Amended IN Assembly March 27, 2023 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 1048Introduced by Assembly Member WicksFebruary 15, 2023 An act to amend Section 1385.02 of, and to add Section 1371.194 to, the Health and Safety Code, and to amend Section 10181.2 of, and to add Section 10120.41 to, the Insurance Code, relating to health care coverage.LEGISLATIVE COUNSEL'S DIGESTAB 1048, as amended, Wicks. Dental benefits and rate review.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 acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law imposes specified coverage and disclosure requirements on health care service plans and health insurers, including specialized plans and insurers, that cover dental services.This bill, on and after January 1, 2024, would prohibit a health care service plan or health insurer that covers dental services, and including a specialized health care service plan or health insurer that covers dental services, from issuing, amending, renewing, or offering a plan contract or policy that imposes a dental waiting period provision or preexisting condition provision, as defined, upon an enrollee or insured. On and after January 1, 2024, the bill also would require a health care service plan or health insurer to disclose, at the time of verification for patient eligibility, whether or not the enrollees or insureds dental coverage is subject to regulation by the relevant department. Because a violation of these requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.Existing law establishes a process for the Department of Managed Health Care and the Department of Insurance to review proposed rate increases by health care service plans and health insurers in the individual or group market in California. Existing law excludes specialized health care service plan contracts and specialized health insurance policies, among others, from those provisions.This bill would include health care service plan contracts and health insurance policies covering dental services, and including specialized health care service plan contracts and specialized health insurance policies covering dental services, within those provisions. The bill would retain the exclusion with respect to specialized health care service plan contracts and specialized health insurance policies that do not provide dental services. The bill would require the Department of Managed Health Care and the Department of Insurance to establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a plan contract or policy of health insurance covering dental services, including a specialized health care service plan contract or specialized health insurance policy covering dental services services that is issued, sold, renewed, or offered by a health care service plan or health insurer is unreasonable, or not justified, under the applicable requirements of the rate review provisions. By making plan contracts covering dental services, including specialized health care service plan contracts that provide dental services subject to these rate review provisions, the bill would expand the scope of a crime, thereby imposing 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 1374.194 is added to the Health and Safety Code, to read:1374.194. (a) The following definitions shall apply for purposes of this section:(1) Dental waiting period provision means a contract provision that limits coverage for a specified period of time following an enrollees effective date of coverage.(2) Health care service plan means a health care service plan that issues, sells, renews, or offers a plan contract covering dental services or services, including a specialized health care service plans plan covering dental services.(3) Preexisting condition provision means a contract provision that excludes coverage for charges or expenses incurred during a specified period or limits coverage for services, charges, or expenses incurred following an enrollees effective date of coverage, as to coverage for a condition for which dental advice, services, diagnosis, care care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.(b) On and after January 1, 2024, a health care service plan shall not issue, amend, renew, or offer a plan contract that imposes a dental waiting period provision or preexisting condition provision upon an enrollee.(c)On and after January 1, 2024, at the time of verification for patient eligibility, a health care service plan shall disclose whether or not the enrollees dental coverage is subject to regulation by the department.(d)(c) This section does not apply to Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.SEC. 2. Section 1385.02 of the Health and Safety Code is amended to read:1385.02. (a) This article shall apply to a health care service plan contract offered in the individual or group market in California, including a health care service plan contract covering dental services and a specialized health care service plan contract covering dental services. However, this article shall not apply to a nondental specialized health care service plan contract, a Medicare supplement contract subject to Article 3.5 (commencing with Section 1358.1), a health care service plan contract offered in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), a health care service plan contract offered in the California Major Risk Medical Insurance Program (Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code), a health care service plan conversion contract offered pursuant to Section 1373.6, a health care service plan contract offered to a federally eligible defined individual under Article 4.6 (commencing with Section 1366.35) or Article 10.5 (commencing with Section 1399.801), or a Mexican prepaid health plan subject to Section 1351.2. This article does not limit, impair, or interfere with the authority of the California Public Employees Retirement System, as set forth in Section 22794 of the Government Code and Article 6 (commencing with Section 22850) of Part 5 of Division 5 of Title 2 of the Government Code.(b) The department shall establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a plan contract covering dental services, including a specialized health care service plan contract covering dental services services, that is issued, sold, renewed, or offered by a health care service plan is unreasonable, or not justified, under the applicable requirements of this article.SEC. 3. Section 10120.41 is added to the Insurance Code, to read:10120.41. (a) For purposes of this section, the following definitions shall apply:(1) Dental waiting period provision means a contract provision that limits coverage for a specified period of time following an insureds effective date of coverage.(2) Health insurer means a health an insurer that issues, sells, renews, or offers a plan contract covering dental services or a health insurance policy covering dental services. policy of health insurance, as defined in subdivision (b) of Section 106, covering dental services, including a specialized health insurance policy covering dental services, as defined in subdivision (c) of Section 106.(3) Preexisting condition provision means a contract provision that excludes coverage for charges or expenses incurred during a specified period or limits coverage for services, charges, or expenses incurred following an insureds effective date of coverage, as to coverage for a condition for which dental advice, services, diagnosis, care care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.(b) On and after January 1, 2024, a health insurer shall not issue, sell, renew, or offer a policy that imposes a dental waiting period provision or preexisting condition provision upon an insured.(c)On and after January 1, 2024, at the time of verification for patient eligibility, a health insurer shall disclose whether or not the insureds dental coverage is subject to regulation by the department.(d)(c) This section does not apply to Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.SEC. 4. Section 10181.2 of the Insurance Code is amended to read:10181.2. (a) This article shall apply to a health insurance policy offered in the individual or group market in California, including a health insurance policy covering dental services and a specialized health insurance policy covering dental services. However, this article shall not apply to a nondental specialized health insurance policy, a Medicare supplement policy subject to Article 6 (commencing with Section 10192.05), a health insurance policy offered in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), a health insurance policy offered in the California Major Risk Medical Insurance Program (Part 6.5 (commencing with Section 12700)), a health insurance conversion policy offered pursuant to Section 12682.1, a health insurance policy offered to a federally eligible defined individual under Chapter 9.5 (commencing with Section 10900), or a Mexican prepaid health plan subject to Section 1351.2 of the Health and Safety Code.(b) The department shall establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a policy of health insurance, as defined in subdivision (b) of Section 106, covering dental services, including a specialized health insurance policy covering dental services services, as defined in subdivision (c) of Section 106, issued, sold, renewed, or offered by a health insurer is unreasonable, or not justified, under the applicable requirements of this article.SEC. 5. 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 Assembly March 27, 2023 CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION Assembly Bill No. 1048Introduced by Assembly Member WicksFebruary 15, 2023 An act to amend Section 1385.02 of, and to add Section 1371.194 to, the Health and Safety Code, and to amend Section 10181.2 of, and to add Section 10120.41 to, the Insurance Code, relating to health care coverage.LEGISLATIVE COUNSEL'S DIGESTAB 1048, as amended, Wicks. Dental benefits and rate review.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 acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law imposes specified coverage and disclosure requirements on health care service plans and health insurers, including specialized plans and insurers, that cover dental services.This bill, on and after January 1, 2024, would prohibit a health care service plan or health insurer that covers dental services, and including a specialized health care service plan or health insurer that covers dental services, from issuing, amending, renewing, or offering a plan contract or policy that imposes a dental waiting period provision or preexisting condition provision, as defined, upon an enrollee or insured. On and after January 1, 2024, the bill also would require a health care service plan or health insurer to disclose, at the time of verification for patient eligibility, whether or not the enrollees or insureds dental coverage is subject to regulation by the relevant department. Because a violation of these requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.Existing law establishes a process for the Department of Managed Health Care and the Department of Insurance to review proposed rate increases by health care service plans and health insurers in the individual or group market in California. Existing law excludes specialized health care service plan contracts and specialized health insurance policies, among others, from those provisions.This bill would include health care service plan contracts and health insurance policies covering dental services, and including specialized health care service plan contracts and specialized health insurance policies covering dental services, within those provisions. The bill would retain the exclusion with respect to specialized health care service plan contracts and specialized health insurance policies that do not provide dental services. The bill would require the Department of Managed Health Care and the Department of Insurance to establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a plan contract or policy of health insurance covering dental services, including a specialized health care service plan contract or specialized health insurance policy covering dental services services that is issued, sold, renewed, or offered by a health care service plan or health insurer is unreasonable, or not justified, under the applicable requirements of the rate review provisions. By making plan contracts covering dental services, including specialized health care service plan contracts that provide dental services subject to these rate review provisions, the bill would expand the scope of a crime, thereby imposing 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 Assembly March 27, 2023
Amended IN Assembly March 27, 2023
CALIFORNIA LEGISLATURE 20232024 REGULAR SESSION
Assembly Bill
No. 1048
Introduced by Assembly Member WicksFebruary 15, 2023
Introduced by Assembly Member Wicks
February 15, 2023
An act to amend Section 1385.02 of, and to add Section 1371.194 to, the Health and Safety Code, and to amend Section 10181.2 of, and to add Section 10120.41 to, the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 1048, as amended, Wicks. Dental benefits and rate review.
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 acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law imposes specified coverage and disclosure requirements on health care service plans and health insurers, including specialized plans and insurers, that cover dental services.This bill, on and after January 1, 2024, would prohibit a health care service plan or health insurer that covers dental services, and including a specialized health care service plan or health insurer that covers dental services, from issuing, amending, renewing, or offering a plan contract or policy that imposes a dental waiting period provision or preexisting condition provision, as defined, upon an enrollee or insured. On and after January 1, 2024, the bill also would require a health care service plan or health insurer to disclose, at the time of verification for patient eligibility, whether or not the enrollees or insureds dental coverage is subject to regulation by the relevant department. Because a violation of these requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.Existing law establishes a process for the Department of Managed Health Care and the Department of Insurance to review proposed rate increases by health care service plans and health insurers in the individual or group market in California. Existing law excludes specialized health care service plan contracts and specialized health insurance policies, among others, from those provisions.This bill would include health care service plan contracts and health insurance policies covering dental services, and including specialized health care service plan contracts and specialized health insurance policies covering dental services, within those provisions. The bill would retain the exclusion with respect to specialized health care service plan contracts and specialized health insurance policies that do not provide dental services. The bill would require the Department of Managed Health Care and the Department of Insurance to establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a plan contract or policy of health insurance covering dental services, including a specialized health care service plan contract or specialized health insurance policy covering dental services services that is issued, sold, renewed, or offered by a health care service plan or health insurer is unreasonable, or not justified, under the applicable requirements of the rate review provisions. By making plan contracts covering dental services, including specialized health care service plan contracts that provide dental services subject to these rate review provisions, the bill would expand the scope of a crime, thereby imposing 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 acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law imposes specified coverage and disclosure requirements on health care service plans and health insurers, including specialized plans and insurers, that cover dental services.
This bill, on and after January 1, 2024, would prohibit a health care service plan or health insurer that covers dental services, and including a specialized health care service plan or health insurer that covers dental services, from issuing, amending, renewing, or offering a plan contract or policy that imposes a dental waiting period provision or preexisting condition provision, as defined, upon an enrollee or insured. On and after January 1, 2024, the bill also would require a health care service plan or health insurer to disclose, at the time of verification for patient eligibility, whether or not the enrollees or insureds dental coverage is subject to regulation by the relevant department. Because a violation of these requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program.
Existing law establishes a process for the Department of Managed Health Care and the Department of Insurance to review proposed rate increases by health care service plans and health insurers in the individual or group market in California. Existing law excludes specialized health care service plan contracts and specialized health insurance policies, among others, from those provisions.
This bill would include health care service plan contracts and health insurance policies covering dental services, and including specialized health care service plan contracts and specialized health insurance policies covering dental services, within those provisions. The bill would retain the exclusion with respect to specialized health care service plan contracts and specialized health insurance policies that do not provide dental services. The bill would require the Department of Managed Health Care and the Department of Insurance to establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a plan contract or policy of health insurance covering dental services, including a specialized health care service plan contract or specialized health insurance policy covering dental services services that is issued, sold, renewed, or offered by a health care service plan or health insurer is unreasonable, or not justified, under the applicable requirements of the rate review provisions. By making plan contracts covering dental services, including specialized health care service plan contracts that provide dental services subject to these rate review provisions, the bill would expand the scope of a crime, thereby imposing 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 1374.194 is added to the Health and Safety Code, to read:1374.194. (a) The following definitions shall apply for purposes of this section:(1) Dental waiting period provision means a contract provision that limits coverage for a specified period of time following an enrollees effective date of coverage.(2) Health care service plan means a health care service plan that issues, sells, renews, or offers a plan contract covering dental services or services, including a specialized health care service plans plan covering dental services.(3) Preexisting condition provision means a contract provision that excludes coverage for charges or expenses incurred during a specified period or limits coverage for services, charges, or expenses incurred following an enrollees effective date of coverage, as to coverage for a condition for which dental advice, services, diagnosis, care care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.(b) On and after January 1, 2024, a health care service plan shall not issue, amend, renew, or offer a plan contract that imposes a dental waiting period provision or preexisting condition provision upon an enrollee.(c)On and after January 1, 2024, at the time of verification for patient eligibility, a health care service plan shall disclose whether or not the enrollees dental coverage is subject to regulation by the department.(d)(c) This section does not apply to Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.SEC. 2. Section 1385.02 of the Health and Safety Code is amended to read:1385.02. (a) This article shall apply to a health care service plan contract offered in the individual or group market in California, including a health care service plan contract covering dental services and a specialized health care service plan contract covering dental services. However, this article shall not apply to a nondental specialized health care service plan contract, a Medicare supplement contract subject to Article 3.5 (commencing with Section 1358.1), a health care service plan contract offered in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), a health care service plan contract offered in the California Major Risk Medical Insurance Program (Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code), a health care service plan conversion contract offered pursuant to Section 1373.6, a health care service plan contract offered to a federally eligible defined individual under Article 4.6 (commencing with Section 1366.35) or Article 10.5 (commencing with Section 1399.801), or a Mexican prepaid health plan subject to Section 1351.2. This article does not limit, impair, or interfere with the authority of the California Public Employees Retirement System, as set forth in Section 22794 of the Government Code and Article 6 (commencing with Section 22850) of Part 5 of Division 5 of Title 2 of the Government Code.(b) The department shall establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a plan contract covering dental services, including a specialized health care service plan contract covering dental services services, that is issued, sold, renewed, or offered by a health care service plan is unreasonable, or not justified, under the applicable requirements of this article.SEC. 3. Section 10120.41 is added to the Insurance Code, to read:10120.41. (a) For purposes of this section, the following definitions shall apply:(1) Dental waiting period provision means a contract provision that limits coverage for a specified period of time following an insureds effective date of coverage.(2) Health insurer means a health an insurer that issues, sells, renews, or offers a plan contract covering dental services or a health insurance policy covering dental services. policy of health insurance, as defined in subdivision (b) of Section 106, covering dental services, including a specialized health insurance policy covering dental services, as defined in subdivision (c) of Section 106.(3) Preexisting condition provision means a contract provision that excludes coverage for charges or expenses incurred during a specified period or limits coverage for services, charges, or expenses incurred following an insureds effective date of coverage, as to coverage for a condition for which dental advice, services, diagnosis, care care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.(b) On and after January 1, 2024, a health insurer shall not issue, sell, renew, or offer a policy that imposes a dental waiting period provision or preexisting condition provision upon an insured.(c)On and after January 1, 2024, at the time of verification for patient eligibility, a health insurer shall disclose whether or not the insureds dental coverage is subject to regulation by the department.(d)(c) This section does not apply to Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.SEC. 4. Section 10181.2 of the Insurance Code is amended to read:10181.2. (a) This article shall apply to a health insurance policy offered in the individual or group market in California, including a health insurance policy covering dental services and a specialized health insurance policy covering dental services. However, this article shall not apply to a nondental specialized health insurance policy, a Medicare supplement policy subject to Article 6 (commencing with Section 10192.05), a health insurance policy offered in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), a health insurance policy offered in the California Major Risk Medical Insurance Program (Part 6.5 (commencing with Section 12700)), a health insurance conversion policy offered pursuant to Section 12682.1, a health insurance policy offered to a federally eligible defined individual under Chapter 9.5 (commencing with Section 10900), or a Mexican prepaid health plan subject to Section 1351.2 of the Health and Safety Code.(b) The department shall establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a policy of health insurance, as defined in subdivision (b) of Section 106, covering dental services, including a specialized health insurance policy covering dental services services, as defined in subdivision (c) of Section 106, issued, sold, renewed, or offered by a health insurer is unreasonable, or not justified, under the applicable requirements of this article.SEC. 5. 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 1374.194 is added to the Health and Safety Code, to read:1374.194. (a) The following definitions shall apply for purposes of this section:(1) Dental waiting period provision means a contract provision that limits coverage for a specified period of time following an enrollees effective date of coverage.(2) Health care service plan means a health care service plan that issues, sells, renews, or offers a plan contract covering dental services or services, including a specialized health care service plans plan covering dental services.(3) Preexisting condition provision means a contract provision that excludes coverage for charges or expenses incurred during a specified period or limits coverage for services, charges, or expenses incurred following an enrollees effective date of coverage, as to coverage for a condition for which dental advice, services, diagnosis, care care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.(b) On and after January 1, 2024, a health care service plan shall not issue, amend, renew, or offer a plan contract that imposes a dental waiting period provision or preexisting condition provision upon an enrollee.(c)On and after January 1, 2024, at the time of verification for patient eligibility, a health care service plan shall disclose whether or not the enrollees dental coverage is subject to regulation by the department.(d)(c) This section does not apply to Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
SECTION 1. Section 1374.194 is added to the Health and Safety Code, to read:
### SECTION 1.
1374.194. (a) The following definitions shall apply for purposes of this section:(1) Dental waiting period provision means a contract provision that limits coverage for a specified period of time following an enrollees effective date of coverage.(2) Health care service plan means a health care service plan that issues, sells, renews, or offers a plan contract covering dental services or services, including a specialized health care service plans plan covering dental services.(3) Preexisting condition provision means a contract provision that excludes coverage for charges or expenses incurred during a specified period or limits coverage for services, charges, or expenses incurred following an enrollees effective date of coverage, as to coverage for a condition for which dental advice, services, diagnosis, care care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.(b) On and after January 1, 2024, a health care service plan shall not issue, amend, renew, or offer a plan contract that imposes a dental waiting period provision or preexisting condition provision upon an enrollee.(c)On and after January 1, 2024, at the time of verification for patient eligibility, a health care service plan shall disclose whether or not the enrollees dental coverage is subject to regulation by the department.(d)(c) This section does not apply to Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
1374.194. (a) The following definitions shall apply for purposes of this section:(1) Dental waiting period provision means a contract provision that limits coverage for a specified period of time following an enrollees effective date of coverage.(2) Health care service plan means a health care service plan that issues, sells, renews, or offers a plan contract covering dental services or services, including a specialized health care service plans plan covering dental services.(3) Preexisting condition provision means a contract provision that excludes coverage for charges or expenses incurred during a specified period or limits coverage for services, charges, or expenses incurred following an enrollees effective date of coverage, as to coverage for a condition for which dental advice, services, diagnosis, care care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.(b) On and after January 1, 2024, a health care service plan shall not issue, amend, renew, or offer a plan contract that imposes a dental waiting period provision or preexisting condition provision upon an enrollee.(c)On and after January 1, 2024, at the time of verification for patient eligibility, a health care service plan shall disclose whether or not the enrollees dental coverage is subject to regulation by the department.(d)(c) This section does not apply to Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
1374.194. (a) The following definitions shall apply for purposes of this section:(1) Dental waiting period provision means a contract provision that limits coverage for a specified period of time following an enrollees effective date of coverage.(2) Health care service plan means a health care service plan that issues, sells, renews, or offers a plan contract covering dental services or services, including a specialized health care service plans plan covering dental services.(3) Preexisting condition provision means a contract provision that excludes coverage for charges or expenses incurred during a specified period or limits coverage for services, charges, or expenses incurred following an enrollees effective date of coverage, as to coverage for a condition for which dental advice, services, diagnosis, care care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.(b) On and after January 1, 2024, a health care service plan shall not issue, amend, renew, or offer a plan contract that imposes a dental waiting period provision or preexisting condition provision upon an enrollee.(c)On and after January 1, 2024, at the time of verification for patient eligibility, a health care service plan shall disclose whether or not the enrollees dental coverage is subject to regulation by the department.(d)(c) This section does not apply to Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
1374.194. (a) The following definitions shall apply for purposes of this section:
(1) Dental waiting period provision means a contract provision that limits coverage for a specified period of time following an enrollees effective date of coverage.
(2) Health care service plan means a health care service plan that issues, sells, renews, or offers a plan contract covering dental services or services, including a specialized health care service plans plan covering dental services.
(3) Preexisting condition provision means a contract provision that excludes coverage for charges or expenses incurred during a specified period or limits coverage for services, charges, or expenses incurred following an enrollees effective date of coverage, as to coverage for a condition for which dental advice, services, diagnosis, care care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.
(b) On and after January 1, 2024, a health care service plan shall not issue, amend, renew, or offer a plan contract that imposes a dental waiting period provision or preexisting condition provision upon an enrollee.
(c)On and after January 1, 2024, at the time of verification for patient eligibility, a health care service plan shall disclose whether or not the enrollees dental coverage is subject to regulation by the department.
(d)
(c) This section does not apply to Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
SEC. 2. Section 1385.02 of the Health and Safety Code is amended to read:1385.02. (a) This article shall apply to a health care service plan contract offered in the individual or group market in California, including a health care service plan contract covering dental services and a specialized health care service plan contract covering dental services. However, this article shall not apply to a nondental specialized health care service plan contract, a Medicare supplement contract subject to Article 3.5 (commencing with Section 1358.1), a health care service plan contract offered in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), a health care service plan contract offered in the California Major Risk Medical Insurance Program (Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code), a health care service plan conversion contract offered pursuant to Section 1373.6, a health care service plan contract offered to a federally eligible defined individual under Article 4.6 (commencing with Section 1366.35) or Article 10.5 (commencing with Section 1399.801), or a Mexican prepaid health plan subject to Section 1351.2. This article does not limit, impair, or interfere with the authority of the California Public Employees Retirement System, as set forth in Section 22794 of the Government Code and Article 6 (commencing with Section 22850) of Part 5 of Division 5 of Title 2 of the Government Code.(b) The department shall establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a plan contract covering dental services, including a specialized health care service plan contract covering dental services services, that is issued, sold, renewed, or offered by a health care service plan is unreasonable, or not justified, under the applicable requirements of this article.
SEC. 2. Section 1385.02 of the Health and Safety Code is amended to read:
### SEC. 2.
1385.02. (a) This article shall apply to a health care service plan contract offered in the individual or group market in California, including a health care service plan contract covering dental services and a specialized health care service plan contract covering dental services. However, this article shall not apply to a nondental specialized health care service plan contract, a Medicare supplement contract subject to Article 3.5 (commencing with Section 1358.1), a health care service plan contract offered in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), a health care service plan contract offered in the California Major Risk Medical Insurance Program (Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code), a health care service plan conversion contract offered pursuant to Section 1373.6, a health care service plan contract offered to a federally eligible defined individual under Article 4.6 (commencing with Section 1366.35) or Article 10.5 (commencing with Section 1399.801), or a Mexican prepaid health plan subject to Section 1351.2. This article does not limit, impair, or interfere with the authority of the California Public Employees Retirement System, as set forth in Section 22794 of the Government Code and Article 6 (commencing with Section 22850) of Part 5 of Division 5 of Title 2 of the Government Code.(b) The department shall establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a plan contract covering dental services, including a specialized health care service plan contract covering dental services services, that is issued, sold, renewed, or offered by a health care service plan is unreasonable, or not justified, under the applicable requirements of this article.
1385.02. (a) This article shall apply to a health care service plan contract offered in the individual or group market in California, including a health care service plan contract covering dental services and a specialized health care service plan contract covering dental services. However, this article shall not apply to a nondental specialized health care service plan contract, a Medicare supplement contract subject to Article 3.5 (commencing with Section 1358.1), a health care service plan contract offered in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), a health care service plan contract offered in the California Major Risk Medical Insurance Program (Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code), a health care service plan conversion contract offered pursuant to Section 1373.6, a health care service plan contract offered to a federally eligible defined individual under Article 4.6 (commencing with Section 1366.35) or Article 10.5 (commencing with Section 1399.801), or a Mexican prepaid health plan subject to Section 1351.2. This article does not limit, impair, or interfere with the authority of the California Public Employees Retirement System, as set forth in Section 22794 of the Government Code and Article 6 (commencing with Section 22850) of Part 5 of Division 5 of Title 2 of the Government Code.(b) The department shall establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a plan contract covering dental services, including a specialized health care service plan contract covering dental services services, that is issued, sold, renewed, or offered by a health care service plan is unreasonable, or not justified, under the applicable requirements of this article.
1385.02. (a) This article shall apply to a health care service plan contract offered in the individual or group market in California, including a health care service plan contract covering dental services and a specialized health care service plan contract covering dental services. However, this article shall not apply to a nondental specialized health care service plan contract, a Medicare supplement contract subject to Article 3.5 (commencing with Section 1358.1), a health care service plan contract offered in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), a health care service plan contract offered in the California Major Risk Medical Insurance Program (Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code), a health care service plan conversion contract offered pursuant to Section 1373.6, a health care service plan contract offered to a federally eligible defined individual under Article 4.6 (commencing with Section 1366.35) or Article 10.5 (commencing with Section 1399.801), or a Mexican prepaid health plan subject to Section 1351.2. This article does not limit, impair, or interfere with the authority of the California Public Employees Retirement System, as set forth in Section 22794 of the Government Code and Article 6 (commencing with Section 22850) of Part 5 of Division 5 of Title 2 of the Government Code.(b) The department shall establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a plan contract covering dental services, including a specialized health care service plan contract covering dental services services, that is issued, sold, renewed, or offered by a health care service plan is unreasonable, or not justified, under the applicable requirements of this article.
1385.02. (a) This article shall apply to a health care service plan contract offered in the individual or group market in California, including a health care service plan contract covering dental services and a specialized health care service plan contract covering dental services. However, this article shall not apply to a nondental specialized health care service plan contract, a Medicare supplement contract subject to Article 3.5 (commencing with Section 1358.1), a health care service plan contract offered in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), a health care service plan contract offered in the California Major Risk Medical Insurance Program (Part 6.5 (commencing with Section 12700) of Division 2 of the Insurance Code), a health care service plan conversion contract offered pursuant to Section 1373.6, a health care service plan contract offered to a federally eligible defined individual under Article 4.6 (commencing with Section 1366.35) or Article 10.5 (commencing with Section 1399.801), or a Mexican prepaid health plan subject to Section 1351.2. This article does not limit, impair, or interfere with the authority of the California Public Employees Retirement System, as set forth in Section 22794 of the Government Code and Article 6 (commencing with Section 22850) of Part 5 of Division 5 of Title 2 of the Government Code.
(b) The department shall establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a plan contract covering dental services, including a specialized health care service plan contract covering dental services services, that is issued, sold, renewed, or offered by a health care service plan is unreasonable, or not justified, under the applicable requirements of this article.
SEC. 3. Section 10120.41 is added to the Insurance Code, to read:10120.41. (a) For purposes of this section, the following definitions shall apply:(1) Dental waiting period provision means a contract provision that limits coverage for a specified period of time following an insureds effective date of coverage.(2) Health insurer means a health an insurer that issues, sells, renews, or offers a plan contract covering dental services or a health insurance policy covering dental services. policy of health insurance, as defined in subdivision (b) of Section 106, covering dental services, including a specialized health insurance policy covering dental services, as defined in subdivision (c) of Section 106.(3) Preexisting condition provision means a contract provision that excludes coverage for charges or expenses incurred during a specified period or limits coverage for services, charges, or expenses incurred following an insureds effective date of coverage, as to coverage for a condition for which dental advice, services, diagnosis, care care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.(b) On and after January 1, 2024, a health insurer shall not issue, sell, renew, or offer a policy that imposes a dental waiting period provision or preexisting condition provision upon an insured.(c)On and after January 1, 2024, at the time of verification for patient eligibility, a health insurer shall disclose whether or not the insureds dental coverage is subject to regulation by the department.(d)(c) This section does not apply to Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
SEC. 3. Section 10120.41 is added to the Insurance Code, to read:
### SEC. 3.
10120.41. (a) For purposes of this section, the following definitions shall apply:(1) Dental waiting period provision means a contract provision that limits coverage for a specified period of time following an insureds effective date of coverage.(2) Health insurer means a health an insurer that issues, sells, renews, or offers a plan contract covering dental services or a health insurance policy covering dental services. policy of health insurance, as defined in subdivision (b) of Section 106, covering dental services, including a specialized health insurance policy covering dental services, as defined in subdivision (c) of Section 106.(3) Preexisting condition provision means a contract provision that excludes coverage for charges or expenses incurred during a specified period or limits coverage for services, charges, or expenses incurred following an insureds effective date of coverage, as to coverage for a condition for which dental advice, services, diagnosis, care care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.(b) On and after January 1, 2024, a health insurer shall not issue, sell, renew, or offer a policy that imposes a dental waiting period provision or preexisting condition provision upon an insured.(c)On and after January 1, 2024, at the time of verification for patient eligibility, a health insurer shall disclose whether or not the insureds dental coverage is subject to regulation by the department.(d)(c) This section does not apply to Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
10120.41. (a) For purposes of this section, the following definitions shall apply:(1) Dental waiting period provision means a contract provision that limits coverage for a specified period of time following an insureds effective date of coverage.(2) Health insurer means a health an insurer that issues, sells, renews, or offers a plan contract covering dental services or a health insurance policy covering dental services. policy of health insurance, as defined in subdivision (b) of Section 106, covering dental services, including a specialized health insurance policy covering dental services, as defined in subdivision (c) of Section 106.(3) Preexisting condition provision means a contract provision that excludes coverage for charges or expenses incurred during a specified period or limits coverage for services, charges, or expenses incurred following an insureds effective date of coverage, as to coverage for a condition for which dental advice, services, diagnosis, care care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.(b) On and after January 1, 2024, a health insurer shall not issue, sell, renew, or offer a policy that imposes a dental waiting period provision or preexisting condition provision upon an insured.(c)On and after January 1, 2024, at the time of verification for patient eligibility, a health insurer shall disclose whether or not the insureds dental coverage is subject to regulation by the department.(d)(c) This section does not apply to Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
10120.41. (a) For purposes of this section, the following definitions shall apply:(1) Dental waiting period provision means a contract provision that limits coverage for a specified period of time following an insureds effective date of coverage.(2) Health insurer means a health an insurer that issues, sells, renews, or offers a plan contract covering dental services or a health insurance policy covering dental services. policy of health insurance, as defined in subdivision (b) of Section 106, covering dental services, including a specialized health insurance policy covering dental services, as defined in subdivision (c) of Section 106.(3) Preexisting condition provision means a contract provision that excludes coverage for charges or expenses incurred during a specified period or limits coverage for services, charges, or expenses incurred following an insureds effective date of coverage, as to coverage for a condition for which dental advice, services, diagnosis, care care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.(b) On and after January 1, 2024, a health insurer shall not issue, sell, renew, or offer a policy that imposes a dental waiting period provision or preexisting condition provision upon an insured.(c)On and after January 1, 2024, at the time of verification for patient eligibility, a health insurer shall disclose whether or not the insureds dental coverage is subject to regulation by the department.(d)(c) This section does not apply to Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
10120.41. (a) For purposes of this section, the following definitions shall apply:
(1) Dental waiting period provision means a contract provision that limits coverage for a specified period of time following an insureds effective date of coverage.
(2) Health insurer means a health an insurer that issues, sells, renews, or offers a plan contract covering dental services or a health insurance policy covering dental services. policy of health insurance, as defined in subdivision (b) of Section 106, covering dental services, including a specialized health insurance policy covering dental services, as defined in subdivision (c) of Section 106.
(3) Preexisting condition provision means a contract provision that excludes coverage for charges or expenses incurred during a specified period or limits coverage for services, charges, or expenses incurred following an insureds effective date of coverage, as to coverage for a condition for which dental advice, services, diagnosis, care care, or treatment was recommended or received during a specified period immediately preceding the effective date of coverage.
(b) On and after January 1, 2024, a health insurer shall not issue, sell, renew, or offer a policy that imposes a dental waiting period provision or preexisting condition provision upon an insured.
(c)On and after January 1, 2024, at the time of verification for patient eligibility, a health insurer shall disclose whether or not the insureds dental coverage is subject to regulation by the department.
(d)
(c) This section does not apply to Medi-Cal dental managed care contracts authorized under Chapter 7 (commencing with Section 14000) and Chapter 8 (commencing with Section 14200) of Part 3 of Division 9 of the Welfare and Institutions Code.
SEC. 4. Section 10181.2 of the Insurance Code is amended to read:10181.2. (a) This article shall apply to a health insurance policy offered in the individual or group market in California, including a health insurance policy covering dental services and a specialized health insurance policy covering dental services. However, this article shall not apply to a nondental specialized health insurance policy, a Medicare supplement policy subject to Article 6 (commencing with Section 10192.05), a health insurance policy offered in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), a health insurance policy offered in the California Major Risk Medical Insurance Program (Part 6.5 (commencing with Section 12700)), a health insurance conversion policy offered pursuant to Section 12682.1, a health insurance policy offered to a federally eligible defined individual under Chapter 9.5 (commencing with Section 10900), or a Mexican prepaid health plan subject to Section 1351.2 of the Health and Safety Code.(b) The department shall establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a policy of health insurance, as defined in subdivision (b) of Section 106, covering dental services, including a specialized health insurance policy covering dental services services, as defined in subdivision (c) of Section 106, issued, sold, renewed, or offered by a health insurer is unreasonable, or not justified, under the applicable requirements of this article.
SEC. 4. Section 10181.2 of the Insurance Code is amended to read:
### SEC. 4.
10181.2. (a) This article shall apply to a health insurance policy offered in the individual or group market in California, including a health insurance policy covering dental services and a specialized health insurance policy covering dental services. However, this article shall not apply to a nondental specialized health insurance policy, a Medicare supplement policy subject to Article 6 (commencing with Section 10192.05), a health insurance policy offered in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), a health insurance policy offered in the California Major Risk Medical Insurance Program (Part 6.5 (commencing with Section 12700)), a health insurance conversion policy offered pursuant to Section 12682.1, a health insurance policy offered to a federally eligible defined individual under Chapter 9.5 (commencing with Section 10900), or a Mexican prepaid health plan subject to Section 1351.2 of the Health and Safety Code.(b) The department shall establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a policy of health insurance, as defined in subdivision (b) of Section 106, covering dental services, including a specialized health insurance policy covering dental services services, as defined in subdivision (c) of Section 106, issued, sold, renewed, or offered by a health insurer is unreasonable, or not justified, under the applicable requirements of this article.
10181.2. (a) This article shall apply to a health insurance policy offered in the individual or group market in California, including a health insurance policy covering dental services and a specialized health insurance policy covering dental services. However, this article shall not apply to a nondental specialized health insurance policy, a Medicare supplement policy subject to Article 6 (commencing with Section 10192.05), a health insurance policy offered in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), a health insurance policy offered in the California Major Risk Medical Insurance Program (Part 6.5 (commencing with Section 12700)), a health insurance conversion policy offered pursuant to Section 12682.1, a health insurance policy offered to a federally eligible defined individual under Chapter 9.5 (commencing with Section 10900), or a Mexican prepaid health plan subject to Section 1351.2 of the Health and Safety Code.(b) The department shall establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a policy of health insurance, as defined in subdivision (b) of Section 106, covering dental services, including a specialized health insurance policy covering dental services services, as defined in subdivision (c) of Section 106, issued, sold, renewed, or offered by a health insurer is unreasonable, or not justified, under the applicable requirements of this article.
10181.2. (a) This article shall apply to a health insurance policy offered in the individual or group market in California, including a health insurance policy covering dental services and a specialized health insurance policy covering dental services. However, this article shall not apply to a nondental specialized health insurance policy, a Medicare supplement policy subject to Article 6 (commencing with Section 10192.05), a health insurance policy offered in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), a health insurance policy offered in the California Major Risk Medical Insurance Program (Part 6.5 (commencing with Section 12700)), a health insurance conversion policy offered pursuant to Section 12682.1, a health insurance policy offered to a federally eligible defined individual under Chapter 9.5 (commencing with Section 10900), or a Mexican prepaid health plan subject to Section 1351.2 of the Health and Safety Code.(b) The department shall establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a policy of health insurance, as defined in subdivision (b) of Section 106, covering dental services, including a specialized health insurance policy covering dental services services, as defined in subdivision (c) of Section 106, issued, sold, renewed, or offered by a health insurer is unreasonable, or not justified, under the applicable requirements of this article.
10181.2. (a) This article shall apply to a health insurance policy offered in the individual or group market in California, including a health insurance policy covering dental services and a specialized health insurance policy covering dental services. However, this article shall not apply to a nondental specialized health insurance policy, a Medicare supplement policy subject to Article 6 (commencing with Section 10192.05), a health insurance policy offered in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code), a health insurance policy offered in the California Major Risk Medical Insurance Program (Part 6.5 (commencing with Section 12700)), a health insurance conversion policy offered pursuant to Section 12682.1, a health insurance policy offered to a federally eligible defined individual under Chapter 9.5 (commencing with Section 10900), or a Mexican prepaid health plan subject to Section 1351.2 of the Health and Safety Code.
(b) The department shall establish the appropriate methodology, factors, and assumptions to determine whether a rate change for a policy of health insurance, as defined in subdivision (b) of Section 106, covering dental services, including a specialized health insurance policy covering dental services services, as defined in subdivision (c) of Section 106, issued, sold, renewed, or offered by a health insurer is unreasonable, or not justified, under the applicable requirements of this article.
SEC. 5. 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. 5. 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. 5. 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. 5.