Bill Text: CA SB923 | 2015-2016 | Regular Session | Chaptered

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Bill Title: Health care coverage: cost-sharing changes.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2016-08-25 - Chaptered by Secretary of State. Chapter 192, Statutes of 2016. [SB923 Detail]

Download: California-2015-SB923-Chaptered.html

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BILL NUMBER: SB 923	CHAPTERED
	BILL TEXT

	CHAPTER  192
	FILED WITH SECRETARY OF STATE  AUGUST 25, 2016
	APPROVED BY GOVERNOR  AUGUST 25, 2016
	PASSED THE SENATE  AUGUST 11, 2016
	PASSED THE ASSEMBLY  AUGUST 4, 2016
	AMENDED IN ASSEMBLY  MAY 31, 2016
	AMENDED IN ASSEMBLY  MAY 18, 2016

INTRODUCED BY   Senator Hernandez

                        JANUARY 28, 2016

   An act to add Section 1374.255 to the Health and Safety Code, and
to add Section 10199.49 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 923, Hernandez. Health care coverage: cost-sharing changes.
   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 provides for the
regulation of health insurers by the Department of Insurance.
Existing law prohibits, except as specified, a health care service
plan or a health insurer, with regard to a group contract or policy,
from changing the premium rates or applicable copayments or
coinsurances or deductibles during the term of a group plan contract
or policy during specified time periods.
   This bill would prohibit, for grandfathered plan contracts and
policies and nongrandfathered plan contracts and policies in the
individual and small group markets, a health care service plan
contract or health insurance policy that is issued, amended, or
renewed on or after January 1, 2017, from changing the cost-sharing
design, as defined, during the plan year or policy year, except when
required by state or federal law. Because a willful violation of this
prohibition 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.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1374.255 is added to the Health and Safety
Code, to read:
   1374.255.  (a) This section shall apply to grandfathered health
care service plan contracts and nongrandfathered health care service
plan contracts in the individual or small group markets that are
issued, amended, or renewed on or after January 1, 2017.
   (b) Notwithstanding paragraph (1) of subdivision (b) of Section
1374.20, a health care service plan contract shall not change the
cost-sharing design during the plan year, except when required by
state or federal law.
   (c) For purposes of this section, the following definitions shall
apply:
   (1) "Cost sharing" includes any copayment, coinsurance,
deductible, or any other form of cost sharing by the enrollee other
than the premium or share of premium.
   (2) "Plan year" has the meaning set forth in Section 144.103 of
Title 45 of the Code of Federal Regulations. For nongrandfathered
health care service plan contracts in the individual market, "plan
year" means the calendar year.
   (3) "Cost-sharing design" means the amount or proportion of cost
sharing applied to a covered benefit.
  SEC. 2.  Section 10199.49 is added to the Insurance Code,
immediately following Section 10199.48, to read:
   10199.49.  (a) This section shall apply to grandfathered health
insurance policies and nongrandfathered health insurance policies in
the individual or small group markets that are issued, amended, or
renewed on or after January 1, 2017.
   (b) Notwithstanding paragraph (1) of subdivision (b) of Section
10199.48, a health insurance policy shall not change the cost-sharing
design during the policy year, except when required by state or
federal law.
   (c) For purposes of this section, the following definitions shall
apply:
   (1) "Cost sharing" includes any copayment, coinsurance,
deductible, or any other form of cost sharing by the insured other
than the premium or share of premium.
   (2) "Policy year" has the meaning set forth in Section 144.103 of
Title 45 of the Code of Federal Regulations. For nongrandfathered
health insurance policies in the individual market, "policy year"
means the calendar year.
   (3) "Cost-sharing design" means the amount or proportion of cost
sharing applied to a covered benefit.
  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.