Bill Text: CA SB1095 | 2009-2010 | Regular Session | Introduced

California Senate Bill 1095 (Prior Session Legislation)

Introduced

Bill Title: California Major Risk Medical Insurance Program.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2010-02-25 - To Com. on HEALTH. [SB1095 Detail]

Download: California-2009-SB1095-Introduced.html

BILL NUMBER: SB 1095	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Aanestad

                        FEBRUARY 17, 2010

   An act to amend Sections 12718 and 12727 of, to add Sections
12712.5 and 12715.5 to, and to add and repeal Section 12721.5 of, the
Insurance Code, relating to health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 1095, as introduced, Aanestad. California Major Risk Medical
Insurance Program.
   Existing law establishes the California Major Risk Medical
Insurance Program (MRMIP) that is administered by the Managed Risk
Medical Insurance Board (MRMIB) to provide major risk medical
coverage to residents, as defined, who, among other matters, have
been rejected for coverage by at least one private health plan.
Existing law requires MRMIB to provide that coverage through
participating health plans, except as specified, and authorizes MRMIB
to provide or purchase stop-loss coverage under which MRMIP and
participating health plans share the risk for health plan expenses
that exceed plan rates. Existing law requires that benefits under the
program be subject to copayments and deductibles authorized by the
board and sets forth certain maximum amounts for deductibles and
copayments.
   The bill would require MRMIB to offer at least 4 different options
for major risk medical coverage with varying deductibles and
out-of-pocket maximums, as specified. The bill would require those
options to include at least one Health Savings Account-compatible
option and would authorize MRMIB to subsidize that option, as
specified. The bill would also authorize MRMIB, until a specified
date and if sufficient funds are available, to participate in
deductible and out-of-pocket maximum reinsurance using specified
products. The bill would require MRMIB to release all program
actuarial data for 2004 to 2007, inclusive, to the Legislative
Analyst's Office, as requested by that office.
   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 12712.5 is added to the Insurance Code, to
read:
   12712.5.  The board shall release to the Legislative Analyst's
Office all program actuarial data for 2004 to 2007, inclusive, as
requested by that office.
  SEC. 2.  Section 12715.5 is added to the Insurance Code, to read:
   12715.5.  (a) Notwithstanding Section 12712.5 or 12723, the board
shall offer at least four different options for major risk medical
coverage pursuant to this part, including at least one Health Savings
Account-compatible option. These options shall provide for both of
the following:
   (1) Varying annual deductibles ranging from five hundred dollars
($500) to two thousand five hundred dollars ($2,500) per individual
and one thousand dollars ($1,000) to four thousand dollars ($4,000)
per family.
   (2) Varying annual out-of-pocket maximums ranging from two
thousand five hundred dollars ($2,500) to five thousand dollars
($5,000) per individual and four thousand dollars ($4,000) to seven
thousand five hundred dollars ($7,500) per family.
   (b) Beginning January 1, 2011, if the board determines that
sufficient program funding is available, the board may subsidize the
Health Savings Account-compatible option offered pursuant to
subdivision (a) on a sliding scale based on income.
  SEC. 3.  Section 12718 of the Insurance Code is amended to read:
   12718.  Benefits under this chapter or Chapter 5 (commencing with
Section 12720) shall be subject to required subscriber copayments and
deductibles as the board may authorize  , as limited by Section
12715.5  . Any authorized copayments shall not exceed 25 percent
 and any authorized deductible shall not exceed an annual
household deductible amount of five hundred dollars ($500) 
. However, health plans not utilizing a deductible may be authorized
to charge an office visit copayment of up to twenty-five dollars
($25). If the board contracts with participating health plans
pursuant to Chapter 5 (commencing with Section 12720), copayments or
deductibles shall be authorized in a manner consistent with the basic
method of operation of the participating health plans  , subject
to Section 12715.5  .  The aggregate amount of
deductible and copayments payable annually under this section shall
not exceed two thousand five hundred dollars ($2,500) for an
individual and four thousand dollars ($4,000) for a family. 

  SEC. 4.  Section 12721.5 is added to the Insurance Code, to read:
   12721.5.  (a) If the board determines there are sufficient funds
available, it may participate, on a sliding scale based on income, in
deductible and out-of-pocket maximum reinsurance using products such
as health reimbursement arrangements, critical insurance policies,
and accident insurance policies.
   (b) This section shall remain in effect only until January 1,
2015, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2015, deletes or extends
that date.
  SEC. 5.  Section 12727 of the Insurance Code is amended to read:
   12727.   Where more than one participating health plan is
offered, the   The  program shall make available to
applicants eligible to enroll in the program sufficient information
to make an informed choice among the  various types of
participating health plans   options provided pursuant
to Section 12715.5  . Each applicant shall be issued an
appropriate document setting forth or summarizing the services to
which an enrollee is entitled, procedures for obtaining major risk
medical coverage, a list of contracting health plans and providers,
and a summary of grievance procedures.