Bill Text: CA AB952 | 2023-2024 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Dental coverage disclosures.

Sponsorship: Partisan Bill (Democrat 1)

Status: (Passed) 2023-07-27 - Chaptered by Secretary of State - Chapter 125, Statutes of 2023. [AB952 Detail]

Download: California-2023-AB952-Amended.html

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Amended  IN  Senate  June 06, 2023

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Assembly Bill

No. 952

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Introduced by Assembly Member Wood

February 14, 2023

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An act to add Section 1374.18 to the Health and Safety Code, and to add Section 10120.42 to the Insurance Code, relating to dental coverage.

LEGISLATIVE COUNSEL'S DIGEST

AB 952, as amended, Wood. Dental coverage disclosures.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act’s requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law imposes specified coverage and disclosure requirements on health care service plans and health insurers, including specialized plans and insurers, that cover dental services.

This bill would require a health care service plan or health insurer that issues, sells, renews, or offers a contract covering dental services, or including a specialized health care service plan or specialized health insurer covering dental services, to disclose whether or not an enrollee’s or insured’s dental coverage is subject to regulation by the appropriate department at the time a treatment plan is communicated to the plan or insurer. The bill would also require that plan or insurer to include whether or not an enrollee’s or insured’s dental coverage is subject to regulation by the appropriate department on an identification card, membership card, coverage card, or other documentation of coverage. “State Regulated” through a provider portal, if available, or otherwise upon request, on or after January 1, 2025. The bill would require a plan or insurer to include the statement “State Regulated,” if the enrollee’s or insured’s dental coverage is subject to regulation by the appropriate department, on an electronic or physical identification card, or both if available, for contracts covering dental services issued on or after January 1, 2025. Because a willful violation of these provisions by a health care service plan 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.

Digest Key

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

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Bill Text

The people of the State of California do enact as follows:

SECTION 1.

 Section 1374.18 is added to the Health and Safety Code, to read:

1374.18.

(a)At the time that an enrollee’s treatment plan is communicated by a provider to a health care service plan for purposes of eligibility and benefit determination, the health care service plan shall disclose whether or not the enrollee’s dental coverage is subject to regulation by the department.

(b)An identification card, membership card, coverage card, or other documentation of coverage issued to a contractholder or enrollee by a health care service plan shall include whether or not the enrollee’s dental coverage is subject to regulation by the department.

1374.18.

 (a) To assist a provider in determining if an enrollee’s health care service plan coverage is regulated by the State of California, the health care service plan shall disclose whether the enrollee’s dental coverage is “State Regulated” through a provider portal, if available, or otherwise upon request, on or after January 1, 2025.

(b) A health care service plan shall include the statement “State Regulated” if the enrollee’s dental coverage is subject to regulation by the department on an electronic or physical identification card, or both if available, for contracts covering dental services issued on or after January 1, 2025.

(c) For purposes of this section, “health care service plan” means a health care service plan that issues, sells, renews, or offers a contract covering dental services or services, including a specialized health care service plan covering dental services.

SEC. 2.

 Section 10120.42 is added to the Insurance Code, to read:

10120.42.

(a)At the time that an insured’s treatment plan is communicated by a provider to a health insurer for purposes of eligibility and benefit determination, the health insurer shall disclose whether or not the insured’s dental coverage is subject to regulation by the department.

(b)An identification card, membership card, coverage card, or other documentation of coverage issued to a policyholder or insured by a health insurer shall include whether or not the insured’s dental coverage is subject to regulation by the department.

10120.42.

 (a) To assist a provider in determining if an insured’s dental coverage is regulated by the State of California, the health insurer shall disclose whether the insured’s dental coverage is “State Regulated” through a provider portal, if available, or otherwise upon request, on or after January 1, 2025.

(b) A health insurer shall include the statement “State Regulated” if the insured’s dental coverage is subject to regulation by the department, on an electronic or physical identification card, or both if available, for policies covering dental services issued on or after January 1, 2025.

(c) For purposes of this section, “health insurer” means a health insurer that issues, sells, renews, or offers a policy covering dental services or services, including a specialized health insurer covering dental services.

SEC. 3.

 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.