SB 1176

  • California Senate Bill
  • 2013-2014 Regular Session
  • Introduced in Senate Feb 20, 2014
  • Passed Senate May 27, 2014
  • Assembly
  • Governor

Health care coverage: cost sharing: monitoring.

Abstract

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 requires a health care service plan or health insurer to limit annual out-of-pocket expenses for all covered benefits, as specified. This bill would require a health care service plan or health insurer to be responsible for monitoring the accrual of out-of-pocket costs toward the annual out-of-pocket limit. The bill would require a health care service plan or health insurer, for cost sharing attributed to in-network providers, including contracted vendors, that count toward the annual limit on out-of-pocket costs, to be solely responsible for monitoring the accrual of out-of-pocket costs and prohibit the health care service plan or health insurer from requiring the consumer to track or monitor the accumulation of cost sharing for covered essential health benefits attributed to in-network providers, including contracted vendors. The bill would require a health care service plan or health insurer to accept claims from the provider or information from the consumer with respect to cost sharing for out-of-network providers who are providing certain emergency services or otherwise providing covered benefits arranged by the health care service plan or health insurer subject to the annual limit on out-of-pocket expenses. The bill would also require the health care service plan or health insurer, if the cost sharing for covered essential health benefits attributable to an enrollee or insured exceeds the maximum annual out-of-pocket limits, to reimburse the enrollee or insured no later than 5 working days after the health care service plan or health insurer is required to reimburse the claim or notify the claimant that the claim is contested or denied. The bill would require that the enrollee or insured have the opportunity to review the accrual of cost sharing and provide additional information regarding cost sharing that should be accrued to the out-of-pocket limit. 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. This bill would make these provisions applicable to nongrandfathered individual and group health care service plans, specialized health care service plans that provide coverage for essential health benefits, nongrandfathered individual and group health insurers, and specialized health insurers that provide coverage for essential health benefits. 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 (1)

Votes


Actions


Nov 30, 2014

Assembly

From Assembly without further action.

Assembly

Died on the inactive file.

Aug 21, 2014

Assembly

Ordered to inactive file on request of Assembly Member V. Manuel PĂ©rez.

Aug 18, 2014

Assembly

Read second time. Ordered to third reading.

Aug 14, 2014

Assembly

From committee: Do pass. (Ayes 12. Noes 5.) (August 14).

Aug 06, 2014

Assembly

Set, first hearing. Referred to APPR. suspense file.

  • Referral-Committee
APPR APPR. suspense file.

Jun 24, 2014

Assembly

Read second time and amended. Re-referred to Com. on APPR.

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

Jun 23, 2014

Assembly

From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 14. Noes 5.) (June 17).

Jun 02, 2014

Assembly

Referred to Com. on HEALTH.

  • Referral-Committee
Com. on HEALTH.

May 28, 2014

Assembly

In Assembly. Read first time. Held at Desk.

May 27, 2014

Senate

Read third time. Passed. (Ayes 24. Noes 11. Page 3605.) Ordered to the Assembly.

May 23, 2014

Senate

Read second time. Ordered to third reading.

Senate

From committee: Do pass. (Ayes 5. Noes 2. Page 3711.) (May 23).

May 16, 2014

Senate

Set for hearing May 23.

May 12, 2014

Senate

Placed on APPR. suspense file.

May 02, 2014

Senate

Set for hearing May 12.

Apr 30, 2014

Senate

Read second time and amended. Re-referred to Com. on APPR.

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

Apr 29, 2014

Senate

From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 7. Noes 1.) (April 24).

Apr 11, 2014

Senate

Set for hearing April 24.

Apr 10, 2014

Senate

Re-referred to Com. on HEALTH.

  • Referral-Committee
Com. on HEALTH.

Apr 07, 2014

Senate

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

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

Mar 06, 2014

Senate

Referred to Com. on RLS.

  • Referral-Committee
Com. on RLS.

Feb 21, 2014

Senate

From printer. May be acted upon on or after March 23.

Feb 20, 2014

Senate

Introduced. Read first time. To Com. on RLS. for assignment. To print.

Bill Text

Bill Text Versions Format
SB1176 HTML
02/20/14 - Introduced PDF
04/07/14 - Amended Senate PDF
04/30/14 - Amended Senate PDF
06/24/14 - Amended Assembly PDF

Related Documents

Document Format
No related documents.

Sources

Data on Open States is updated periodically throughout the day from the official website of the California State Legislature.

If you notice any inconsistencies with these official sources, feel free to file an issue.