Bill Text: CA SB368 | 2021-2022 | Regular Session | Amended

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

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Bill Title: Health care coverage: deductibles and out-of-pocket expenses.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2021-10-06 - Chaptered by Secretary of State. Chapter 602, Statutes of 2021. [SB368 Detail]

Download: California-2021-SB368-Amended.html

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Amended  IN  Senate  March 22, 2021

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Senate Bill

No. 368

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Introduced by Senator Limón

February 10, 2021

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An act to add Section 1367.0061 to the Health and Safety Code, and to add Section 10112.281 to the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL'S DIGEST

SB 368, as amended, Limón. Health care coverage: deductibles and out-of-pocket expenses.

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. A willful violation of the act is a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law sets limits on the amount of the deductible and out-of-pocket expenses that may be included in specified health care service plan contracts and health insurance policies.

This bill, for a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2022, in the individual or group market, would require the health care service plan or health insurer to monitor an enrollee’s or insured’s accrual balance toward their annual deductible and out-of-pocket maximum, if any. The bill would require a health care service plan or health insurer to provide an enrollee or insured with their accrual balance toward their annual deductible and out-of-pocket maximum on a monthly basis during any for every month in which benefits were used, and would allow an enrollee or insured to request their most up-to-date accrual balances from their health care service plan or health insurer at any time. The bill would require accrual updates to be mailed to enrollees unless the enrollee has elected to opt out of mailed notice and elected to receive the accrual update electronically, as specified. Because a willful violation of the bill’s 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 1367.0061 is added to the Health and Safety Code, immediately following Section 1367.006, to read:

1367.0061.

 (a) For a health care service plan contract issued, amended, or renewed on or after January 1, 2022, in the individual or group market, a health care service plan shall monitor an enrollee’s accrual toward their annual deductible, if any, for covered benefits.

(1) A health care service plan shall provide an enrollee with their accrual balance toward their annual deductible on a monthly basis during any for every month in which benefits were used.

(2) An enrollee may request their most up-to-date accrual balance toward their annual deductible from their health care service plan at any time.

(b) For a health care service plan contract issued, amended, or renewed on or after January 1, 2022, in the individual or group market, a health care service plan shall monitor an enrollee’s accrual toward their annual out-of-pocket maximum, if any, for covered benefits.

(1) A health care service plan shall provide an enrollee with their accrual balance toward their annual out-of-pocket maximum on a monthly basis during any for every month in which benefits were used.

(2) An enrollee may request their most up-to-date accrual balance toward their annual out-of-pocket maximum from their health care service plan at any time.

(c) Accrual updates shall be mailed to enrollees unless the enrollee has elected to opt out of mailed notice and elected to receive the accrual update electronically.

(1) Enrollees who have opted out of receiving mailed notice may opt back in at any time.

(2) Accrual updates may be included with evidence of benefit statements.

SEC. 2.

 Section 10112.281 is added to the Insurance Code, immediately following Section 10112.28, to read:

10112.281.

 (a) For a health insurance policy issued, amended, or renewed on or after January 1, 2022, in the individual or group market, a health insurer shall monitor an insured’s accrual toward their annual deductible, if any, for covered benefits.

(1) A health insurer shall provide an insured with their accrual balance toward their annual deductible on a monthly basis during any for every month in which benefits were used.

(2) An insured may request their most up-to-date accrual balance toward their annual deductible from their health insurer at any time.

(b) For a health insurance policy issued, amended, or renewed on or after January 1, 2022, in the individual or group market, an insurer shall monitor an insured’s accrual balance toward their annual out-of-pocket maximum, if any, for covered benefits.

(1) A health insurance policy shall provide an insured with their accrual balance toward their annual out-of-pocket maximum on a monthly basis during any for every month in which benefits were used.

(2) An insured may request their most up-to-date accrual balance toward their annual out-of-pocket maximum from their health insurer at any time.

(c) Accrual updates shall be mailed to an insured unless the insured has elected to opt out of mailed notice and elected to receive the accrual update electronically as allowed according to Section 38.6.

(1) Insureds who have opted out of receiving mailed notice may opt back in at any time.

(2) Accrual updates may be included with evidence of benefit statements.

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.