BILL ANALYSIS �
AB 912
Page 1
GOVERNOR'S VETO
AB 912 (Quirk-Silva)
As Amended September 3, 2013
2/3 vote
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|ASSEMBLY: |52-26|(May 29, 2013) |SENATE: |24-12|(September 6, |
| | | | | |2013) |
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|ASSEMBLY: |51-26|(September 10, | | | |
| | |2013) | | | |
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Original Committee Reference: HEALTH
SUMMARY : Mandates that every large group health care service
plan contract and health insurance policy that is issued,
amended, or renewed, on and after January 1, 2014, provide
coverage for medically necessary expenses for standard fertility
preservation services when a necessary medical treatment may
directly or indirectly cause iatrogenic infertility to an
enrollee or insured.
The Senate amendments :
1)Limit this bill to plans and policies sold in the large group
health insurance market.
2)Define "Standard fertility preservation services" as
procedures consistent with established medical practices and
professional guidelines published by the American Society for
Reproductive Medicine, the American Society of Clinical
Oncology, or other reputable professional medical
organizations.
3)Define "May directly or indirectly cause" as treatment with a
likely side effect of infertility as established by the
AB 912
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American Society for Reproductive Medicine, the American
Society of Clinical Oncology, or other reputable professional
organizations.
4)Authorize the Department of Health Care (DMHC) and the
California Department of Insurance (CDI) to adopt regulations
to implement this bill.
EXISTING LAW establishes the Knox-Keene Health Care Service Plan
Act of 1975 to regulate and license health plans and specialized
health plans by DMHC, mandates coverage for basic health care
services, and provides for the regulation of health insurers by
the CDI. Requires health plan contracts and health insurance
policies to offer group coverage for the treatment of
infertility, as defined.
AS PASSED BY THE ASSEMBLY , this bill mandated that every group
or individual health care service plan contract and health
insurance policy that is issued, amended, or renewed, on and
after January 1, 2014, provide coverage for medically necessary
expenses for standard fertility preservation services when a
necessary medical treatment may cause iatrogenic infertility to
an enrollee or insured.
FISCAL EFFECT : According to the Senate Appropriations
Committee, increased health care costs to California Public
Employees' Retirement System (CalPERS) of about $70,000 per year
(various funds) based on an analysis by the California Health
Benefits Review Program. However, CalPERS indicates that their
costs from this bill could be higher, depending on the demand
for fertility preservation services related to infertility
caused by medications and procedures other than those used to
treat cancer. No anticipated costs to the Medi-Cal program.
Under existing law, Medi-Cal managed care plans are not
considered "large group" plans and thus are not impacted by this
benefit mandate. No anticipated costs to the state to pay for
the cost of subsidizing benefits in the California Health
Benefit Exchange. One-time costs of about $20,000 for the
review of plan filings by the DMHC (Managed Care Fund). Ongoing
costs of about $10,000 per year for review of insurance policy
filings by the CDI (Insurance Fund).
AB 912
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GOVERNOR'S VETO MESSAGE :
The bill requires health plans and insurers to cover
fertility preservation services when a medical
treatment may cause infertility. This requirement
would apply only to health coverage purchased by large
employers.
Large group employers already have the ability to
negotiate richer benefit packages that meet the needs
of their employees. While I understand the desire to
preserve fertility where possible, such coverage was
not included in the essential health benefits that the
Legislature passed just last year for individual and
small group coverage.
Coverage that goes beyond the essential health
benefits is no doubt useful and desirable for many,
but we should not consider mandating additional
benefits until we implement the comprehensive package
of reforms that are required by the federal Affordable
Care Act.
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097
FN: 0002889