CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 1246Introduced by Assembly Member LimnFebruary 21, 2019 An act to add Section 10112.285 to the Insurance Code, relating to healthcare coverage. LEGISLATIVE COUNSEL'S DIGESTAB 1246, as introduced, Limn. Healthcare coverage: basic health care services.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 the regulation of health insurers by the Department of Insurance.Existing law requires all health care service plan contracts, and, if applicable, specialized health care service plan contracts, to provide subscribers and enrollees with certain basic health care services, as defined, including physician services and hospital inpatient services, except as specified. Existing law affirms the authority of the Department of Managed Health Care to regulate the provision of medically necessary prescription drug benefits by a health care service plan to the extent the plan provides coverage for those benefits.Existing law requires individual or small group health insurance policies issued, amended, or renewed on or after January 1, 2017, to include coverage for essential health benefits, as defined, including medically necessary basic health care services.This bill would require large group health insurance policies, except certain specialized health insurance policies, issued, amended, or renewed on or after January 1, 2020, to include coverage for medically necessary basic health care services and, to the extent the policy covers prescription drugs, coverage for medically necessary prescription drugs.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NO Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 10112.285 is added to the Insurance Code, immediately following Section 10112.28, to read:10112.285. (a) A large group health insurance policy issued, amended, or renewed on or after January 1, 2020, shall include coverage for medically necessary basic health care services, as defined in subdivision (b) of Section 1345 of the Health and Safety Code and Section 1300.67 of Title 28 of the California Code of Regulations.(b) To the extent a large group health insurance policy covers prescription drugs, a large group health insurance policy issued, amended, or renewed on or after January 1, 2020, shall cover medically necessary prescription drugs, as described in Section 1342.7 of the Health and Safety Code.(c) This section does not prohibit a large group health insurance policy from covering additional benefits.(d) This section does not apply to a specialized health insurance policy that covers only dental or vision services.
CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 1246Introduced by Assembly Member LimnFebruary 21, 2019 An act to add Section 10112.285 to the Insurance Code, relating to healthcare coverage. LEGISLATIVE COUNSEL'S DIGESTAB 1246, as introduced, Limn. Healthcare coverage: basic health care services.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 the regulation of health insurers by the Department of Insurance.Existing law requires all health care service plan contracts, and, if applicable, specialized health care service plan contracts, to provide subscribers and enrollees with certain basic health care services, as defined, including physician services and hospital inpatient services, except as specified. Existing law affirms the authority of the Department of Managed Health Care to regulate the provision of medically necessary prescription drug benefits by a health care service plan to the extent the plan provides coverage for those benefits.Existing law requires individual or small group health insurance policies issued, amended, or renewed on or after January 1, 2017, to include coverage for essential health benefits, as defined, including medically necessary basic health care services.This bill would require large group health insurance policies, except certain specialized health insurance policies, issued, amended, or renewed on or after January 1, 2020, to include coverage for medically necessary basic health care services and, to the extent the policy covers prescription drugs, coverage for medically necessary prescription drugs.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: NO Local Program: NO
CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION
Assembly Bill No. 1246
Introduced by Assembly Member LimnFebruary 21, 2019
Introduced by Assembly Member Limn
February 21, 2019
An act to add Section 10112.285 to the Insurance Code, relating to healthcare coverage.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 1246, as introduced, Limn. Healthcare coverage: basic health care services.
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 the regulation of health insurers by the Department of Insurance.Existing law requires all health care service plan contracts, and, if applicable, specialized health care service plan contracts, to provide subscribers and enrollees with certain basic health care services, as defined, including physician services and hospital inpatient services, except as specified. Existing law affirms the authority of the Department of Managed Health Care to regulate the provision of medically necessary prescription drug benefits by a health care service plan to the extent the plan provides coverage for those benefits.Existing law requires individual or small group health insurance policies issued, amended, or renewed on or after January 1, 2017, to include coverage for essential health benefits, as defined, including medically necessary basic health care services.This bill would require large group health insurance policies, except certain specialized health insurance policies, issued, amended, or renewed on or after January 1, 2020, to include coverage for medically necessary basic health care services and, to the extent the policy covers prescription drugs, coverage for medically necessary prescription drugs.
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 the regulation of health insurers by the Department of Insurance.
Existing law requires all health care service plan contracts, and, if applicable, specialized health care service plan contracts, to provide subscribers and enrollees with certain basic health care services, as defined, including physician services and hospital inpatient services, except as specified. Existing law affirms the authority of the Department of Managed Health Care to regulate the provision of medically necessary prescription drug benefits by a health care service plan to the extent the plan provides coverage for those benefits.
Existing law requires individual or small group health insurance policies issued, amended, or renewed on or after January 1, 2017, to include coverage for essential health benefits, as defined, including medically necessary basic health care services.
This bill would require large group health insurance policies, except certain specialized health insurance policies, issued, amended, or renewed on or after January 1, 2020, to include coverage for medically necessary basic health care services and, to the extent the policy covers prescription drugs, coverage for medically necessary prescription drugs.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. Section 10112.285 is added to the Insurance Code, immediately following Section 10112.28, to read:10112.285. (a) A large group health insurance policy issued, amended, or renewed on or after January 1, 2020, shall include coverage for medically necessary basic health care services, as defined in subdivision (b) of Section 1345 of the Health and Safety Code and Section 1300.67 of Title 28 of the California Code of Regulations.(b) To the extent a large group health insurance policy covers prescription drugs, a large group health insurance policy issued, amended, or renewed on or after January 1, 2020, shall cover medically necessary prescription drugs, as described in Section 1342.7 of the Health and Safety Code.(c) This section does not prohibit a large group health insurance policy from covering additional benefits.(d) This section does not apply to a specialized health insurance policy that covers only dental or vision services.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. Section 10112.285 is added to the Insurance Code, immediately following Section 10112.28, to read:10112.285. (a) A large group health insurance policy issued, amended, or renewed on or after January 1, 2020, shall include coverage for medically necessary basic health care services, as defined in subdivision (b) of Section 1345 of the Health and Safety Code and Section 1300.67 of Title 28 of the California Code of Regulations.(b) To the extent a large group health insurance policy covers prescription drugs, a large group health insurance policy issued, amended, or renewed on or after January 1, 2020, shall cover medically necessary prescription drugs, as described in Section 1342.7 of the Health and Safety Code.(c) This section does not prohibit a large group health insurance policy from covering additional benefits.(d) This section does not apply to a specialized health insurance policy that covers only dental or vision services.
SECTION 1. Section 10112.285 is added to the Insurance Code, immediately following Section 10112.28, to read:
### SECTION 1.
10112.285. (a) A large group health insurance policy issued, amended, or renewed on or after January 1, 2020, shall include coverage for medically necessary basic health care services, as defined in subdivision (b) of Section 1345 of the Health and Safety Code and Section 1300.67 of Title 28 of the California Code of Regulations.(b) To the extent a large group health insurance policy covers prescription drugs, a large group health insurance policy issued, amended, or renewed on or after January 1, 2020, shall cover medically necessary prescription drugs, as described in Section 1342.7 of the Health and Safety Code.(c) This section does not prohibit a large group health insurance policy from covering additional benefits.(d) This section does not apply to a specialized health insurance policy that covers only dental or vision services.
10112.285. (a) A large group health insurance policy issued, amended, or renewed on or after January 1, 2020, shall include coverage for medically necessary basic health care services, as defined in subdivision (b) of Section 1345 of the Health and Safety Code and Section 1300.67 of Title 28 of the California Code of Regulations.(b) To the extent a large group health insurance policy covers prescription drugs, a large group health insurance policy issued, amended, or renewed on or after January 1, 2020, shall cover medically necessary prescription drugs, as described in Section 1342.7 of the Health and Safety Code.(c) This section does not prohibit a large group health insurance policy from covering additional benefits.(d) This section does not apply to a specialized health insurance policy that covers only dental or vision services.
10112.285. (a) A large group health insurance policy issued, amended, or renewed on or after January 1, 2020, shall include coverage for medically necessary basic health care services, as defined in subdivision (b) of Section 1345 of the Health and Safety Code and Section 1300.67 of Title 28 of the California Code of Regulations.(b) To the extent a large group health insurance policy covers prescription drugs, a large group health insurance policy issued, amended, or renewed on or after January 1, 2020, shall cover medically necessary prescription drugs, as described in Section 1342.7 of the Health and Safety Code.(c) This section does not prohibit a large group health insurance policy from covering additional benefits.(d) This section does not apply to a specialized health insurance policy that covers only dental or vision services.
10112.285. (a) A large group health insurance policy issued, amended, or renewed on or after January 1, 2020, shall include coverage for medically necessary basic health care services, as defined in subdivision (b) of Section 1345 of the Health and Safety Code and Section 1300.67 of Title 28 of the California Code of Regulations.
(b) To the extent a large group health insurance policy covers prescription drugs, a large group health insurance policy issued, amended, or renewed on or after January 1, 2020, shall cover medically necessary prescription drugs, as described in Section 1342.7 of the Health and Safety Code.
(c) This section does not prohibit a large group health insurance policy from covering additional benefits.
(d) This section does not apply to a specialized health insurance policy that covers only dental or vision services.