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SB 2

  • California Senate Bill
  • 2013-2014, 1st Special Session
  • Introduced in Senate Jan 28, 2013
  • Passed Senate Feb 28, 2013
  • Passed Assembly Apr 25, 2013
  • Governor

Health care coverage.

Bill Subjects

Health Care Coverage.

Abstract

(1) Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA) , enacts various health care coverage market reforms that take effect January 1, 2014. Among other things, PPACA requires each health insurance issuer that offers health insurance coverage in the individual or group market in a state to accept every employer and individual in the state that applies for that coverage and to renew that coverage at the option of the plan sponsor or the individual. PPACA prohibits a group health plan and a health insurance issuer offering group or individual health insurance coverage from imposing any preexisting condition exclusion with respect to that plan or coverage. PPACA allows the premium rate charged by a health insurance issuer offering small group or individual coverage to vary only by rating area, age, tobacco use, and whether the coverage is for an individual or family and prohibits discrimination against individuals based on health status, as specified. PPACA requires an issuer to consider all enrollees in its individual market plans to be part of a single risk pool and to consider all enrollees in its small group market plans to be part of a single risk pool, as specified. PPACA also requires each state to, by January 1, 2014, establish an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers, 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 requires plans offering coverage in the individual market to offer coverage for a child subject to specified requirements. Existing law establishes the California Health Benefit Exchange (Exchange) to facilitate the purchase of qualified health plans through the Exchange by qualified individuals and qualified small employers by January 1, 2014. This bill would require a health care service plan, on and after October 1, 2013, to offer, market, and sell all of the plan's health benefit plans that are sold in the individual market for policy years on or after January 1, 2014, to all individuals and dependents in each service area in which the plan provides or arranges for the provision of health care services, as specified, but would require plans to limit enrollment in individual health benefit plans to specified open enrollment and special enrollment periods. The bill would prohibit these health care service plans from imposing any preexisting condition exclusion upon any individual and from conditioning the issuance or offering of individual health benefit plans on any health status-related factor, as specified. The bill would require a health care service plan to consider the claims experience of all enrollees of its nongrandfathered individual health benefit plans offered in the state to be part of a single risk pool, as specified, would require the plan to establish a specified index rate for that market, and would authorize the plan to vary premiums from the index rate based only on specified factors. The bill would authorize plans to use only age, geographic region, and family size for purposes of establishing rates for individual health benefit plans, as specified. The bill would require plans to provide specified information regarding the Exchange to applicants for and subscribers of individual health benefit plans offered outside the Exchange. The bill would prohibit a plan from advertising or marketing an individual grandfathered health plan for the purpose of enrolling a dependent of the subscriber in the plan and would also require plans to annually issue a specified notice to subscribers enrolled in a grandfathered plan. The bill would authorize the director to require a plan to discontinue offering individual plan contracts if the director determines the plan does not have sufficient financial viability or organizational capacity, as specified. The bill would make certain of these provisions inoperative if, and 12 months after, specified provisions of PPACA are repealed or amended, as specified. Existing law requires health care service plans to guarantee issue their small employer health benefit plans, as specified. With respect to nongrandfathered small employer health benefit plans for plan years on or after January 1, 2014, among other things, existing law provides certain exceptions from the guarantee issue requirement, allows the premium for small employer health benefit plans to vary only by age, geographic region, and family size, as specified, and requires plans to provide special enrollment periods and coverage effective dates consistent with the individual nongrandfathered market in the state. Existing law provides that these provisions shall be inoperative if specified provisions of PPACA are repealed. This bill would modify the small employer special enrollment periods and coverage effective dates for purposes of consistency with the individual market reforms described above. The bill would also modify the exceptions from the guarantee issue requirement and the manner in which a plan determines premium rates for a small employer health benefit plan, as specified. The bill would also require a plan to consider the claims experience of all enrollees of its nongrandfathered small employer health benefit plans offered in this state to be part of a single risk pool, as specified, would require the plan to establish a specified index rate for that market, and would authorize the plan to vary premiums from the index rate based only on specified factors. The bill would make certain of these provisions inoperative, as specified, if, and 12 months after, specified provisions of PPACA are repealed. Because a willful violation of these requirements with respect to health care service plans would be a crime, the bill would impose a state-mandated local program. (2) PPACA requires a state or the United States Secretary of Health and Human Services to implement a risk adjustment program for the 2014 benefit year and every benefit year thereafter, under which a charge is assessed on low actuarial risk plans and a payment is made to high actuarial risk plans, as specified. If a state that elects to operate an American Health Benefit Exchange elects not to administer this risk adjustment program, the secretary will operate the program and issuers will be required to submit data for purposes of the program to the secretary. This bill would require that any data submitted by health care service plans to the secretary for purposes of the risk adjustment program also be submitted to the Department of Managed Health Care in the same format. The bill would require the department to use that data for specified purposes. (3) PPACA requires health insurance issuers to provide a summary of benefits and coverage explanation pursuant to specified standards to applicants and enrollees or policyholders. Existing law requires health care service plans to use disclosure forms that contain specified information regarding the contracts issued by the plan, including the benefits and coverage of the contract, and the exceptions, reductions, and limitations that apply to the contract. Existing law requires health care service plans that offer individual or small group coverage to also provide a uniform health plan benefits and coverage matrix containing the plan's major provisions, as specified. This bill would require that certain health care service plan contracts satisfy these requirements by providing a uniform summary of benefits and coverage required by federal law. (4) This bill would become operative only if AB 2 of the 2013–14 First Extraordinary Session is enacted and becomes effective. (5) 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.

Bill Sponsors (2)

Ed Hernandez

  • Democratic
Author

Bill Monning

  • Democratic
  • upper
  • 17
Principal Coauthor

Votes


Apr 17, 2013

Assembly

Feb 28, 2013

Senate

Feb 21, 2013

Senate

Actions


May 09, 2013

California State Legislature

Approved by the Governor.

California State Legislature

Chaptered by Secretary of State. Chapter 2, Statutes of 2013-14 First Extraordinary Session.

May 01, 2013

California State Legislature

Enrolled and presented to the Governor at 11 a.m.

Apr 29, 2013

Senate

Assembly amendments concurred in. (Ayes 27. Noes 9. Page 60.) Ordered to engrossing and enrolling.

Apr 25, 2013

Senate

In Senate. Concurrence in Assembly amendments pending.

Assembly

Read third time. Passed. (Ayes 51. Noes 25. Page 93.) Ordered to the Senate.

Apr 18, 2013

Assembly

Read second time. Ordered to third reading.

Apr 17, 2013

Assembly

From committee: Do pass. (Ayes 12. Noes 5.) (April 17).

Apr 10, 2013

Assembly

From committee: Do pass and re-refer to Com. on APPR. (Ayes 13. Noes 6.) (April 9). Re-referred to Com. on APPR.

  • Committee-Passage-Favorable
  • Referral-Committee
  • Committee-Passage
Com. on APPR.

Apr 01, 2013

Assembly

From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.

  • Committee-Passage
  • Amendment-Passage
  • Reading-2
  • Reading-1
  • Referral-Committee
Com. on HEALTH.

Mar 21, 2013

Assembly

From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.

  • Committee-Passage
  • Amendment-Passage
  • Reading-2
  • Reading-1
  • Referral-Committee
Com. on HEALTH.

Mar 12, 2013

Assembly

Hearing postponed by committee.

Mar 07, 2013

Assembly

From committee with author's amendments. Read second time and amended. Re-referred to Com. on HEALTH.

  • Committee-Passage
  • Amendment-Passage
  • Reading-2
  • Reading-1
  • Referral-Committee
Com. on HEALTH.

Mar 04, 2013

Assembly

Re-referred to Com. on HEALTH.

  • Referral-Committee
Com. on HEALTH.

Feb 28, 2013

Assembly

In Assembly. Read first time. Held at Desk.

Senate

Read third time. Passed. (Ayes 26. Noes 10. Page 18.) Ordered to the Assembly.

Feb 25, 2013

Senate

Read second time. Ordered to third reading.

Feb 21, 2013

Senate

From committee: Do pass. (Ayes 5. Noes 2.) (February 21).

Senate

From committee: Do pass and re-refer to Com. on APPR. (Ayes 7. Noes 2.) (February 20). Re-referred to Com. on APPR.

  • Committee-Passage-Favorable
  • Referral-Committee
  • Committee-Passage
Com. on APPR.

Feb 15, 2013

Senate

Set for hearing February 21 in APPR. pending receipt.

Feb 08, 2013

Senate

Set for hearing February 20.

Feb 07, 2013

Senate

Re-referred to Com. on HEALTH.

  • Referral-Committee
Com. on HEALTH.

Jan 28, 2013

Senate

Introduced. Read first time. Referred to Com. on RLS.

  • Reading-1
  • Referral-Committee
  • Introduction
Com. on RLS.

Bill Text

Bill Text Versions Format
SB2 HTML
01/28/13 - Introduced PDF
03/07/13 - Amended Assembly PDF
03/21/13 - Amended Assembly PDF
04/01/13 - Amended Assembly PDF
04/30/13 - Enrolled PDF
05/09/13 - Chaptered PDF

Related Documents

Document Format
No related documents.

Sources

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