BILL ANALYSIS                                                                                                                                                                                                    �



                                                                      



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          |SENATE RULES COMMITTEE            |                   SB 757|
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                              UNFINISHED BUSINESS


          Bill No:  SB 757
          Author:   Lieu (D), et al.
          Amended:  8/22/11
          Vote:     21

           
           SENATE HEALTH COMMITTEE  :  6-3, 4/27/11
          AYES:  Hernandez, Alquist, De Le�n, DeSaulnier, Rubio, Wolk
          NOES:  Strickland, Anderson, Blakeslee

           SENATE JUDICIARY COMMITTEE  :  3-2, 5/3/11
          AYES:  Evans, Corbett, Leno
          NOES:  Harman, Blakeslee

           SENATE APPROPRIATIONS COMMITTEE  :  6-2, 5/16/11
          AYES:  Kehoe, Alquist, Lieu, Pavley, Price, Steinberg
          NOES:  Emmerson, Runner
          NO VOTE RECORDED:  Walters

           SENATE FLOOR  :  25-13, 5/31/11
          AYES:  Alquist, Calderon, Corbett, Correa, De Le�n, 
            DeSaulnier, Evans, Hancock, Hernandez, Kehoe, Leno, Lieu, 
            Liu, Lowenthal, Negrete McLeod, Padilla, Pavley, Price, 
            Rubio, Simitian, Steinberg, Vargas, Wolk, Wright, Yee
          NOES:  Anderson, Blakeslee, Cannella, Dutton, Emmerson, 
            Fuller, Gaines, Huff, La Malfa, Runner, Strickland, 
            Walters, Wyland
          NO VOTE RECORDED:  Berryhill, Harman

           ASSEMBLY FLOOR  :  50-24, 9/1/11 - See last page for vote


           SUBJECT  :    Discrimination
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           SOURCE  :     Equality California


           DIGEST  :    This bill requires every group health care 
          service plan contract and every policy or certificate of 
          group health insurance marketed, issued, or delivered to a 
          resident of this state, regardless of the situs of the 
          contract to comply with existing law that provides for 
          equal coverage for registered domestic partners.

           Assembly Amendments  specify that this bill prohibits such 
          contracts, policies, or certificates of an employee, 
          subscriber, insured, or policyholder from discriminating in 
          coverage between different sex and same sex spouses and 
          domestic partners and states that the prohibitions and 
          requirements imposed by this bill are in addition to any 
          other prohibitions and requirements imposed by existing 
          law.

           ANALYSIS  :    

          Existing law:

          1. Provides for the regulation of health care service plans 
             (health plans) by the Department of Managed Health Care. 
              

          2. Provides for the regulation of all forms of insurance, 
             including health insurance, by the Department of 
             Insurance.

          3. Provides that every disability insurance policy covering 
             hospital, medical or surgical expenses, that is 
             advertised, issued, or delivered to a California 
             resident, regardless of the location of the contract or 
             master group policyholder, is subject to all 
             requirements in the California Insurance Code, except 
             those policies issued outside California to an employer 
             whose principal place of business and majority of 
             employees are outside California.

          4. Requires group health plans, health insurers, and all 
             other forms of insurance that provide dependent coverage 

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             to provide coverage for a registered domestic partner 
             that is equal to the coverage provided to a spouse.

          5. Provides that any group health plan contract, health 
             insurance policy, or any other insurance policy, shall 
             be deemed to provide coverage for a registered domestic 
             partner that is equal to the coverage provided to a 
             spouse.

          This bill:

          1. Requires every group health plan contract and every 
             policy or certificate of group health insurance 
             marketed, issued, or delivered to a resident of this 
             state, regardless of the situs of the contract to comply 
             with existing law that provides for equal coverage for 
             registered domestic partners.

          2. Prohibits such contracts, policies, or certificates of 
             an employee, subscriber, insured, or policyholder from 
             discriminating in coverage between different sex and 
             same sex spouses and domestic partners and states that 
             the prohibitions and requirements imposed by this bill 
             are in addition to any other prohibitions and 
             requirements imposed by existing law.

           Background
           
           Extraterritoriality  .  Employers located in one state often 
          employ individuals who reside in another state, or have 
          employees in multiple states.  Many such employers purchase 
          a single group health plan or insurance policy covering all 
          of their employees, wherever they are located, which 
          results in such group plans and policies providing coverage 
          to residents of more than one state.  In most states, the 
          location of the employer's headquarters dictates which 
          state's insurance regulations apply, not the location of 
          the employee, as is the case with individual insurance 
          products.  For example, if an employer is headquartered in 
          New York and has some employees living in New Jersey, New 
          York insurance regulations will apply to the insurance 
          coverage of those employees who live in New Jersey.  This 
          is similar to California law.


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          An exception to this rule occurs in states that choose to 
          exercise territorial jurisdiction; these states are known 
          as extraterritorial states.  States with extraterritorial 
          laws require health insurers to provide benefits based on 
          the laws of the state where an employee resides, regardless 
          of where the employer is located.

          There are currently 12 states that exercise territorial 
          jurisdiction of insurance laws for health insurance 
          policies.  They include Alaska, Arkansas, Connecticut, 
          Delaware, Indiana, Kansas, Mississippi, Montana, North 
          Carolina, Oklahoma, Utah and Washington.  Any other state's 
          group health insurance laws do not apply in these states.  
          This means that a policy issued by a New York-based insurer 
          to a New York employer for an employee residing in 
          Connecticut is subject to Connecticut's insurance 
          regulations and the New York insurer must issue a 
          certificate of insurance that complies with Connecticut 
          insurance law.  

           Comment
           
          Existing law, AB 2208 (Kehoe), Chapter 488, Statutes of 
          2004, establishes the California Insurance Equality Act, 
          which requires all types of insurance, including health 
          insurance, to provide coverage to registered domestic 
          partners equal to that provided to a spouse.

          This bill, with the words "regardless of the situs of the 
          contract or master policyholder," seeks to clarify that 
          this parity requirement extends to insurance provided to 
          California residents by employers located out-of-state with 
          out-of-state insurance contracts or policies.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes   
          Local:  Yes

          According to the Assembly Appropriations Committee: 

          1. Potential minor, absorbable costs to the Department of 
             Managed Health Care and California Department Insurance 
             related to ensuring carrier compliance with the 
             provisions of this bill that states that policies and 
             plan contracts may not discriminate on the basis of the 

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             sex of spouses or domestic partners. 

          2. As it is unclear how the provisions of this bill that 
             apply to out-of-state carriers can be enforced by state 
             regulators, there is no anticipated direct state fiscal 
             impact for enforcement.

           SUPPORT  :   (Verified  8/22/11)

          Equality California (source)
          Department of Insurance
          California School Employees Association
          California Association of Marriage and Family Therapists
          Greater San Diego Business Association


           ARGUMENTS IN SUPPORT  :    Equality California, the sponsor 
          of this bill, asserts that employees of out-of-state 
          companies who live in California and are in a domestic 
          partnership are often the victims of discrimination because 
          their employer contracts with an out-of-state insurer that 
          does not provide equal benefits to domestic partners.  
          Because of this practice, domestic partners and employers 
          are often forced to switch insurers to purchase coverage 
          that treats spouses and domestic partners equally.  
          Equality California believes that this bill ensures that 
          such out-of-state insurers must abide by the same 
          nondiscrimination laws that California insurers already do. 


          Writing in support, the California Association of Marriage 
          and Family Therapists (CAMFT) argues that the 2004 
          California Insurance Equality Act was intended to provide a 
          necessary and consistent standard of nondiscrimination in 
          insurance by ensuring that insurance companies treat 
          domestic partners in the same manner as spouses in the 
          purchase of insurance.  CAMFT believes this bill ensures 
          that out-of-state plans and insurers also adhere to the 
          nondiscrimination laws of California, thereby assuring 
          legislative intent behind the California Insurance Equality 
          Act.


           ASSEMBLY FLOOR  :  50-24, 9/1/11

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          AYES:  Alejo, Allen, Ammiano, Atkins, Beall, Block, 
            Blumenfield, Bradford, Brownley, Buchanan, Butler, 
            Charles Calderon, Campos, Carter, Cedillo, Chesbro, 
            Dickinson, Eng, Feuer, Fletcher, Fong, Fuentes, Furutani, 
            Galgiani, Gatto, Gordon, Hall, Hayashi, Hill, Huber, 
            Hueso, Huffman, Lara, Bonnie Lowenthal, Ma, Mendoza, 
            Mitchell, Monning, Pan, Perea, V. Manuel P�rez, 
            Portantino, Skinner, Solorio, Swanson, Torres, 
            Wieckowski, Williams, Yamada, John A. P�rez
          NOES:  Achadjian, Bill Berryhill, Conway, Donnelly, Beth 
            Gaines, Garrick, Grove, Hagman, Halderman, Harkey, 
            Jeffries, Jones, Knight, Logue, Mansoor, Miller, Morrell, 
            Nestande, Nielsen, Norby, Olsen, Silva, Valadao, Wagner
          NO VOTE RECORDED:  Bonilla, Cook, Davis, Gorell, Roger 
            Hern�ndez, Smyth


          CTW:kc  9/1/11   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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