010, the federal government passed national health
care reform. Because of this, effective January 1, 2014, you may
become eligible for reduced-cost comprehensive health care coverage
through the California Health Benefit Exchange. To learn more, visit
www.healthexchange.ca.gov or call 1-888-(insert telephone number)."
SEC. 3. Section 1366.50 is added to the Health and Safety Code, to
read:
1366.50. (a) (1) Except for a specialized
health care service plan, every health care service plan contract
that is issued, amended, delivered, or renewed in this state on or
after January 1, 2014, that provides medical and hospital coverage
under an employer-sponsored group plan for an employer subject to
COBRA, as defined in subdivision (e) of Section 1373.621, or an
employer group for which the plan is required to offer Cal-COBRA
coverage, as defined in subdivision (f) of Section 1373.621,
including a carrier providing replacement coverage under Section
1399.63, shall, consistent with this section, transfer information to
the Exchange in order to initiate an application for enrollment
for a former employee or former dependent of an employee. At
the time that the health care service plan contract is issued,
amended, delivered, or renewed on or after January 1, 2012, the
for a qualified beneficiary upon a qualifying event.
(2) Prior to the transfer of the
information to the Exchange, the health care service plan shall
obtain the written consent of the enrollee to provide the
minimum necessary information to the Exchange in the event
that the individual or dependent ceases to be enrolled in coverage
under an employer-sponsored group plan . If the individual
does not provide his or her consent, the health care service plan
shall not transfer any information regarding that individual to the
Exchange. Consent may be obtained at the time of the qualifying
event.
(b) (1) The health care service plan shall provide to the
California Health Benefit Exchange information regarding the former
employee and any dependents covered under the group coverage. The
information provided shall include the name or names, most recent
address, and any other information that is in the possession of the
plan and that the Exchange may require in order to determine
eligibility, facilitate enrollment in coverage, and maximize
continuity of care, and shall be provided in a manner to be
prescribed by the Exchange. The information shall be provided in a
manner consistent with Section 1411 of the federal Patient Protection
and Affordable Care Act (Public Law 111-148) and consistent
with other state and federal medical privacy laws .
(2) The provision of this information shall initiate an
application for enrollment in coverage within the meaning of Section
100503 of the Government Code. Nothing in this section shall be
construed to alter the responsibility of the Exchange or other state
and local government entities with respect to the criteria and
process for eligibility and enrollment in the Exchange and other
public health care coverage programs.
(c) (1) On and after January 1, 2012, until December 31, 2013, the
health care service plan shall provide the following notification
to employees, members, former employees, spouses, or former
spouses: to qualified beneficiaries upon a qualifying
event:
"Please examine your options carefully before declining this
coverage. Until January 1, 2014, you should be aware that companies
selling individual health insurance to adults who are 19 years of age
or older typically require a review of your medical history that
could result in a higher premium or you could be denied coverage
entirely. Effective January 1, 2010, children under 19 years of age
cannot be denied individual coverage based on medical history, but
may pay a higher premium depending on medical history."
(2) On and after January 1, 2014, notification provided to
employees, members, former employees, dependents, or former
dependents qualified beneficiaries upon a qualifying
event shall also include the following notification in 12-point
type:
"Because you are no longer enrolled in coverage provided by your
employer or the employer of a family member, an application for
health care coverage through the California Health Benefit Exchange
has been made for you. You are not required to accept coverage from
the Exchange. Your payment for this coverage will be based on your
income last year. If you make significantly less or more this year
than you made last year, please tell the California Health Benefit
Exchange and your charges will be based on your current income. If
your income is low, you may qualify for no-cost coverage through
Medi-Cal. For more information, check www.healthcare.ca.gov or call
1-888-Healthhelp (insert telephone number)."
"In March of 2010, the federal government passed national health
care reform. Because of this, you may be eligible for reduced-cost
comprehensive health care coverage through the California Health
Benefit Exchange. Because you are losing your coverage from your
employer or the employer of a family member, an application will be
sent to the California Health Benefit Exchange to make it easier for
you to get health care coverage.
Eligibility for reduced-cost coverage through the California
Health Benefit Exchange or no-cost coverage through Medi-Cal is based
on your income. You will be contacted by the Exchange to complete
the application. You are not required to accept coverage from the
Exchange. To learn more, or to contact the Exchange, visit
www.healthexchange.ca.gov or call 1-888-(insert telephone number)."
(3) To decline health care coverage from the Exchange pursuant to
this section, the individual shall elect to do so by notifying the
Exchange in writing within 63 calendar days of the date of
termination of group coverage.
(3) A person for whom an application for enrollment in the
Exchange has been initiated by the transfer of information under this
section shall be given the opportunity to provide informed consent
to use the transferred information to commence eligibility
determination and complete enrollment as well as the opportunity to
correct any transferred information or provide additional information
before a final eligibility determination is made. If the individual
fails to consent or fails to respond to the opportunity to consent
within a reasonable period of time, that failure to consent or to
respond timely shall be construed as discontinuing the application.
(d) For purposes of this section:
(1) "Qualified beneficiary" means any individual who, on the day
before the qualifying event, is an enrollee in a group benefit plan
offered by a health care service plan and who has a qualifying event.
(2) "Qualifying event" means any of the following events that
would result in a loss of coverage under the group benefit plan to a
qualified beneficiary:
(A) The death of the covered employee.
(B) The termination of employment or reduction in hours of the
covered employee's employment.
(C) The divorce or legal separation of the covered employee from
the covered employee's spouse.
(D) The loss of dependent status by a dependent enrolled in the
group benefit plan.
(E) With respect to a covered dependent only, the covered employee'
s entitlement to benefits under Title XVIII of the federal Social
Security Act.
SEC. 4. Section 1366.51 is added to the Health and Safety Code, to
read:
1366.51. (a) Except (1)
On or after January 1, 2014, except for a specialized
health care service plan, every health care service plan contract
that is issued, amended, delivered, or renewed in this state
on or after January 1, 2014, that provides medical and hospital
coverage to an individual shall, in the individual
market shall, consistent with this section, transfer
information to the Exchange in order to initiate an application for
enrollment for a former employee or former dependent of an
employee. At the time that the health care service plan contract is
issued, amended, delivered, or renewed on an
individual at such time as the individual ceases to be enrolled in
coverage.
(2) On or after January 1, 2012,
the health care service plan shall obtain the written
consent of the enrollee to provide the minimum necessary information
to the Exchange in the event that the individual or dependent ceases
to be enrolled in individual coverage. If the individual does not
provide his or her consent, the health care service plan shall not
transfer any information regarding that individual to the Exchange.
Consent may be obtained at the time of the qualifying event.
(b) (1) The health care service plan shall provide to the
California Health Benefit Exchange information regarding the former
covered individual and any dependents that chose not to renew
individual coverage. The information provided shall include the name
or names, most recent address, and any other information that is in
the possession of the plan and that the Exchange may require in
order to determine eligibility, facilitate enrollment in coverage,
and maximize continuity of care, and shall be provided in a
manner to be prescribed by the Exchange. The information shall be
provided in a manner consistent with Section 1411 of the federal
Patient Protection and Affordable Care Act (Public Law 111-148)
and consistent with other state and federal medical privacy laws
.
(2) The provision of this information shall initiate an
application for enrollment in coverage within the meaning of Section
100503 of the Government Code.
(c) (1) On and after January 1, 2014, the health care service plan
shall provide the following notification to individuals, dependents,
or former dependents who cease to be enrolled in individual
coverage in 12-point type:
"Because you are no longer enrolled in coverage purchased by you
as an individual or as the dependent of a family member, an
application for health care coverage through the California Health
Benefit Exchange has been made for you. You are not required to
accept coverage from the Exchange. Your payment for coverage will be
based on your income last year. If you make significantly less or
more this year than you made last year, please tell the California
Health Benefit Exchange and your charges will be based on your
current income. If your income is low, you may qualify for no-cost
coverage through Medi-Cal. For more information, check
www.healthcare.ca.gov or call 1-888-Healthhelp (insert telephone
number)."
"In March of 2010, the federal government passed national health
care reform. Because of this, you may be eligible for reduced-cost
comprehensive health care coverage through the California Health
Benefit Exchange. Because you are losing your coverage as an
individual, an application will be sent to the California Health
Benefit Exchange to make it easier for you to get health care
coverage.
Eligibility for reduced-cost coverage through the California
Health Benefit Exchange or no-cost coverage through Medi-Cal is based
on your income. You will be contacted by the Exchange to complete
the application. You are not required to accept coverage from the
Exchange. To learn more, or to contact the Exchange, visit
www.healthexchange.ca.gov or call 1-888-(insert telephone number)."
(2) To decline health care coverage from the Exchange pursuant to
this section, the individual shall elect to do so by notifying the
Exchange in writing within 63 calendar days of the date of
termination of individual coverage.
(2) A person for whom an application for enrollment in the
Exchange has been initiated by the transfer of information under this
section shall be given the opportunity to provide informed consent
to use the transferred information to commence eligibility
determination and complete enrollment as well as the opportunity to
correct any transferred information or provide additional information
before a final eligibility determination is made. If the individual
fails to consent or fails to respond to the opportunity to consent
within a reasonable period of time, that failure to consent or to
respond timely shall be construed as discontinuing the application.
(d) Effective July 1, 2013, until July 1, 2020, the health care
service plan shall provide to individuals, dependents, or former
dependents with coverage in the individual market the following
notification in 12-point type and prominently displayed in the
evidence of coverage:
"In March of 2010, the federal government passed national health
care reform. Because of this, as an individual buying your own health
insurance, in January 2014, you may become eligible for reduced-cost
comprehensive health care coverage through the California Health
Benefit Exchange. To learn more, please visit
www.healthexchange.ca.gov or call 1-888-(insert telephone number)."
SEC. 5. Section 10786 is added to the Insurance Code, to read:
10786. (a) (1) Every health insurance
policy that is issued, amended, delivered, or renewed in this state
on or after January 1, 2014, that provides medical and hospital
coverage under an employer-sponsored group plan for an employer
subject to COBRA, as defined in subdivision (e) of Section 10116.5,
or an employer group for which the plan is required to offer
Cal-COBRA coverage, as defined in subdivision (f) of Section 10116.5,
including a carrier providing replacement coverage under Section
10128.3, shall, consistent with this section, transfer information to
the Exchange in order to initiate an application for enrollment
for a former employee or former dependent of an employee. At
the time that the health insurance policy is issued, amended,
delivered, or renewed on or after January 1, 2012, the health insurer
for a qualified beneficiary upon a qualifying event.
(2) Prior to the transfer of the
information to the Exchange, the health insurer shall obtain
the written consent of the insured to provide the minimum
necessary information to the Exchange in the event that the
individual or dependent ceases to be enrolled in coverage under an
employer-sponsored group plan . If the individual does not
provide his or her consent, the health insurer shall not transfer any
information regarding that individual to the Exchange. Consent
may be obtained at the time of the qualifying event.
(b) (1) The health insurer shall provide to the California Health
Benefit Exchange information regarding the former employee and any
dependents covered under the group coverage. The information provided
shall include the name or names, most recent address, and any other
information that is in the possession of the insurer and that the
Exchange may require in order to determine eligibility,
facilitate enrollment in coverage, and maximize continuity of care,
and shall be provided in a manner to be prescribed by the
Exchange. The information shall be provided in a manner consistent
with Section 1411 of the federal Patient Protection and Affordable
Care Act (Public Law 111-148) and consistent with other state
and federal medical privacy laws .
(2) The provision of this information shall initiate an
application for enrollment in coverage within the meaning of Section
100503 of the Government Code. Nothing in this section shall be
construed to alter the responsibility of the Exchange or other state
and local government entities with respect to the criteria and
process for eligibility and enrollment in the Exchange and other
public health care coverage programs.
(c) (1) On and after January 1, 2012, until December 31, 2013, the
health insurer shall provide the following notification to
employees, members, former employees, spouses, or former spouses:
qualified beneficiaries upon a qualifying event:
"Please examine your options carefully before declining this
coverage. Until January 1, 2014, you should be aware that companies
selling individual health insurance to adults who are 19 years of age
or older typically require a review of your medical history that
could result in a higher premium or you could be denied coverage
entirely. Effective January 1, 2010, children under 19 years of age
cannot be denied individual coverage based on medical history, but
may pay a higher premium depending on medical history."
(2) On and after January 1, 2014, the health insurer shall provide
the following notification to employees, members, former
employees, dependents, or former dependents qualified
beneficiaries upon a qualifying event in 12-point type:
"Because you are no longer enrolled in coverage provided by your
employer or the employer of a family member, an application for
health care coverage through the California Health Benefit Exchange
has been made for you. You are not required to accept coverage from
the Exchange. Your payment for this coverage will be based on your
income last year. If you make significantly less or more this year
than you made last year, please tell the California Health Benefit
Exchange and your charges will be based on your current income. If
your income is low, you may qualify for no-cost coverage through
Medi-Cal. For more information, check www.healthcare.ca.gov or call
1-888-Healthhelp (insert telephone number)."
"In March of 2010, the federal government passed national health
care reform. Because of this, you may be eligible for reduced-cost
comprehensive health care coverage through the California Health
Benefit Exchange. Because you are losing your coverage from your
employer or the employer of a family member, an application will be
sent to the California Health Benefit Exchange to make it easier for
you to get health care coverage.
Eligibility for reduced-cost coverage through the California
Health Benefit Exchange or no-cost coverage through Medi-Cal is based
on your income. You will be contacted by the Exchange to complete
the application. You are not required to accept coverage from the
Exchange. To learn more, or to contact the Exchange, visit
www.healthexchange.ca.gov or call 1-888-(insert telephone number)."
(3) To decline health care coverage from the Exchange pursuant to
this section, the individual shall elect to do so by notifying the
Exchange in writing within 63 calendar days of the date of
termination of group coverage.
(3) A person for whom an application for enrollment in the
Exchange has been initiated by the transfer of information under this
section shall be given the opportunity to provide informed consent
to use the transferred information to commence eligibility
determination and complete enrollment as well as the opportunity to
correct any transferred information or provide additional information
before a final eligibility determination is made. If the individual
fails to consent or fails to respond to the opportunity to consent
within a reasonable period of time, that failure to consent or to
respond timely shall be construed as discontinuing the application.
(d) For purposes of this section:
(1) "Qualified beneficiary" means any individual who, on the day
before the qualifying event, is an enrollee in a group benefit plan
offered by a health insurer and who has a qualifying event.
(2) "Qualifying event" means any of the following events that
would result in a loss of coverage under the group benefit plan to a
qualified beneficiary:
(A) The death of the covered employee.
(B) The termination of employment or reduction in hours of the
covered employee's employment.
(C) The divorce or legal separation of the covered employee from
the covered employee's spouse.
(D) The loss of dependent status by a dependent enrolled in the
group benefit plan.
(E) With respect to a covered dependent only, the covered employee'
s entitlement to benefits under Title XVIII of the federal Social
Security Act.
SEC. 6. Section 10787 is added to the Insurance Code, to read:
10787. (a) Every (1)
On or after January 1, 2014, every health insurance policy
that is issued, amended, delivered, or renewed in this
state on or after January 1, 2014, that provides medical and hospital
coverage to an individual in the individual market
shall, consistent with this section, transfer information to
the Exchange in order to initiate an application for enrollment
for a former employee or former dependent of an employee. At
the time that the health insurance policy is issued, amended,
delivered, or renewed on for the individual at such
time as the individual ceases to be enrolled in coverage.
(2) On or after January 1, 2012,
the health insurer shall obtain the written consent of the
insured to provide the minimum necessary information to the Exchange
in the event that the individual or dependent ceases to be enrolled
in individual coverage. If the individual does not provide his or her
consent, the health insurer shall not transfer any information
regarding that individual to the Exchange. Consent may be
obtained at the time of the qualifying event.
(b) (1) The health insurer shall provide to the California Health
Benefit Exchange information regarding the former covered individual
and any dependents that chose not to renew individual coverage. The
information provided shall include the name or names, most recent
address, and any other information that is in the possession of the
insurer and that the Exchange may require in order to determine
eligibility, facilitate enrollment in coverage, and maximize
continuity of care, and shall be provided in a manner to be
prescribed by the Exchange. The information shall be provided in a
manner consistent with Section 1411 of the federal Patient Protection
and Affordable Care Act (Public Law 111-148) and consistent
with other state and federal medical privacy laws .
(2) The provision of this information shall initiate an
application for enrollment in coverage within the meaning of Section
100503 of the Government Code.
(c) (1) On and after January 1, 2014, the health insurer shall
provide the following notification to individuals, dependents, or
former dependents who cease to be enrolled in individual
coverage in 12-point type:
"Because you are no longer enrolled in coverage purchased by you
as an individual or as the dependent of a family member, an
application for health care coverage through the California Health
Benefit Exchange has been made for you. You are not required to
accept coverage from the Exchange. Your payment for coverage will be
based on your income last year. If you make significantly
less or more this year than you made
last year, please tell the California Health Benefit Exchange and
your charges will be based on your current income. If your income is
low, you may qualify for no-cost coverage through Medi-Cal. For more
information, check www.healthcare.ca.gov or call 1-888-Healthhelp
(insert telephone number)."
"In March of 2010, the federal government passed national health
care reform. Because of this, you may be eligible for reduced-cost
comprehensive health care coverage through the California Health
Benefit Exchange. Because you are losing your coverage as an
individual, an application will be sent to the California Health
Benefit Exchange to make it easier for you to get health care
coverage.
Eligibility for reduced-cost coverage through the California
Health Benefit Exchange or no-cost coverage through Medi-Cal is based
on your income. You will be contacted by the Exchange to complete
the application. You are not required to accept coverage from the
Exchange. To learn more, or to contact the Exchange, visit
www.healthexchange.ca.gov or call 1-888-(insert telephone number)."
(2) To decline health care coverage from the Exchange pursuant to
this section, the individual shall elect to do so by notifying the
Exchange in writing within 63 calendar days of the date of
termination of individual coverage.
(2) A person for whom an application for enrollment in the
Exchange has been initiated by the transfer of information under this
section shall be given the opportunity to provide informed consent
to use the transferred information to commence eligibility
determination and complete enrollment as well as the opportunity to
correct any transferred information or provide additional information
before a final eligibility determination is made. If the individual
fails to consent or fails to respond to the opportunity to consent
within a reasonable period of time, that failure to consent or to
respond timely shall be construed as discontinuing the application.
(d) Effective July 1, 2013, until July 1, 2020, the health insurer
shall provide the following notification to individuals, dependents,
or former dependents with coverage in the individual market, the
following notification in 12-point type and prominently displayed in
the evidence of coverage:
"In March of 2010, the federal government passed national health
care reform. Because of this, as an individual buying your own health
insurance, in January 2014, you may become eligible for reduced-cost
comprehensive health care coverage through the California Health
Benefit Exchange. To learn more, please visit
www.healthexchange.ca.gov or call 1-888-(insert telephone number)."
SEC. 7. Section 2800.2 of the Labor Code is amended to read:
2800.2. (a) Any employer, employee association, or other entity
otherwise providing hospital, surgical, or major medical benefits to
its employees or members is solely responsible for notification of
its employees or members of the conversion coverage made available
pursuant to Part 6.1 (commencing with Section 12670) of Division 2 of
the Insurance Code or Section 1373.6 of the Health and Safety Code.
At the time that the health care service plan contract or health
insurance policy is issued, amended, delivered, or renewed on or
after January 1, 2012, the employer, employee association, or other
entity shall obtain the written consent of the enrollee or
insured to provide the minimum necessary information to the Exchange
in the event that the individual or dependent ceases to be enrolled
in coverage under this section. If the individual does not provide
his or her consent, the employer, employee association, or other
entity shall not transfer any information regarding that individual
to the Exchange.
(1) The employer, employee association, or other entity otherwise
providing hospital, surgical, or major medical benefits to its
employees or members shall provide to the California Health Benefit
Exchange information regarding the former employee and any dependents
covered under the group coverage. The information provided shall
include the name or names, most recent address, and any other
information that is in the possession of the employer, employee
association, or other entity and that the Exchange may require in a
manner to be prescribed by the Exchange. The information shall be
provided in a manner consistent with Section 1411 of the federal
Patient Protection and Affordable Care Act (Public Law 111-148)
and consistent with other state and federal medical privacy laws
.
(2) The provision of this information shall initiate an
application for enrollment in coverage within the meaning of Section
100503 of the Government Code.
(b) Any employer, employee association, or other entity, whether
private or public, that provides hospital, medical, or surgical
expense coverage that a former employee may continue under Section
4980B of Title 26 of the United States Code, Section 1161 et seq. of
Title 29 of the United States Code, or Section 300bb of Title 42 of
the United States Code, as added by the Consolidated Omnibus Budget
Reconciliation Act of 1985 (Public Law 99-272), and as may be later
amended (hereafter "COBRA"), shall, in conjunction with the
notification required by COBRA that COBRA continuation coverage will
cease and conversion coverage is available, and as a part of the
notification required by subdivision (a), also notify the former
employee, spouse, or former spouse of the availability of the
continuation coverage under Section 1373.621 of the Health and Safety
Code and Sections 10116.5 and 11512.03 of the Insurance Code.
(c) (1) On or after July 1, 2006, until January 1, 2012,
notification provided to employees, members, former employees,
spouses, or former spouses under subdivisions (a) and (b) shall also
include the following notification:
"Please examine your options carefully before declining this
coverage. 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."
(2) On and after January 1, 2012, until December 31, 2013, the
employer, employee association, or other entity shall provide the
following notification to employees, members, former employees,
spouses, or former spouses under subdivisions (a) and (b):
"Please examine your options carefully before declining this
coverage. In March of 2010, the federal government en
acted national health care reform. Until January 1, 2014, you
should be aware that companies selling individual health insurance to
adults who are 19 years of age or older typically require a review
of your medical history that could result in a higher premium or you
could be denied coverage entirely. Effective January 1, 2010,
children under 19 years of age cannot be denied individual coverage
based on medical history but may pay a higher premium depending on
medical history."
(3) On and after January 1, 2014, the employer, employee
association, or other entity shall provide the following notification
to employees, members, former employees, spouses, or former spouses
under subdivisions (a) and (b):
"Because you are no longer enrolled in coverage, an application
for health care coverage through the California Health Benefit
Exchange has been made for you. You are not required to accept
coverage from the Exchange. You will be charged for Exchange coverage
based on your income last year. If you make significantly less or
more this year than you made last year, please tell the California
Health Benefit Exchange and your charges will be based on your
current income. If your income is low, you may qualify for no-cost
coverage through Medi-Cal. For more information, check
www.healthcare.ca.gov or call 1-888-Healthhelp (insert telephone
number)."
"In March of 2010, the federal government passed national health
care reform. Because of this, you may be eligible for reduced-cost
comprehensive health care coverage through the California Health
Benefit Exchange. Because you are losing your coverage from your
employer or from the employer of a family member, an application will
be sent to the California Health Benefit Exchange to make it easier
for you to get health care coverage.
Eligibility for low-cost coverage through the California Health
Benefit Exchange or no-cost coverage through Medi-Cal is based on
your income. You will be contacted by the Exchange to complete the
application. You are not required to accept coverage from the
Exchange. To learn more, or to contact the Exchange, visit
www.healthexchange.ca.gov or call 1-888-(insert telephone number)."
(d) To decline health care coverage through the Exchange pursuant
to this section, the individual shall elect to do so by notifying the
Exchange in writing within 63 calendar days of the date of
termination of individual coverage.
(d) A person for whom an application for enrollment in the
Exchange has been initiated by the transfer of information under this
section shall be given the opportunity to provide informed consent
to use the transferred information to commence eligibility
determination and complete enrollment as well as the opportunity to
correct any transferred information or provide additional information
before a final eligibility determination is made. If the individual
fails to consent or fails to respond to the opportunity to consent
within a reasonable period of time, that failure to consent or to
respond timely shall be construed as discontinuing the application.
SEC. 8. Section 1342.5 is added to the Unemployment Insurance
Code, to read:
1342.5. (a) On and after January 1, 2014, when an individual
files a new claim for unemployment compensation under this chapter,
the department shall do all of the following:
(1) (A) Provide to the California Health Benefit Exchange the
name, address, and any other identifying information that is in the
possession of the department as the Exchange may require in a manner
to be prescribed by the Exchange. To maximize the number of
individual Californians complying with the requirements of the
federal Patient Protection and Affordable Care Act (Public Law
111-148) by obtaining coverage consistent with the provisions of
federal law, the Exchange shall seek approval from the United States
Department of Health and Human Services to transfer the minimum
information necessary to initiate an application for enrollment under
this section consistent with Section 100503 of the Government Code.
(B) The provision of this information shall initiate an
application for enrollment in coverage within the meaning of Section
100503 of the Government Code.
(2) Provide the following notice to the individual:
"Because you have applied for unemployment compensation, an
application for health care coverage through the California Health
Benefit Exchange has been made for you. You are not required to
accept coverage from the Exchange. You will be charged for Exchange
coverage based on your income last year. If you make significantly
less or more this year than you made last year, please tell the
California Health Benefit Exchange and your charges will be based on
your current income. If your income is low, you may qualify for
no-cost coverage through Medi-Cal. For more information, check
www.healthcare.ca.gov or call 1-888-Healthhelp (insert telephone
number)."
"In March of 2010, the federal government passed national health
care reform. Because of this, you may be eligible for reduced-cost
comprehensive health care coverage through the California Health
Benefit Exchange. Because you are no longer employed and may need
health coverage, an application will be sent to the California Health
Benefit Exchange to make it easier for you to get health care
coverage.
Eligibility for low-cost coverage through the California Health
Benefit Exchange or no-cost coverage through Medi-Cal is based on
your income. You will be contacted by the Exchange to complete the
application. You are not required to accept coverage from the
Exchange. To learn more, or to contact the Exchange, visit
www.healthexchange.ca.gov or call 1-888-(insert telephone number)."
(b) To decline health care coverage through the Exchange pursuant
to this section, the individual shall elect to do so by notifying the
Exchange in writing.
(b) A person for whom an application for enrollment in the
Exchange has been initiated by the transfer of information under this
section shall be given the opportunity to provide informed consent
to use the transferred information to commence eligibility
determination and complete enrollment as well as the opportunity to
correct any transferred information or provide additional information
before a final eligibility determination is made. If the individual
fails to consent or fails to respond to the opportunity to consent
within a reasonable period of time, that failure to consent or to
respond timely shall be construed as discontinuing the application.
(c) The department shall provide on its Internet Web site a link
to the Internet Web site of the California Health Benefit Exchange
and a notice that low-cost or no-cost health care coverage may be
obtained through the Exchange for those who are unemployed or
disabled.
(d) The department may, by regulation, modify the wording of any
notice required by this section for purposes of clarity, readability,
and accuracy, except that a modification shall not change the
substantive meaning of the notice. The addition or correction of a
telephone number or Internet Web site may be implemented by guidance
and shall not require the adoption of a regulation.
(c)
(e) This section shall be implemented consistent with
federal guidance and shall be operative only to the extent that it is
funded out of non-General Fund moneys.
SEC. 9. Section 2706.5 is added to the Unemployment Insurance
Code, to read:
2706.5. (a) When Effective January 1,
2013, when an individual files a new claim for disability
benefits under this part, the department shall provide the following
notice to the individual:
"If you do not have affordable health care coverage, effective
January 1, 2014, you may obtain health care coverage through the
California Health Benefit Exchange. What you pay for coverage through
the Exchange will depend on how much you make. If your income is
low, you may qualify for no-cost coverage through Medi-Cal. For more
information, check www.healthcare.ca.gov or call 1-888-Healthhelp
(insert telephone number)."
"In March of 2010, the federal government passed national health
care reform. Because of this, if you do not have other health
coverage, in January 2014, you may become eligible for reduced-cost
comprehensive health care coverage through the California Health
Benefit Exchange. To learn more, please visit
www.healthexchange.ca.gov or call 1-888-(insert telephone number)."
(b) This notice shall be provided upon initial application whether
or not the individual is eligible for disability benefits.
(c) The department may, by regulation, modify the wording of any
notice required by this section for purposes of clarity, readability,
and accuracy, except that a modification shall not change the
substantive meaning of the notice. The addition or correction of a
telephone number or Internet Web site may be implemented by guidance
and shall not require the adoption of a regulation.
SEC. 10. 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.