BILL NUMBER: AB 2587INTRODUCED BILL TEXT INTRODUCED BY Assembly Member Tom Berryhill FEBRUARY 19, 2010 An act to add Section 1367.001 to the Health and Safety Code, and to add Section 10112.55 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGEST AB 2587, as introduced, Tom Berryhill. Health care coverage: benefit mandates. 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. Existing law also provides for regulation of health insurers by the Department of Insurance. Existing law imposes certain benefit mandates on health care service plan contracts and health insurance policies. This bill would exempt a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2011, from complying with those benefit mandates, as specified, until the Department of Managed Health Care or the Department of Insurance, as applicable, issues a declaration finding that the state unemployment rate has been no more than 5.5% for 4 consecutive quarters. 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 1367.001 is added to the Health and Safety Code, to read: 1367.001. (a) Notwithstanding any other provision of this chapter, until the department issues a declaration finding that the state unemployment rate, as determined by the official statistics of the Labor Market Information Division of the Employment Development Department, has been no more than 5.5 percent for four consecutive quarters, a health care service plan contract issued, amended, or renewed on or after January 1, 2011, shall not be required to comply with the benefit mandates imposed by this chapter, including any benefit mandates that become operative on or after January 1, 2011. (b) (1) For purposes of this section, "benefit mandate" means a requirement to do any of the following: (A) Permit a subscriber or enrollee to obtain health care treatment or services from a particular type of health care provider. (B) Offer or provide coverage for the screening, diagnosis, or treatment of a particular disease or condition. (C) Offer or provide coverage of a particular type of health care treatment or service, or of medical equipment, medical supplies, or drugs used in connection with a health care treatment or service. (2) Notwithstanding paragraph (1), "benefit mandate" does not include the requirement to provide basic health care services imposed under subdivision (i) of Section 1367. SEC. 2. Section 10112.55 is added to the Insurance Code, to read: 10112.55. (a) Notwithstanding Section 10112.5 or any other provision of this part, until the department issues a declaration finding that the state unemployment rate, as determined by the official statistics of the Labor Market Information Division of the Employment Development Department, has been no more than 5.5 percent for four consecutive quarters, a health insurance policy issued, amended, or renewed on or after January 1, 2011, shall not be required to comply with the benefit mandates imposed by this part, including any benefit mandates that become operative on or after January 1, 2011. (b) For purposes of this section, "benefit mandate" means a requirement to do any of the following: (1) Permit a policyholder or insured to obtain health care treatment or services from a particular type of health care provider. (2) Offer or provide coverage for the screening, diagnosis, or treatment of a particular disease or condition. (3) Offer or provide coverage of a particular type of health care treatment or service, or of medical equipment, medical supplies, or drugs used in connection with a health care treatment or service.