Bill Text: CA SB1053 | 2013-2014 | Regular Session | Amended

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

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Bill Title: Health care coverage: contraceptives.

Spectrum: Partisan Bill (Democrat 10-0)

Status: (Passed) 2014-09-25 - Chaptered by Secretary of State. Chapter 576, Statutes of 2014. [SB1053 Detail]

Download: California-2013-SB1053-Amended.html

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BILL NUMBER: SB 1053	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 22, 2014
	AMENDED IN SENATE  APRIL 9, 2014

INTRODUCED BY   Senator Mitchell
    (   Coauthors:   Senators  
DeSaulnier,   Evans,   and Wolk   ) 
    (   Coauthors:   Assembly Members 
 Ammiano,   Garcia,   Mullin,  
Skinner,   Ting,   and Wieckowski   )


                        FEBRUARY 18, 2014

   An act to amend Section 1367.25 of the Health and Safety Code, and
to amend Section 10123.196 of the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 1053, as amended, Mitchell. Health care coverage:
contraceptives.
   Existing law, the federal Patient Protection and Affordable Care
Act (PPACA), enacts various reforms to the health insurance market.
Among other things, PPACA requires a nongrandfathered group health
plan and a health insurance issuer offering group or individual
insurance coverage to provide coverage for and not impose cost
sharing requirements for certain preventive services, including those
preventive care and screenings for women provided in specified
guidelines. PPACA requires those plans and issuers to provide
coverage without cost sharing for all federal Food and Drug
Administration approved contraceptive methods, sterilization
procedures, and patient education and counseling for all women with
reproductive capacity, as prescribed by a provider, except as
specified.
   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 a crime. Existing law also provides for the
regulation of health insurers by the Department of Insurance.
Existing law requires a health care service plan contract or health
insurance policy that provides coverage for outpatient prescription
drug benefits to provide coverage for a variety of federal Food and
Drug Administration (FDA) approved prescription contraceptive methods
designated by the plan or insurer, except as specified. Existing law
authorizes a religious employer, as defined, to request a contract
or policy without coverage of FDA approved contraceptive methods that
are contrary to the employer's religious tenets and, if so
requested, requires a contract or policy to be provided without that
coverage. Existing law requires an individual or small group health
care service plan contract or health insurance policy issued,
amended, or renewed on or after January 1, 2014, to cover essential
health benefits, which are defined to include the health benefits
covered by particular benchmark plans.
   This bill would require a health care service plan contract or
health insurance policy issued, amended, or renewed on or after
January 1, 2015, to provide coverage for all FDA approved
contraceptive drugs, devices, and products  in each
contraceptive category outlined by the FDA  , as well as
voluntary sterilization procedures  and   ,
 contraceptive education and counseling  , and related
followup services  . The bill would prohibit a nongrandfathered
plan contract or health insurance policy from imposing any
cost-sharing requirements or other restrictions or delays with
respect to this coverage, except as specified. The bill would also
authorize a plan or insurer to require a prescription to trigger
coverage of FDA approved over-the-counter contraceptive methods and
supplies. The bill would retain the provision authorizing a religious
employer to request a contract or policy without coverage of FDA
approved contraceptive methods that are contrary to the employer's
religious tenets. Because a willful violation of the bill's
requirements 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.
   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.  The Legislature hereby finds and declares all of the
following:
   (a) California has a long history of expanding timely access to
birth control to prevent unintended pregnancy.
   (b) The federal Patient Protection and Affordable Care Act
includes a contraceptive coverage guarantee as part of a broader
requirement for health insurance carriers and plans to cover key
preventive care services without out-of-pocket costs for patients.
   (c) The Legislature intends to build on existing state and federal
law to ensure greater contraceptive coverage equity and timely
access to all federal Food and Drug Administration approved methods
of birth control for all individuals covered by health care service
plan contracts and health insurance policies in California. 
   (d) Medical management techniques such as denials, step therapy,
or prior authorization in public and private health care coverage can
impede access to the most effective contraceptive methods. 
  SEC. 2.  Section 1367.25 of the Health and Safety Code is amended
to read:
   1367.25.  (a)  A group health care service plan contract, except
for a specialized health care service plan contract, that is issued,
amended, renewed, or delivered on or after January 1, 2000, through
December 31, 2014, inclusive, and an individual health care service
plan contract that is amended, renewed, or delivered on or after
January 1, 2000, through December 31, 2014, inclusive, except for a
specialized health care service plan contract, shall provide coverage
for the following, under general terms and conditions applicable to
all benefits:
   (1)  A health care service plan contract that provides coverage
for outpatient prescription drug benefits shall include coverage for
a variety of federal Food and Drug Administration (FDA) approved
prescription contraceptive methods designated by the plan. In the
event the patient's participating provider, acting within his or her
scope of practice, determines that none of the methods designated by
the plan is medically appropriate for the patient's medical or
personal history, the plan shall also provide coverage for another
FDA approved, medically appropriate prescription contraceptive method
prescribed by the patient's provider.
   (2)  Benefits for an enrollee under this subdivision shall be the
same for an enrollee's covered spouse and covered nonspouse
dependents.
   (b) (1) A group or individual health care service plan contract,
except for a specialized health care service plan contract, that is
issued, amended, renewed, or delivered on or after January 1, 2015,
shall provide coverage for all of the following:
   (A) All FDA approved contraceptive drugs, devices, and 
products in each contraceptive category outlined by the FDA,
  products,  including drugs, devices, and products
available over the counter, as prescribed by the enrollee's
provider.
   (B) Voluntary sterilization procedures.
   (C) Patient education and counseling on contraception. 
   (D) Followup services related to the drugs, devices, products, and
procedures covered under this subdivision, including, but not
limited to, management of side effects, counseling for continued
adherence, and device removal. 
   (2) (A) Except for a grandfathered health plan, and subject to
subparagraph (B), a health care service plan subject to this
subdivision shall not impose a deductible, coinsurance, copayment, or
any other cost-sharing requirement on the coverage provided pursuant
to this subdivision.
   (B) A health care service plan may cover a generic drug, device,
or product without cost sharing and impose cost sharing for
equivalent nonpreferred or branded drugs, devices, or products.
However, if a generic version of a drug, device, or product is not
available, or is deemed medically inadvisable by the enrollee's
provider, a health care service plan shall provide coverage for the
nonpreferred or brand name drug, device, or product without cost
sharing.
   (3) A health care service plan may require a prescription to
trigger coverage of FDA approved over-the-counter contraceptive
methods and supplies under this subdivision.
   (4) Except as otherwise authorized under this section, a health
care service plan shall not impose any restrictions or delays on the
coverage required under this subdivision.
   (5) Benefits for an enrollee under this subdivision shall be the
same for an enrollee's covered spouse and covered nonspouse
dependents.
   (c) Notwithstanding any other provision of this section, a
religious employer may request a health care service plan contract
without coverage for FDA approved contraceptive methods that are
contrary to the religious employer's religious tenets. If so
requested, a health care service plan contract shall be provided
without coverage for contraceptive methods.
   (1)  For purposes of this section, a "religious employer" is an
entity for which each of the following is true:
   (A)  The inculcation of religious values is the purpose of the
entity.
   (B)  The entity primarily employs persons who share the religious
tenets of the entity.
   (C)  The entity serves primarily persons who share the religious
tenets of the entity.
   (D)  The entity is a nonprofit organization as described in
Section 6033(a)(2)(A)i or iii, of the Internal Revenue Code of 1986,
as amended.
   (2)  Every religious employer that invokes the exemption provided
under this section shall provide written notice to prospective
enrollees prior to enrollment with the plan, listing the
contraceptive health care services the employer refuses to cover for
religious reasons.
   (d) Nothing in this section shall be construed to exclude coverage
for contraceptive supplies as prescribed by a provider, acting
within his or her scope of practice, for reasons other than
contraceptive purposes, such as decreasing the risk of ovarian cancer
or eliminating symptoms of menopause, or for contraception that is
necessary to preserve the life or health of an enrollee.
   (e) Nothing in this section shall be construed to deny or restrict
in any way the department's authority to ensure plan compliance with
this chapter when a plan provides coverage for contraceptive drugs,
devices, and products.
   (f) Nothing in this section shall be construed to require an
individual or group health care service plan contract to cover
experimental or investigational treatments.
   (g) For purposes of this section, the following definitions apply:

   (1) "Grandfathered health plan" has the meaning set forth in
Section 1251 of PPACA.
   (2) "PPACA" means the federal Patient Protection and Affordable
Care Act (Public Law 111-148), as amended by the federal Health Care
and Education Reconciliation Act of 2010 (Public Law 111-152), and
any rules, regulations, or guidance issued thereunder.
   (3) With respect to health care service plan contracts issued,
amended, or renewed on or after January 1, 2015, "provider" means an
individual who is certified or licensed pursuant to Division 2
(commencing with Section 500) of the Business and Professions Code,
or an initiative act referred to in that division, or Division 2.5
(commencing with Section 1797).
  SEC. 3.  Section 10123.196 of the Insurance Code is amended to
read:
   10123.196.  (a) An individual or group policy of disability
insurance issued, amended, renewed, or delivered on or after January
1, 2000, through December 31, 2014, inclusive, that provides coverage
for hospital, medical, or surgical expenses, shall provide coverage
for the following, under the same terms and conditions as applicable
to all benefits:
   (1) A disability insurance policy that provides coverage for
outpatient prescription drug benefits shall include coverage for a
variety of federal Food and Drug Administration (FDA) approved
prescription contraceptive methods, as designated by the insurer. If
an insured's health care provider determines that none of the methods
designated by the disability insurer is medically appropriate for
the insured's medical or personal history, the insurer shall, in the
alternative, provide coverage for some other FDA approved
prescription contraceptive method prescribed by the patient's health
care provider.
   (2) Coverage with respect to an insured under this subdivision
shall be identical for an insured's covered spouse and covered
nonspouse dependents.
   (b) (1) A group or individual policy of disability insurance,
except for a specialized health insurance policy, that is issued,
amended, renewed, or delivered on or after January 1, 2015, shall
provide coverage for all of the following:
   (A) All FDA approved contraceptive drugs, devices, and products
 in each contraceptive category outlined by the FDA 
, including drugs, devices, and products available over the counter,
as prescribed by the insured's provider.
   (B) Voluntary sterilization procedures.
   (C) Patient education and counseling on contraception. 
   (D) Followup services related to the drugs, devices, products, and
procedures covered under this subdivision, including, but not
limited to, management of side effects, counseling for continued
adherence, and device removal. 
   (2) (A) Except for a grandfathered health plan, and subject to
subparagraph (B), a disability insurer subject to this subdivision
shall not impose a deductible, coinsurance, copayment, or any other
cost-sharing requirement on the coverage provided pursuant to this
subdivision.
   (B) A disability insurer may cover a generic drug, device, or
product without cost sharing and impose cost sharing for an
equivalent nonpreferred or branded drug, device, or product. However,
if a generic version of a drug, device, or product is not available,
or is deemed medically inadvisable by the insured's provider, a
disability insurer shall provide coverage for the nonpreferred or
brand name drug, device, or product without cost sharing.
   (3) An insurer may require a prescription to trigger coverage of
FDA approved over-the-counter contraceptive methods and supplies
under this subdivision.
   (4) Except as otherwise authorized under this section, an insurer
shall not impose any restrictions or delays on the coverage required
under this subdivision.
   (5) Coverage with respect to an insured under this subdivision
shall be identical for an insured's covered spouse and covered
nonspouse dependents.
   (c) Nothing in this section shall be construed to deny or restrict
in any way any existing right or benefit provided under law or by
contract.
   (d) Nothing in this section shall be construed to require an
individual or group disability insurance policy to cover experimental
or investigational treatments.
   (e) Notwithstanding any other provision of this section, a
religious employer may request a disability insurance policy without
coverage for contraceptive methods that are contrary to the religious
employer's religious tenets. If so requested, a disability insurance
policy shall be provided without coverage for contraceptive methods.

   (1) For purposes of this section, a "religious employer" is an
entity for which each of the following is true:
   (A) The inculcation of religious values is the purpose of the
entity.
   (B) The entity primarily employs persons who share the religious
tenets of the entity.
   (C) The entity serves primarily persons who share the religious
tenets of the entity.
   (D) The entity is a nonprofit organization pursuant to Section
6033(a)(2)(A)(i) or (iii) of the Internal Revenue Code of 1986, as
amended.
   (2) Every religious employer that invokes the exemption provided
under this section shall provide written notice to any prospective
employee once an offer of employment has been made, and prior to that
person commencing that employment, listing the contraceptive health
care services the employer refuses to cover for religious reasons.
   (f) Nothing in this section shall be construed to exclude coverage
for contraceptive supplies as prescribed by a provider, acting
within his or her scope of practice, for reasons other than
contraceptive purposes, such as decreasing the risk of ovarian cancer
or eliminating symptoms of menopause, or for contraception that is
necessary to preserve the life or health of an insured.
   (g) This section shall only apply to disability insurance policies
or contracts that are defined as health benefit plans pursuant to
subdivision (a) of Section 10198.6, except that for accident only,
specified disease, or hospital indemnity coverage, coverage for
benefits under this section shall apply to the extent that the
benefits are covered under the general terms and conditions that
apply to all other benefits under the policy or contract. Nothing in
this section shall be construed as imposing a new benefit mandate on
accident only, specified disease, or hospital indemnity insurance.
   (h) For purposes of this section, the following definitions apply:

   (1) "Grandfathered health plan" has the meaning set forth in
Section 1251 of PPACA.
   (2) "PPACA" means the federal Patient Protection and Affordable
Care Act (Public Law 111-148), as amended by the federal Health Care
and Education Reconciliation Act of 2010 (Public Law 111-152), and
any rules, regulations, or guidance issued thereunder.
   (3) With respect to policies of disability insurance issued,
amended, or renewed on or after January 1, 2015, "health care
provider" means an individual who is certified or licensed pursuant
to Division 2 (commencing with Section 500) of the Business and
Professions Code, or an initiative act referred to in that division,
or Division 2.5 (commencing with Section 1797) of the Health and
Safety Code.
  SEC. 4.  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.