Amended IN Senate August 12, 2020 Amended IN Assembly May 20, 2020 Amended IN Assembly May 11, 2020 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 2118Introduced by Assembly Member Kalra(Coauthor: Assembly Member Gonzalez)February 06, 2020 An act to add Section 1385.043 to the Health and Safety Code Code, and to add Section 10181.46 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTAB 2118, as amended, Kalra. Health care service plans and health insurers: reporting requirements.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 requires a health care service plan or health insurer offering a contract or policy in the individual, small, and large group markets to file specified information, including total earned premiums and total incurred claims for each contract or policy form, with the appropriate department at least 120 days before implementing a rate change. Existing law requires a large group market health care service plan or insurer to report additional information relating to cost sharing and specified aggregate rate information. Existing law requires the Department of Managed Health Care and the Department of Insurance to conduct an annual public meeting regarding large group rates.This bill would expand reporting requirements for require health care service plans and health insurers, insurers to report to the Department of Managed Health Care and the Department of Insurance, respectively, by October 1, 2021, and annually thereafter, for products in the individual and small group markets to include, markets, and for rates effective during the 12-month period ending January 1 of the following year, specified information on on specified information, including premiums, cost sharing, benefits, enrollment, and trend factors as reported in all rate filings for the health care service plan or insurer, including both price and utilization. The bill factors, and would exclude specified prescribed information from the reporting requirements until January 1, 2023. The bill would require each department, beginning in 2022, to annually present the information required by the bill at the meeting regarding large group rates and at a public meeting of the board of Covered California, as specified. reported information at specified meetings, including a public meeting of the executive board of the California Health Benefit Exchange. The bill would also require each department to post the information reported under this section on its internet website no later than December 15 of each year.Because a violation of the bill 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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 1385.043 is added to the Health and Safety Code, to read:1385.043. (a) A health care service plan shall annually report to the department the following information for all products that the plan offers and sells in the individual and small group markets, including both on-exchange and off-exchange enrollment, for rates effective during the 12-month period ending January 1 of the following year:(1) Information on premiums, including share of premium premium, if applicable,weighted average premium, average premium weighted by enrollment, and average rate change.(2) Cost sharing, including deductibles, maximum out-of-pocket limit, copayments, coinsurance, and any other cost sharing for covered benefits as well as high deductible health plans.(3)Benefits, including those in addition to essential health benefits or basic health care services and those offered in products subject to the standard benefit design that are in addition to benefits offered in the standard benefit design.(3) (A) For nongrandfathered plans, benefits, including essential health benefits or basic health care services.(B) For grandfathered plans, basic health care services and mandates.(4) Standard and nonstandard benefit designs, including on-exchange and off-exchange nonstandard benefit designs.(5) Enrollment by actuarial value tier, product, benefit design and premiums, including both of the following:(A) Enrollment in products with zero deductibles, high deductibles as defined in this section, and deductibles between zero and high.(B) (i) Enrollment by premium or share of premium, if applicable. premium.(ii) For small group products, enrollment by share of premium.(b)(6) Trend factors as reported in all individual and small group rate filings for the health care service plan, including both price and utilization, as required in Section 1385.03.(b) By October 1, 2021, and annually thereafter, a health care service plan shall submit the annual report, as described under subdivision (a), to the department in a form and manner determined by the department.(c) Beginning in 2022, the department shall present annually annually present the information reported under this section in the meeting specified in Section 1385.045 or a meeting of the Financial Solvency Standards Board. The department also shall present the information at a public meeting of the board of Covered California. executive board of the California Health Benefit Exchange. The department also shall post the information reported under this section on its internet website no later than December 15 of each year.(d) The following definitions apply for purposes of this section:(1) Weighted average premium Average premium weighted by enrollment means the following:(A) For the individual market, the average premium shall be weighted by the number of individual enrollees in the plans individual market and adjusted to the most commonly sold individual market benefit design plan, by enrollment, during the 12-month period.(B) For the small group market, the average premium shall be weighted by the number of enrollees in each small group benefit design in the plans small group market and adjusted to the most commonly sold small group benefit design plan, by enrollment, during the 12-month period.(2) Benefit design means the cost sharing for covered benefits.(3) High deductible has the same meaning as defined in Section 223(c)(2)(A) of Title 26 of the United States Code.(4) Nonstandard benefit design means a benefit design other than the standard benefit design.(5) Share of premium means the share of premium paid by the enrollee on behalf of the enrollee and any dependents, not the subscriber.(4)(6) Standard benefit design means the standardized product consistent with Section 1366.6 of this code and products approved by the executive board of the California Health Benefit Exchange pursuant to subdivision (c) of Section 100504 of the Government Code. (e) Until January 1, 2023, a health care service plan shall not be required to report either of the following information:(1) Share of premium paid by enrollee.(2)Covered benefits that differ from essential health benefits, or for a qualified health plan, benefits in addition to those required in the standard benefit design.(3)(2) Enrollment by benefit design, deductible, or share of premium.SEC. 2. Section 10181.46 is added to the Insurance Code, to read:10181.46. (a) A health insurer shall annually report to the department the following information for all products that the insurer offers and sells in the individual and small group markets, including both on-exchange and off-exchange enrollment, for rates effective during the 12-month period ending January 1 of the following year:(1) Information on premiums, including share of premium premium, if applicable,weighted average premium, average premium weighted by enrollment, and average rate change.(2) Cost sharing, including deductibles, maximum out-of-pocket limit, copayments, coinsurance and any other cost sharing for covered benefits as well as high deductible health plans. policies.(3)Benefits, including those in addition to essential health benefits or basic health care services and those offered in products subject to the standard benefit design that are in addition to benefits offered in the standard benefit design.(3) (A) For nongrandfathered policies, essential health benefits and basic health care services.(B) For grandfathered policies, covered benefits, including mandates, if any.(4) Standard and nonstandard benefit designs, including on-exchange and off-exchange nonstandard benefit designs.(5) Enrollment by actuarial value tier, product, benefit design and premiums, including both of the following:(A) Enrollment in products with zero deductibles, high deductibles as defined in this section, and deductibles between zero and high.(B) (i) Enrollment by premium or share of premium, if applicable. premium.(ii) For small group products, enrollment by share of premium.(b)(6) Trend factors as reported in all individual and small group rate filings for the health insurer, including both price and utilization, as required in Section 10181.3.(b) By October 1, 2021, and annually thereafter, a health insurer shall submit the annual report, as described under subdivision (a), to the department in a form and manner determined by the department.(c) Beginning in 2022, the department shall present annually annually present the information reported under this section in the meeting specified in Section 10181.45. The department also shall present this information at a public meeting of the board of Covered California. executive board of the California Health Benefit Exchange. The department also shall post the information reported under this section on its internet website no later than December 15 of each year.(d) For purposes of this section, the following definitions apply:(1) Weighted average premium Average premium weighted by enrollment means both of the following:(A) For the individual market, the average premium shall be weighted by the number of individual insureds in the plans insurers individual market and adjusted to the most commonly sold individual market benefit design plan, by enrollment during the 12-month period.(B) For the small group market, the average premium shall be weighted by the number of insureds in each small group benefit design in the insurers small group market and adjusted to the most commonly sold small group benefit design plan, by enrollment during the 12-month period.(2) Benefit design means the cost sharing for covered benefits.(3) High deductible has the same meaning as defined in Section 223(c)(2)(A) of Title 26 of the United States Code.(4) Nonstandard benefit design means a benefit design other than the standard benefit design.(5) Share of premium means the share of premium paid by the insured on behalf of the insured and any dependents, not the employer.(4)(6) Standard benefit design means the standardized product, consistent with Section 10112.3 of this code and products approved by the executive board of the California Health Benefit Exchange pursuant to subdivision (c) of Section 100504 of the Government Code. (e) Until January 1, 2023, a health insurer shall not be required to report either of the following information:(1) Share of premium paid by insured.(2)Covered benefits that differ from essential health benefits or for a qualified health plan, benefits in addition to those required in the standard benefit design.(3)(2) Enrollment by benefit design, deductible, or share of premium.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
Amended IN Senate August 12, 2020 Amended IN Assembly May 20, 2020 Amended IN Assembly May 11, 2020 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 2118Introduced by Assembly Member Kalra(Coauthor: Assembly Member Gonzalez)February 06, 2020 An act to add Section 1385.043 to the Health and Safety Code Code, and to add Section 10181.46 to the Insurance Code, relating to health care coverage. LEGISLATIVE COUNSEL'S DIGESTAB 2118, as amended, Kalra. Health care service plans and health insurers: reporting requirements.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 requires a health care service plan or health insurer offering a contract or policy in the individual, small, and large group markets to file specified information, including total earned premiums and total incurred claims for each contract or policy form, with the appropriate department at least 120 days before implementing a rate change. Existing law requires a large group market health care service plan or insurer to report additional information relating to cost sharing and specified aggregate rate information. Existing law requires the Department of Managed Health Care and the Department of Insurance to conduct an annual public meeting regarding large group rates.This bill would expand reporting requirements for require health care service plans and health insurers, insurers to report to the Department of Managed Health Care and the Department of Insurance, respectively, by October 1, 2021, and annually thereafter, for products in the individual and small group markets to include, markets, and for rates effective during the 12-month period ending January 1 of the following year, specified information on on specified information, including premiums, cost sharing, benefits, enrollment, and trend factors as reported in all rate filings for the health care service plan or insurer, including both price and utilization. The bill factors, and would exclude specified prescribed information from the reporting requirements until January 1, 2023. The bill would require each department, beginning in 2022, to annually present the information required by the bill at the meeting regarding large group rates and at a public meeting of the board of Covered California, as specified. reported information at specified meetings, including a public meeting of the executive board of the California Health Benefit Exchange. The bill would also require each department to post the information reported under this section on its internet website no later than December 15 of each year.Because a violation of the bill 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.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES
Amended IN Senate August 12, 2020 Amended IN Assembly May 20, 2020 Amended IN Assembly May 11, 2020
Amended IN Senate August 12, 2020
Amended IN Assembly May 20, 2020
Amended IN Assembly May 11, 2020
CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION
Assembly Bill
No. 2118
Introduced by Assembly Member Kalra(Coauthor: Assembly Member Gonzalez)February 06, 2020
Introduced by Assembly Member Kalra(Coauthor: Assembly Member Gonzalez)
February 06, 2020
An act to add Section 1385.043 to the Health and Safety Code Code, and to add Section 10181.46 to the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 2118, as amended, Kalra. Health care service plans and health insurers: reporting requirements.
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 requires a health care service plan or health insurer offering a contract or policy in the individual, small, and large group markets to file specified information, including total earned premiums and total incurred claims for each contract or policy form, with the appropriate department at least 120 days before implementing a rate change. Existing law requires a large group market health care service plan or insurer to report additional information relating to cost sharing and specified aggregate rate information. Existing law requires the Department of Managed Health Care and the Department of Insurance to conduct an annual public meeting regarding large group rates.This bill would expand reporting requirements for require health care service plans and health insurers, insurers to report to the Department of Managed Health Care and the Department of Insurance, respectively, by October 1, 2021, and annually thereafter, for products in the individual and small group markets to include, markets, and for rates effective during the 12-month period ending January 1 of the following year, specified information on on specified information, including premiums, cost sharing, benefits, enrollment, and trend factors as reported in all rate filings for the health care service plan or insurer, including both price and utilization. The bill factors, and would exclude specified prescribed information from the reporting requirements until January 1, 2023. The bill would require each department, beginning in 2022, to annually present the information required by the bill at the meeting regarding large group rates and at a public meeting of the board of Covered California, as specified. reported information at specified meetings, including a public meeting of the executive board of the California Health Benefit Exchange. The bill would also require each department to post the information reported under this section on its internet website no later than December 15 of each year.Because a violation of the bill 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.
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 requires a health care service plan or health insurer offering a contract or policy in the individual, small, and large group markets to file specified information, including total earned premiums and total incurred claims for each contract or policy form, with the appropriate department at least 120 days before implementing a rate change. Existing law requires a large group market health care service plan or insurer to report additional information relating to cost sharing and specified aggregate rate information. Existing law requires the Department of Managed Health Care and the Department of Insurance to conduct an annual public meeting regarding large group rates.
This bill would expand reporting requirements for require health care service plans and health insurers, insurers to report to the Department of Managed Health Care and the Department of Insurance, respectively, by October 1, 2021, and annually thereafter, for products in the individual and small group markets to include, markets, and for rates effective during the 12-month period ending January 1 of the following year, specified information on on specified information, including premiums, cost sharing, benefits, enrollment, and trend factors as reported in all rate filings for the health care service plan or insurer, including both price and utilization. The bill factors, and would exclude specified prescribed information from the reporting requirements until January 1, 2023. The bill would require each department, beginning in 2022, to annually present the information required by the bill at the meeting regarding large group rates and at a public meeting of the board of Covered California, as specified. reported information at specified meetings, including a public meeting of the executive board of the California Health Benefit Exchange. The bill would also require each department to post the information reported under this section on its internet website no later than December 15 of each year.
Because a violation of the bill 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.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. Section 1385.043 is added to the Health and Safety Code, to read:1385.043. (a) A health care service plan shall annually report to the department the following information for all products that the plan offers and sells in the individual and small group markets, including both on-exchange and off-exchange enrollment, for rates effective during the 12-month period ending January 1 of the following year:(1) Information on premiums, including share of premium premium, if applicable,weighted average premium, average premium weighted by enrollment, and average rate change.(2) Cost sharing, including deductibles, maximum out-of-pocket limit, copayments, coinsurance, and any other cost sharing for covered benefits as well as high deductible health plans.(3)Benefits, including those in addition to essential health benefits or basic health care services and those offered in products subject to the standard benefit design that are in addition to benefits offered in the standard benefit design.(3) (A) For nongrandfathered plans, benefits, including essential health benefits or basic health care services.(B) For grandfathered plans, basic health care services and mandates.(4) Standard and nonstandard benefit designs, including on-exchange and off-exchange nonstandard benefit designs.(5) Enrollment by actuarial value tier, product, benefit design and premiums, including both of the following:(A) Enrollment in products with zero deductibles, high deductibles as defined in this section, and deductibles between zero and high.(B) (i) Enrollment by premium or share of premium, if applicable. premium.(ii) For small group products, enrollment by share of premium.(b)(6) Trend factors as reported in all individual and small group rate filings for the health care service plan, including both price and utilization, as required in Section 1385.03.(b) By October 1, 2021, and annually thereafter, a health care service plan shall submit the annual report, as described under subdivision (a), to the department in a form and manner determined by the department.(c) Beginning in 2022, the department shall present annually annually present the information reported under this section in the meeting specified in Section 1385.045 or a meeting of the Financial Solvency Standards Board. The department also shall present the information at a public meeting of the board of Covered California. executive board of the California Health Benefit Exchange. The department also shall post the information reported under this section on its internet website no later than December 15 of each year.(d) The following definitions apply for purposes of this section:(1) Weighted average premium Average premium weighted by enrollment means the following:(A) For the individual market, the average premium shall be weighted by the number of individual enrollees in the plans individual market and adjusted to the most commonly sold individual market benefit design plan, by enrollment, during the 12-month period.(B) For the small group market, the average premium shall be weighted by the number of enrollees in each small group benefit design in the plans small group market and adjusted to the most commonly sold small group benefit design plan, by enrollment, during the 12-month period.(2) Benefit design means the cost sharing for covered benefits.(3) High deductible has the same meaning as defined in Section 223(c)(2)(A) of Title 26 of the United States Code.(4) Nonstandard benefit design means a benefit design other than the standard benefit design.(5) Share of premium means the share of premium paid by the enrollee on behalf of the enrollee and any dependents, not the subscriber.(4)(6) Standard benefit design means the standardized product consistent with Section 1366.6 of this code and products approved by the executive board of the California Health Benefit Exchange pursuant to subdivision (c) of Section 100504 of the Government Code. (e) Until January 1, 2023, a health care service plan shall not be required to report either of the following information:(1) Share of premium paid by enrollee.(2)Covered benefits that differ from essential health benefits, or for a qualified health plan, benefits in addition to those required in the standard benefit design.(3)(2) Enrollment by benefit design, deductible, or share of premium.SEC. 2. Section 10181.46 is added to the Insurance Code, to read:10181.46. (a) A health insurer shall annually report to the department the following information for all products that the insurer offers and sells in the individual and small group markets, including both on-exchange and off-exchange enrollment, for rates effective during the 12-month period ending January 1 of the following year:(1) Information on premiums, including share of premium premium, if applicable,weighted average premium, average premium weighted by enrollment, and average rate change.(2) Cost sharing, including deductibles, maximum out-of-pocket limit, copayments, coinsurance and any other cost sharing for covered benefits as well as high deductible health plans. policies.(3)Benefits, including those in addition to essential health benefits or basic health care services and those offered in products subject to the standard benefit design that are in addition to benefits offered in the standard benefit design.(3) (A) For nongrandfathered policies, essential health benefits and basic health care services.(B) For grandfathered policies, covered benefits, including mandates, if any.(4) Standard and nonstandard benefit designs, including on-exchange and off-exchange nonstandard benefit designs.(5) Enrollment by actuarial value tier, product, benefit design and premiums, including both of the following:(A) Enrollment in products with zero deductibles, high deductibles as defined in this section, and deductibles between zero and high.(B) (i) Enrollment by premium or share of premium, if applicable. premium.(ii) For small group products, enrollment by share of premium.(b)(6) Trend factors as reported in all individual and small group rate filings for the health insurer, including both price and utilization, as required in Section 10181.3.(b) By October 1, 2021, and annually thereafter, a health insurer shall submit the annual report, as described under subdivision (a), to the department in a form and manner determined by the department.(c) Beginning in 2022, the department shall present annually annually present the information reported under this section in the meeting specified in Section 10181.45. The department also shall present this information at a public meeting of the board of Covered California. executive board of the California Health Benefit Exchange. The department also shall post the information reported under this section on its internet website no later than December 15 of each year.(d) For purposes of this section, the following definitions apply:(1) Weighted average premium Average premium weighted by enrollment means both of the following:(A) For the individual market, the average premium shall be weighted by the number of individual insureds in the plans insurers individual market and adjusted to the most commonly sold individual market benefit design plan, by enrollment during the 12-month period.(B) For the small group market, the average premium shall be weighted by the number of insureds in each small group benefit design in the insurers small group market and adjusted to the most commonly sold small group benefit design plan, by enrollment during the 12-month period.(2) Benefit design means the cost sharing for covered benefits.(3) High deductible has the same meaning as defined in Section 223(c)(2)(A) of Title 26 of the United States Code.(4) Nonstandard benefit design means a benefit design other than the standard benefit design.(5) Share of premium means the share of premium paid by the insured on behalf of the insured and any dependents, not the employer.(4)(6) Standard benefit design means the standardized product, consistent with Section 10112.3 of this code and products approved by the executive board of the California Health Benefit Exchange pursuant to subdivision (c) of Section 100504 of the Government Code. (e) Until January 1, 2023, a health insurer shall not be required to report either of the following information:(1) Share of premium paid by insured.(2)Covered benefits that differ from essential health benefits or for a qualified health plan, benefits in addition to those required in the standard benefit design.(3)(2) Enrollment by benefit design, deductible, or share of premium.SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
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 1385.043 is added to the Health and Safety Code, to read:1385.043. (a) A health care service plan shall annually report to the department the following information for all products that the plan offers and sells in the individual and small group markets, including both on-exchange and off-exchange enrollment, for rates effective during the 12-month period ending January 1 of the following year:(1) Information on premiums, including share of premium premium, if applicable,weighted average premium, average premium weighted by enrollment, and average rate change.(2) Cost sharing, including deductibles, maximum out-of-pocket limit, copayments, coinsurance, and any other cost sharing for covered benefits as well as high deductible health plans.(3)Benefits, including those in addition to essential health benefits or basic health care services and those offered in products subject to the standard benefit design that are in addition to benefits offered in the standard benefit design.(3) (A) For nongrandfathered plans, benefits, including essential health benefits or basic health care services.(B) For grandfathered plans, basic health care services and mandates.(4) Standard and nonstandard benefit designs, including on-exchange and off-exchange nonstandard benefit designs.(5) Enrollment by actuarial value tier, product, benefit design and premiums, including both of the following:(A) Enrollment in products with zero deductibles, high deductibles as defined in this section, and deductibles between zero and high.(B) (i) Enrollment by premium or share of premium, if applicable. premium.(ii) For small group products, enrollment by share of premium.(b)(6) Trend factors as reported in all individual and small group rate filings for the health care service plan, including both price and utilization, as required in Section 1385.03.(b) By October 1, 2021, and annually thereafter, a health care service plan shall submit the annual report, as described under subdivision (a), to the department in a form and manner determined by the department.(c) Beginning in 2022, the department shall present annually annually present the information reported under this section in the meeting specified in Section 1385.045 or a meeting of the Financial Solvency Standards Board. The department also shall present the information at a public meeting of the board of Covered California. executive board of the California Health Benefit Exchange. The department also shall post the information reported under this section on its internet website no later than December 15 of each year.(d) The following definitions apply for purposes of this section:(1) Weighted average premium Average premium weighted by enrollment means the following:(A) For the individual market, the average premium shall be weighted by the number of individual enrollees in the plans individual market and adjusted to the most commonly sold individual market benefit design plan, by enrollment, during the 12-month period.(B) For the small group market, the average premium shall be weighted by the number of enrollees in each small group benefit design in the plans small group market and adjusted to the most commonly sold small group benefit design plan, by enrollment, during the 12-month period.(2) Benefit design means the cost sharing for covered benefits.(3) High deductible has the same meaning as defined in Section 223(c)(2)(A) of Title 26 of the United States Code.(4) Nonstandard benefit design means a benefit design other than the standard benefit design.(5) Share of premium means the share of premium paid by the enrollee on behalf of the enrollee and any dependents, not the subscriber.(4)(6) Standard benefit design means the standardized product consistent with Section 1366.6 of this code and products approved by the executive board of the California Health Benefit Exchange pursuant to subdivision (c) of Section 100504 of the Government Code. (e) Until January 1, 2023, a health care service plan shall not be required to report either of the following information:(1) Share of premium paid by enrollee.(2)Covered benefits that differ from essential health benefits, or for a qualified health plan, benefits in addition to those required in the standard benefit design.(3)(2) Enrollment by benefit design, deductible, or share of premium.
SECTION 1. Section 1385.043 is added to the Health and Safety Code, to read:
### SECTION 1.
1385.043. (a) A health care service plan shall annually report to the department the following information for all products that the plan offers and sells in the individual and small group markets, including both on-exchange and off-exchange enrollment, for rates effective during the 12-month period ending January 1 of the following year:(1) Information on premiums, including share of premium premium, if applicable,weighted average premium, average premium weighted by enrollment, and average rate change.(2) Cost sharing, including deductibles, maximum out-of-pocket limit, copayments, coinsurance, and any other cost sharing for covered benefits as well as high deductible health plans.(3)Benefits, including those in addition to essential health benefits or basic health care services and those offered in products subject to the standard benefit design that are in addition to benefits offered in the standard benefit design.(3) (A) For nongrandfathered plans, benefits, including essential health benefits or basic health care services.(B) For grandfathered plans, basic health care services and mandates.(4) Standard and nonstandard benefit designs, including on-exchange and off-exchange nonstandard benefit designs.(5) Enrollment by actuarial value tier, product, benefit design and premiums, including both of the following:(A) Enrollment in products with zero deductibles, high deductibles as defined in this section, and deductibles between zero and high.(B) (i) Enrollment by premium or share of premium, if applicable. premium.(ii) For small group products, enrollment by share of premium.(b)(6) Trend factors as reported in all individual and small group rate filings for the health care service plan, including both price and utilization, as required in Section 1385.03.(b) By October 1, 2021, and annually thereafter, a health care service plan shall submit the annual report, as described under subdivision (a), to the department in a form and manner determined by the department.(c) Beginning in 2022, the department shall present annually annually present the information reported under this section in the meeting specified in Section 1385.045 or a meeting of the Financial Solvency Standards Board. The department also shall present the information at a public meeting of the board of Covered California. executive board of the California Health Benefit Exchange. The department also shall post the information reported under this section on its internet website no later than December 15 of each year.(d) The following definitions apply for purposes of this section:(1) Weighted average premium Average premium weighted by enrollment means the following:(A) For the individual market, the average premium shall be weighted by the number of individual enrollees in the plans individual market and adjusted to the most commonly sold individual market benefit design plan, by enrollment, during the 12-month period.(B) For the small group market, the average premium shall be weighted by the number of enrollees in each small group benefit design in the plans small group market and adjusted to the most commonly sold small group benefit design plan, by enrollment, during the 12-month period.(2) Benefit design means the cost sharing for covered benefits.(3) High deductible has the same meaning as defined in Section 223(c)(2)(A) of Title 26 of the United States Code.(4) Nonstandard benefit design means a benefit design other than the standard benefit design.(5) Share of premium means the share of premium paid by the enrollee on behalf of the enrollee and any dependents, not the subscriber.(4)(6) Standard benefit design means the standardized product consistent with Section 1366.6 of this code and products approved by the executive board of the California Health Benefit Exchange pursuant to subdivision (c) of Section 100504 of the Government Code. (e) Until January 1, 2023, a health care service plan shall not be required to report either of the following information:(1) Share of premium paid by enrollee.(2)Covered benefits that differ from essential health benefits, or for a qualified health plan, benefits in addition to those required in the standard benefit design.(3)(2) Enrollment by benefit design, deductible, or share of premium.
1385.043. (a) A health care service plan shall annually report to the department the following information for all products that the plan offers and sells in the individual and small group markets, including both on-exchange and off-exchange enrollment, for rates effective during the 12-month period ending January 1 of the following year:(1) Information on premiums, including share of premium premium, if applicable,weighted average premium, average premium weighted by enrollment, and average rate change.(2) Cost sharing, including deductibles, maximum out-of-pocket limit, copayments, coinsurance, and any other cost sharing for covered benefits as well as high deductible health plans.(3)Benefits, including those in addition to essential health benefits or basic health care services and those offered in products subject to the standard benefit design that are in addition to benefits offered in the standard benefit design.(3) (A) For nongrandfathered plans, benefits, including essential health benefits or basic health care services.(B) For grandfathered plans, basic health care services and mandates.(4) Standard and nonstandard benefit designs, including on-exchange and off-exchange nonstandard benefit designs.(5) Enrollment by actuarial value tier, product, benefit design and premiums, including both of the following:(A) Enrollment in products with zero deductibles, high deductibles as defined in this section, and deductibles between zero and high.(B) (i) Enrollment by premium or share of premium, if applicable. premium.(ii) For small group products, enrollment by share of premium.(b)(6) Trend factors as reported in all individual and small group rate filings for the health care service plan, including both price and utilization, as required in Section 1385.03.(b) By October 1, 2021, and annually thereafter, a health care service plan shall submit the annual report, as described under subdivision (a), to the department in a form and manner determined by the department.(c) Beginning in 2022, the department shall present annually annually present the information reported under this section in the meeting specified in Section 1385.045 or a meeting of the Financial Solvency Standards Board. The department also shall present the information at a public meeting of the board of Covered California. executive board of the California Health Benefit Exchange. The department also shall post the information reported under this section on its internet website no later than December 15 of each year.(d) The following definitions apply for purposes of this section:(1) Weighted average premium Average premium weighted by enrollment means the following:(A) For the individual market, the average premium shall be weighted by the number of individual enrollees in the plans individual market and adjusted to the most commonly sold individual market benefit design plan, by enrollment, during the 12-month period.(B) For the small group market, the average premium shall be weighted by the number of enrollees in each small group benefit design in the plans small group market and adjusted to the most commonly sold small group benefit design plan, by enrollment, during the 12-month period.(2) Benefit design means the cost sharing for covered benefits.(3) High deductible has the same meaning as defined in Section 223(c)(2)(A) of Title 26 of the United States Code.(4) Nonstandard benefit design means a benefit design other than the standard benefit design.(5) Share of premium means the share of premium paid by the enrollee on behalf of the enrollee and any dependents, not the subscriber.(4)(6) Standard benefit design means the standardized product consistent with Section 1366.6 of this code and products approved by the executive board of the California Health Benefit Exchange pursuant to subdivision (c) of Section 100504 of the Government Code. (e) Until January 1, 2023, a health care service plan shall not be required to report either of the following information:(1) Share of premium paid by enrollee.(2)Covered benefits that differ from essential health benefits, or for a qualified health plan, benefits in addition to those required in the standard benefit design.(3)(2) Enrollment by benefit design, deductible, or share of premium.
1385.043. (a) A health care service plan shall annually report to the department the following information for all products that the plan offers and sells in the individual and small group markets, including both on-exchange and off-exchange enrollment, for rates effective during the 12-month period ending January 1 of the following year:(1) Information on premiums, including share of premium premium, if applicable,weighted average premium, average premium weighted by enrollment, and average rate change.(2) Cost sharing, including deductibles, maximum out-of-pocket limit, copayments, coinsurance, and any other cost sharing for covered benefits as well as high deductible health plans.(3)Benefits, including those in addition to essential health benefits or basic health care services and those offered in products subject to the standard benefit design that are in addition to benefits offered in the standard benefit design.(3) (A) For nongrandfathered plans, benefits, including essential health benefits or basic health care services.(B) For grandfathered plans, basic health care services and mandates.(4) Standard and nonstandard benefit designs, including on-exchange and off-exchange nonstandard benefit designs.(5) Enrollment by actuarial value tier, product, benefit design and premiums, including both of the following:(A) Enrollment in products with zero deductibles, high deductibles as defined in this section, and deductibles between zero and high.(B) (i) Enrollment by premium or share of premium, if applicable. premium.(ii) For small group products, enrollment by share of premium.(b)(6) Trend factors as reported in all individual and small group rate filings for the health care service plan, including both price and utilization, as required in Section 1385.03.(b) By October 1, 2021, and annually thereafter, a health care service plan shall submit the annual report, as described under subdivision (a), to the department in a form and manner determined by the department.(c) Beginning in 2022, the department shall present annually annually present the information reported under this section in the meeting specified in Section 1385.045 or a meeting of the Financial Solvency Standards Board. The department also shall present the information at a public meeting of the board of Covered California. executive board of the California Health Benefit Exchange. The department also shall post the information reported under this section on its internet website no later than December 15 of each year.(d) The following definitions apply for purposes of this section:(1) Weighted average premium Average premium weighted by enrollment means the following:(A) For the individual market, the average premium shall be weighted by the number of individual enrollees in the plans individual market and adjusted to the most commonly sold individual market benefit design plan, by enrollment, during the 12-month period.(B) For the small group market, the average premium shall be weighted by the number of enrollees in each small group benefit design in the plans small group market and adjusted to the most commonly sold small group benefit design plan, by enrollment, during the 12-month period.(2) Benefit design means the cost sharing for covered benefits.(3) High deductible has the same meaning as defined in Section 223(c)(2)(A) of Title 26 of the United States Code.(4) Nonstandard benefit design means a benefit design other than the standard benefit design.(5) Share of premium means the share of premium paid by the enrollee on behalf of the enrollee and any dependents, not the subscriber.(4)(6) Standard benefit design means the standardized product consistent with Section 1366.6 of this code and products approved by the executive board of the California Health Benefit Exchange pursuant to subdivision (c) of Section 100504 of the Government Code. (e) Until January 1, 2023, a health care service plan shall not be required to report either of the following information:(1) Share of premium paid by enrollee.(2)Covered benefits that differ from essential health benefits, or for a qualified health plan, benefits in addition to those required in the standard benefit design.(3)(2) Enrollment by benefit design, deductible, or share of premium.
1385.043. (a) A health care service plan shall annually report to the department the following information for all products that the plan offers and sells in the individual and small group markets, including both on-exchange and off-exchange enrollment, for rates effective during the 12-month period ending January 1 of the following year:
(1) Information on premiums, including share of premium premium, if applicable,weighted average premium, average premium weighted by enrollment, and average rate change.
(2) Cost sharing, including deductibles, maximum out-of-pocket limit, copayments, coinsurance, and any other cost sharing for covered benefits as well as high deductible health plans.
(3)Benefits, including those in addition to essential health benefits or basic health care services and those offered in products subject to the standard benefit design that are in addition to benefits offered in the standard benefit design.
(3) (A) For nongrandfathered plans, benefits, including essential health benefits or basic health care services.
(B) For grandfathered plans, basic health care services and mandates.
(4) Standard and nonstandard benefit designs, including on-exchange and off-exchange nonstandard benefit designs.
(5) Enrollment by actuarial value tier, product, benefit design and premiums, including both of the following:
(A) Enrollment in products with zero deductibles, high deductibles as defined in this section, and deductibles between zero and high.
(B) (i) Enrollment by premium or share of premium, if applicable. premium.
(ii) For small group products, enrollment by share of premium.
(b)
(6) Trend factors as reported in all individual and small group rate filings for the health care service plan, including both price and utilization, as required in Section 1385.03.
(b) By October 1, 2021, and annually thereafter, a health care service plan shall submit the annual report, as described under subdivision (a), to the department in a form and manner determined by the department.
(c) Beginning in 2022, the department shall present annually annually present the information reported under this section in the meeting specified in Section 1385.045 or a meeting of the Financial Solvency Standards Board. The department also shall present the information at a public meeting of the board of Covered California. executive board of the California Health Benefit Exchange. The department also shall post the information reported under this section on its internet website no later than December 15 of each year.
(d) The following definitions apply for purposes of this section:
(1) Weighted average premium Average premium weighted by enrollment means the following:
(A) For the individual market, the average premium shall be weighted by the number of individual enrollees in the plans individual market and adjusted to the most commonly sold individual market benefit design plan, by enrollment, during the 12-month period.
(B) For the small group market, the average premium shall be weighted by the number of enrollees in each small group benefit design in the plans small group market and adjusted to the most commonly sold small group benefit design plan, by enrollment, during the 12-month period.
(2) Benefit design means the cost sharing for covered benefits.
(3) High deductible has the same meaning as defined in Section 223(c)(2)(A) of Title 26 of the United States Code.
(4) Nonstandard benefit design means a benefit design other than the standard benefit design.
(5) Share of premium means the share of premium paid by the enrollee on behalf of the enrollee and any dependents, not the subscriber.
(4)
(6) Standard benefit design means the standardized product consistent with Section 1366.6 of this code and products approved by the executive board of the California Health Benefit Exchange pursuant to subdivision (c) of Section 100504 of the Government Code.
(e) Until January 1, 2023, a health care service plan shall not be required to report either of the following information:
(1) Share of premium paid by enrollee.
(2)Covered benefits that differ from essential health benefits, or for a qualified health plan, benefits in addition to those required in the standard benefit design.
(3)
(2) Enrollment by benefit design, deductible, or share of premium.
SEC. 2. Section 10181.46 is added to the Insurance Code, to read:10181.46. (a) A health insurer shall annually report to the department the following information for all products that the insurer offers and sells in the individual and small group markets, including both on-exchange and off-exchange enrollment, for rates effective during the 12-month period ending January 1 of the following year:(1) Information on premiums, including share of premium premium, if applicable,weighted average premium, average premium weighted by enrollment, and average rate change.(2) Cost sharing, including deductibles, maximum out-of-pocket limit, copayments, coinsurance and any other cost sharing for covered benefits as well as high deductible health plans. policies.(3)Benefits, including those in addition to essential health benefits or basic health care services and those offered in products subject to the standard benefit design that are in addition to benefits offered in the standard benefit design.(3) (A) For nongrandfathered policies, essential health benefits and basic health care services.(B) For grandfathered policies, covered benefits, including mandates, if any.(4) Standard and nonstandard benefit designs, including on-exchange and off-exchange nonstandard benefit designs.(5) Enrollment by actuarial value tier, product, benefit design and premiums, including both of the following:(A) Enrollment in products with zero deductibles, high deductibles as defined in this section, and deductibles between zero and high.(B) (i) Enrollment by premium or share of premium, if applicable. premium.(ii) For small group products, enrollment by share of premium.(b)(6) Trend factors as reported in all individual and small group rate filings for the health insurer, including both price and utilization, as required in Section 10181.3.(b) By October 1, 2021, and annually thereafter, a health insurer shall submit the annual report, as described under subdivision (a), to the department in a form and manner determined by the department.(c) Beginning in 2022, the department shall present annually annually present the information reported under this section in the meeting specified in Section 10181.45. The department also shall present this information at a public meeting of the board of Covered California. executive board of the California Health Benefit Exchange. The department also shall post the information reported under this section on its internet website no later than December 15 of each year.(d) For purposes of this section, the following definitions apply:(1) Weighted average premium Average premium weighted by enrollment means both of the following:(A) For the individual market, the average premium shall be weighted by the number of individual insureds in the plans insurers individual market and adjusted to the most commonly sold individual market benefit design plan, by enrollment during the 12-month period.(B) For the small group market, the average premium shall be weighted by the number of insureds in each small group benefit design in the insurers small group market and adjusted to the most commonly sold small group benefit design plan, by enrollment during the 12-month period.(2) Benefit design means the cost sharing for covered benefits.(3) High deductible has the same meaning as defined in Section 223(c)(2)(A) of Title 26 of the United States Code.(4) Nonstandard benefit design means a benefit design other than the standard benefit design.(5) Share of premium means the share of premium paid by the insured on behalf of the insured and any dependents, not the employer.(4)(6) Standard benefit design means the standardized product, consistent with Section 10112.3 of this code and products approved by the executive board of the California Health Benefit Exchange pursuant to subdivision (c) of Section 100504 of the Government Code. (e) Until January 1, 2023, a health insurer shall not be required to report either of the following information:(1) Share of premium paid by insured.(2)Covered benefits that differ from essential health benefits or for a qualified health plan, benefits in addition to those required in the standard benefit design.(3)(2) Enrollment by benefit design, deductible, or share of premium.
SEC. 2. Section 10181.46 is added to the Insurance Code, to read:
### SEC. 2.
10181.46. (a) A health insurer shall annually report to the department the following information for all products that the insurer offers and sells in the individual and small group markets, including both on-exchange and off-exchange enrollment, for rates effective during the 12-month period ending January 1 of the following year:(1) Information on premiums, including share of premium premium, if applicable,weighted average premium, average premium weighted by enrollment, and average rate change.(2) Cost sharing, including deductibles, maximum out-of-pocket limit, copayments, coinsurance and any other cost sharing for covered benefits as well as high deductible health plans. policies.(3)Benefits, including those in addition to essential health benefits or basic health care services and those offered in products subject to the standard benefit design that are in addition to benefits offered in the standard benefit design.(3) (A) For nongrandfathered policies, essential health benefits and basic health care services.(B) For grandfathered policies, covered benefits, including mandates, if any.(4) Standard and nonstandard benefit designs, including on-exchange and off-exchange nonstandard benefit designs.(5) Enrollment by actuarial value tier, product, benefit design and premiums, including both of the following:(A) Enrollment in products with zero deductibles, high deductibles as defined in this section, and deductibles between zero and high.(B) (i) Enrollment by premium or share of premium, if applicable. premium.(ii) For small group products, enrollment by share of premium.(b)(6) Trend factors as reported in all individual and small group rate filings for the health insurer, including both price and utilization, as required in Section 10181.3.(b) By October 1, 2021, and annually thereafter, a health insurer shall submit the annual report, as described under subdivision (a), to the department in a form and manner determined by the department.(c) Beginning in 2022, the department shall present annually annually present the information reported under this section in the meeting specified in Section 10181.45. The department also shall present this information at a public meeting of the board of Covered California. executive board of the California Health Benefit Exchange. The department also shall post the information reported under this section on its internet website no later than December 15 of each year.(d) For purposes of this section, the following definitions apply:(1) Weighted average premium Average premium weighted by enrollment means both of the following:(A) For the individual market, the average premium shall be weighted by the number of individual insureds in the plans insurers individual market and adjusted to the most commonly sold individual market benefit design plan, by enrollment during the 12-month period.(B) For the small group market, the average premium shall be weighted by the number of insureds in each small group benefit design in the insurers small group market and adjusted to the most commonly sold small group benefit design plan, by enrollment during the 12-month period.(2) Benefit design means the cost sharing for covered benefits.(3) High deductible has the same meaning as defined in Section 223(c)(2)(A) of Title 26 of the United States Code.(4) Nonstandard benefit design means a benefit design other than the standard benefit design.(5) Share of premium means the share of premium paid by the insured on behalf of the insured and any dependents, not the employer.(4)(6) Standard benefit design means the standardized product, consistent with Section 10112.3 of this code and products approved by the executive board of the California Health Benefit Exchange pursuant to subdivision (c) of Section 100504 of the Government Code. (e) Until January 1, 2023, a health insurer shall not be required to report either of the following information:(1) Share of premium paid by insured.(2)Covered benefits that differ from essential health benefits or for a qualified health plan, benefits in addition to those required in the standard benefit design.(3)(2) Enrollment by benefit design, deductible, or share of premium.
10181.46. (a) A health insurer shall annually report to the department the following information for all products that the insurer offers and sells in the individual and small group markets, including both on-exchange and off-exchange enrollment, for rates effective during the 12-month period ending January 1 of the following year:(1) Information on premiums, including share of premium premium, if applicable,weighted average premium, average premium weighted by enrollment, and average rate change.(2) Cost sharing, including deductibles, maximum out-of-pocket limit, copayments, coinsurance and any other cost sharing for covered benefits as well as high deductible health plans. policies.(3)Benefits, including those in addition to essential health benefits or basic health care services and those offered in products subject to the standard benefit design that are in addition to benefits offered in the standard benefit design.(3) (A) For nongrandfathered policies, essential health benefits and basic health care services.(B) For grandfathered policies, covered benefits, including mandates, if any.(4) Standard and nonstandard benefit designs, including on-exchange and off-exchange nonstandard benefit designs.(5) Enrollment by actuarial value tier, product, benefit design and premiums, including both of the following:(A) Enrollment in products with zero deductibles, high deductibles as defined in this section, and deductibles between zero and high.(B) (i) Enrollment by premium or share of premium, if applicable. premium.(ii) For small group products, enrollment by share of premium.(b)(6) Trend factors as reported in all individual and small group rate filings for the health insurer, including both price and utilization, as required in Section 10181.3.(b) By October 1, 2021, and annually thereafter, a health insurer shall submit the annual report, as described under subdivision (a), to the department in a form and manner determined by the department.(c) Beginning in 2022, the department shall present annually annually present the information reported under this section in the meeting specified in Section 10181.45. The department also shall present this information at a public meeting of the board of Covered California. executive board of the California Health Benefit Exchange. The department also shall post the information reported under this section on its internet website no later than December 15 of each year.(d) For purposes of this section, the following definitions apply:(1) Weighted average premium Average premium weighted by enrollment means both of the following:(A) For the individual market, the average premium shall be weighted by the number of individual insureds in the plans insurers individual market and adjusted to the most commonly sold individual market benefit design plan, by enrollment during the 12-month period.(B) For the small group market, the average premium shall be weighted by the number of insureds in each small group benefit design in the insurers small group market and adjusted to the most commonly sold small group benefit design plan, by enrollment during the 12-month period.(2) Benefit design means the cost sharing for covered benefits.(3) High deductible has the same meaning as defined in Section 223(c)(2)(A) of Title 26 of the United States Code.(4) Nonstandard benefit design means a benefit design other than the standard benefit design.(5) Share of premium means the share of premium paid by the insured on behalf of the insured and any dependents, not the employer.(4)(6) Standard benefit design means the standardized product, consistent with Section 10112.3 of this code and products approved by the executive board of the California Health Benefit Exchange pursuant to subdivision (c) of Section 100504 of the Government Code. (e) Until January 1, 2023, a health insurer shall not be required to report either of the following information:(1) Share of premium paid by insured.(2)Covered benefits that differ from essential health benefits or for a qualified health plan, benefits in addition to those required in the standard benefit design.(3)(2) Enrollment by benefit design, deductible, or share of premium.
10181.46. (a) A health insurer shall annually report to the department the following information for all products that the insurer offers and sells in the individual and small group markets, including both on-exchange and off-exchange enrollment, for rates effective during the 12-month period ending January 1 of the following year:(1) Information on premiums, including share of premium premium, if applicable,weighted average premium, average premium weighted by enrollment, and average rate change.(2) Cost sharing, including deductibles, maximum out-of-pocket limit, copayments, coinsurance and any other cost sharing for covered benefits as well as high deductible health plans. policies.(3)Benefits, including those in addition to essential health benefits or basic health care services and those offered in products subject to the standard benefit design that are in addition to benefits offered in the standard benefit design.(3) (A) For nongrandfathered policies, essential health benefits and basic health care services.(B) For grandfathered policies, covered benefits, including mandates, if any.(4) Standard and nonstandard benefit designs, including on-exchange and off-exchange nonstandard benefit designs.(5) Enrollment by actuarial value tier, product, benefit design and premiums, including both of the following:(A) Enrollment in products with zero deductibles, high deductibles as defined in this section, and deductibles between zero and high.(B) (i) Enrollment by premium or share of premium, if applicable. premium.(ii) For small group products, enrollment by share of premium.(b)(6) Trend factors as reported in all individual and small group rate filings for the health insurer, including both price and utilization, as required in Section 10181.3.(b) By October 1, 2021, and annually thereafter, a health insurer shall submit the annual report, as described under subdivision (a), to the department in a form and manner determined by the department.(c) Beginning in 2022, the department shall present annually annually present the information reported under this section in the meeting specified in Section 10181.45. The department also shall present this information at a public meeting of the board of Covered California. executive board of the California Health Benefit Exchange. The department also shall post the information reported under this section on its internet website no later than December 15 of each year.(d) For purposes of this section, the following definitions apply:(1) Weighted average premium Average premium weighted by enrollment means both of the following:(A) For the individual market, the average premium shall be weighted by the number of individual insureds in the plans insurers individual market and adjusted to the most commonly sold individual market benefit design plan, by enrollment during the 12-month period.(B) For the small group market, the average premium shall be weighted by the number of insureds in each small group benefit design in the insurers small group market and adjusted to the most commonly sold small group benefit design plan, by enrollment during the 12-month period.(2) Benefit design means the cost sharing for covered benefits.(3) High deductible has the same meaning as defined in Section 223(c)(2)(A) of Title 26 of the United States Code.(4) Nonstandard benefit design means a benefit design other than the standard benefit design.(5) Share of premium means the share of premium paid by the insured on behalf of the insured and any dependents, not the employer.(4)(6) Standard benefit design means the standardized product, consistent with Section 10112.3 of this code and products approved by the executive board of the California Health Benefit Exchange pursuant to subdivision (c) of Section 100504 of the Government Code. (e) Until January 1, 2023, a health insurer shall not be required to report either of the following information:(1) Share of premium paid by insured.(2)Covered benefits that differ from essential health benefits or for a qualified health plan, benefits in addition to those required in the standard benefit design.(3)(2) Enrollment by benefit design, deductible, or share of premium.
10181.46. (a) A health insurer shall annually report to the department the following information for all products that the insurer offers and sells in the individual and small group markets, including both on-exchange and off-exchange enrollment, for rates effective during the 12-month period ending January 1 of the following year:
(1) Information on premiums, including share of premium premium, if applicable,weighted average premium, average premium weighted by enrollment, and average rate change.
(2) Cost sharing, including deductibles, maximum out-of-pocket limit, copayments, coinsurance and any other cost sharing for covered benefits as well as high deductible health plans. policies.
(3)Benefits, including those in addition to essential health benefits or basic health care services and those offered in products subject to the standard benefit design that are in addition to benefits offered in the standard benefit design.
(3) (A) For nongrandfathered policies, essential health benefits and basic health care services.
(B) For grandfathered policies, covered benefits, including mandates, if any.
(4) Standard and nonstandard benefit designs, including on-exchange and off-exchange nonstandard benefit designs.
(5) Enrollment by actuarial value tier, product, benefit design and premiums, including both of the following:
(A) Enrollment in products with zero deductibles, high deductibles as defined in this section, and deductibles between zero and high.
(B) (i) Enrollment by premium or share of premium, if applicable. premium.
(ii) For small group products, enrollment by share of premium.
(b)
(6) Trend factors as reported in all individual and small group rate filings for the health insurer, including both price and utilization, as required in Section 10181.3.
(b) By October 1, 2021, and annually thereafter, a health insurer shall submit the annual report, as described under subdivision (a), to the department in a form and manner determined by the department.
(c) Beginning in 2022, the department shall present annually annually present the information reported under this section in the meeting specified in Section 10181.45. The department also shall present this information at a public meeting of the board of Covered California. executive board of the California Health Benefit Exchange. The department also shall post the information reported under this section on its internet website no later than December 15 of each year.
(d) For purposes of this section, the following definitions apply:
(1) Weighted average premium Average premium weighted by enrollment means both of the following:
(A) For the individual market, the average premium shall be weighted by the number of individual insureds in the plans insurers individual market and adjusted to the most commonly sold individual market benefit design plan, by enrollment during the 12-month period.
(B) For the small group market, the average premium shall be weighted by the number of insureds in each small group benefit design in the insurers small group market and adjusted to the most commonly sold small group benefit design plan, by enrollment during the 12-month period.
(2) Benefit design means the cost sharing for covered benefits.
(3) High deductible has the same meaning as defined in Section 223(c)(2)(A) of Title 26 of the United States Code.
(4) Nonstandard benefit design means a benefit design other than the standard benefit design.
(5) Share of premium means the share of premium paid by the insured on behalf of the insured and any dependents, not the employer.
(4)
(6) Standard benefit design means the standardized product, consistent with Section 10112.3 of this code and products approved by the executive board of the California Health Benefit Exchange pursuant to subdivision (c) of Section 100504 of the Government Code.
(e) Until January 1, 2023, a health insurer shall not be required to report either of the following information:
(1) Share of premium paid by insured.
(2)Covered benefits that differ from essential health benefits or for a qualified health plan, benefits in addition to those required in the standard benefit design.
(3)
(2) Enrollment by benefit design, deductible, or share of premium.
SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
### SEC. 3.