Bill Text: CA AB2752 | 2015-2016 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Health care coverage: continuity of care.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2016-11-30 - From committee without further action. [AB2752 Detail]

Download: California-2015-AB2752-Amended.html

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BILL NUMBER: AB 2752	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 12, 2016

INTRODUCED BY   Assembly Member Nazarian

                        FEBRUARY 19, 2016

   An act to add Section 1399.7 to the Health and Safety Code, and to
add Section 10133.58 to the Insurance Code, relating to health care
coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 2752, as amended, Nazarian. Health care coverage: continuity of
care.
   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 also provides for the
regulation of health insurers by the Insurance Commissioner. 

   Existing law requires certain nongrandfathered health care service
plan contracts and health insurance policies to provide for a limit
on annual out-of-pocket expenses for covered benefits, as specified.
Existing law requires a health care service plan to furnish services
in a manner providing continuity of care. Existing law requires a
health insurer covering hospital, medical, and surgical expenses on a
group basis and that contracts with providers for alternative rates
to file a written policy with the Department of Insurance describing
how the insurer will facilitate the continuity of care for new
insureds receiving services during a current episode of care for an
acute condition from a noncontracting provider.  
   This bill would declare the intent of the Legislature to enact
legislation that would provide greater consumer protections regarding
continuity of care for an enrollee or insured, and that would give
relief to an enrollee or insured that would prevent an enrollee or
insured from paying maximum out-of-pocket expenses twice in one year
if the enrollee or insured involuntarily changes health plans or
insurers.  
   Existing law requires plans and insurers to annually issue
specified notices pertaining to health care coverage to enrollees and
insureds. 
   This bill would require a health care service plan or a health
 insurer to annually, every October 1,  
insurer, for a health care service plan contract or a health
insurance policy that is issued, renewed, or amended on or after
January 1, 2017, to  notify an enrollee or insured  in
annual renewal materials  that the  enrollees's
  enrollee's  or insured's  prescription 
drug  treatment  is no longer covered by the plan or
 policy,   policy   or has changed
tiers in the plan's or insurer's drug formulary,  if that is the
 case, and that the enrollee's or insured's provider is no
longer part of the provider network, if that is the  case.
 The bill would exempt a specialized health care service plan
that covers dental or vision services from that requirement. The bill
would also require a health care service plan or health insurer, for
a health care service plan contract or a health insurance policy
that is issued, renewed, or amended on or after January 1, 2017, to
include in annual renewal materials information regarding the plan's
provider directory or directories.  Because a willful violation
of that requirement 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.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
   
  SECTION 1.    It is the intent of the Legislature
to enact legislation that would provide greater consumer protections
regarding continuity of care for an enrollee or insured, and that
would give relief to an enrollee or insured that would prevent him or
her from paying maximum out-of-pocket expense twice in one year if
he or she involuntarily changes health plans or health insurers.

   SEC. 2.   SECTION 1.   Section 1399.7 is
added to the Health and Safety Code, to read:
   1399.7.  (a)  Annually every October 1, a  
(1)     A  health care service  plan
 plan, for a health care service plan contract that is
issued, renewed, or amended on or after January 1, 2017,  shall
include in  annual  renewal materials a notice to an
enrollee that the enrollee's current  prescription  drug
 treatment  is no longer covered by the 
plan,   plan or has changed tiers in the plan's drug
formulary,  if that is the case. 
   (2) This subdivision does not apply to a specialized health care
service plan that covers dental or vision services. 
   (b)  Annually every October 1, a   A 
  health care service  plan   plan, for
a health care service plan contract that is issued, renewed, or
amended on or after January 1, 2017,  shall include in 
annual  renewal materials  a notice to an enrollee that
the enrollee's current provider is no longer part of the health care
service plan's provider network, if that is the case.  
information regarding the health care service plan's provider
directory or directories. 
   SEC. 3.   SEC. 2.   Section 10133.58 is
added to the Insurance Code, to read:
   10133.58.  (a)  Annually every October 1, a  
(1)     A  health  insurer 
 insurer, for a health insurance policy that is issued, renewed,
or amended on or after January 1, 2017, shall include in 
annual  renewal materials a notice to an insured that the
insured's current  prescription  drug  treatment
 is no longer covered by the  policy,  
policy or has changed tiers in the insurer's drug formulary, 
if that is the case. 
   (2) This subdivision does not apply to a specialized health
insurance policy that covers dental or vision services. 
   (b)  Annually every October 1, a   A 
health  insurer   insurer, for a health
insurance policy that is issued, renewed, or amended on or after
January 1, 2017,  shall include in  annual  renewal
materials  a notice to an insured that the insured's current
provider is no longer part of the health benefit plan's provider
network, if that is the case.   information regarding
the health insurer's provider directory or directories. 
   SEC. 4.   SEC. 3.   No reimbursement is
required by this act pursuant to Section 6 of Article XIII B 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 XIII
B of the California Constitution.