BILL NUMBER: SB 1321	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 9, 2012

INTRODUCED BY   Senator Harman

                        FEBRUARY 23, 2012

   An act to add Section 100509 to the Government Code, relating to
health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1321, as amended, Harman. Essential health benefits.
   Commencing January 1, 2014, existing law, the federal Patient
Protection and Affordable Care Act (PPACA), requires a health
insurance issuer that offers coverage in the small group or
individual market to ensure that such coverage includes the essential
health benefits package, as defined. PPACA requires each state to,
by January 1, 2014, establish an American Health Benefit Exchange
that facilitates the purchase of qualified health plans by qualified
individuals and qualified small employers. PPACA defines a qualified
health plan as a plan that, among other requirements, provides the
essential health benefits package. Existing state law creates the
California Health Benefit Exchange to facilitate the purchase of
qualified health plans by qualified individuals and qualified small
employers by January 1, 2014.
   This bill would require the board of the California Health Benefit
Exchange to determine the  average premium per enrollee or
insured for   total cost of benefits for  each
health plan listed as an  optional   essential
health benefits  benchmark plan  option  in regulations
adopted pursuant to PPACA. The bill would require that the plan with
the lowest  average premium per enrollee or insured
  total cost of benefits  set the benchmark for
items and services to be included in the definition of essential
health benefits under PPACA. The bill would specify that its
provisions shall only be implemented to the extent consistent with
regulations adopted pursuant to PPACA.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


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

  SECTION 1.  Section 100509 is added to the Government Code, to
read:
   100509.  (a) The board shall determine the  average
premium per enrollee or insured   total cost of benefits
 for each health plan listed as an  optional 
 essential health benefits  benchmark plan  option 
in regulations adopted pursuant to Section 1302 of the federal
Patient Protection and Affordable Care Act (42 U.S.C. Sec. 18022).
The board's determinations pursuant to this section shall be posted
on its Internet Web site and submitted to the Assembly Committee on
Health and the Senate Committee on Health.
   (b) The health plan  under sub   division (a) 
with the lowest  average premium per enrollee or insured
  total cost of benefits  , as determined by the
board under subdivision (a), shall set the benchmark for items and
services to be included in the definition of essential health
benefits under Section 1302 of the federal Patient Protection and
Affordable Care Act (42 U.S.C. Sec. 18022).
   (c) This section shall only be implemented to the extent
consistent with regulations adopted by the United States Department
of Health and Human Services under Section 1302 of the federal
Patient Protection and Affordable Care Act (42 U.S.C. Sec. 18022).