AB 1461 - An Act to Amend Sections 1363 and 1399.829 Of, to Amend the Heading of Article 11.7 (Commencing with Section 1399.825) of Chapter 2.2 of Division 2 Of, to Add Section 1399.836 To, to Add Article 11.8 (Commencing with Section 1399.845) to Chapter 2.2 of Division 2 Of, and to Repeal Section 1399.816 Of, the Health and Safety Code, and to Amend Section 10965.3 of the Insurance Code, Relating to Health Care Coverage.

An Act to Amend Sections 1363 and 1399.829 Of, to Amend the Heading of Article 11.7 (Commencing with Section 1399.825) of Chapter 2.2 of Division 2 Of, to Add Section 1399.836 To, to Add Article 11.8 (Commencing with Section 1399.845) to Chapter 2.2 of Division 2 Of, and to Repeal Section 1399.816 Of, the Health and Safety Code, and to Amend Section 10965.3 of the Insurance Code, Relating to Health Care Coverage.

AB 1461 — 2011-2012 Legislature

Summary

(1)Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA) enacts various health care coverage market reforms that take effect January 1, 2014. Among other things, PPACA requires each health insurance issuer that offers health insurance coverage in the individual or group market in a state to accept every employer and individual in the state that applies for that coverage and to renew that coverage at the option of the plan sponsor or the individual. PPACA prohibits a group health plan and a health insurance issuer offering group or individual health insurance coverage from imposing any preexisting condition exclusion with respect to that plan or coverage. PPACA allows the premium rate charge by a health insurance issuer offering small group or individual coverage to vary only by family composition, rating area, age, and tobacco use, as specified, and prohibits discrimination against individuals based on health status.

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… More

(1)Existing federal law, the federal Patient Protection and Affordable Care Act (PPACA) enacts various health care coverage market reforms that take effect January 1, 2014. Among other things, PPACA requires each health insurance issuer that offers health insurance coverage in the individual or group market in a state to accept every employer and individual in the state that applies for that coverage and to renew that coverage at the option of the plan sponsor or the individual. PPACA prohibits a group health plan and a health insurance issuer offering group or individual health insurance coverage from imposing any preexisting condition exclusion with respect to that plan or coverage. PPACA allows the premium rate charge by a health insurance issuer offering small group or individual coverage to vary only by family composition, rating area, age, and tobacco use, as specified, and prohibits discrimination against individuals based on health status.

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 requires plans offering coverage in the individual market to offer coverage for a child subject to specified requirements.

This bill would require a plan, on and after October 1, 2013, to offer, market, and sell all of the plan’s health benefit plans that are sold in the individual market to all individuals and dependents in each service area in which the plan provides or arranges for the provision of health care services, with coverage effective on or after January 1, 2014, as specified, but would require plans to limit enrollment in individual health benefit plans to specified open enrollment and special enrollment periods. The bill would prohibit these health benefit plans from imposing any preexisting condition upon any individual. Commencing January 1, 2014, the bill would prohibit a plan from conditioning the issuance or offering of individual health benefit plans on any health status-related factor, as specified, and would authorize plans to use only age, geographic region, and whether the plan covers an individual or family for purposes of establishing rates for individual health benefit plans, as specified. The bill would require a health care service plan to issue a specified notice at least 60 days prior to the renewal date of an individual grandfathered health plan to all subscribers of the plan. The bill would make certain of these provisions inoperative if the corresponding provisions of PPACA are repealed and would make other related conforming changes.

Because a willful violation of the bill’s requirements with respect to health care service plans would be a crime, the bill would impose a state-mandated local program.

(2)PPACA requires health insurance issuers to provide a summary of benefits and coverage explanation pursuant to specified standards to applicants and enrollees or policyholders.

Existing law requires health care service plans to use disclosure forms that contain specified information regarding the contracts issued by the plan, including the benefits and coverage of the contract, and the exceptions, reductions, and limitations that apply to the contract. Existing law requires health care service plans that offer individual or small group coverage to also provide a uniform health plan benefits and coverage matrix containing the plan’s major provisions, as specified.

This bill would authorize the Department of Managed Health Care to waive or modify those requirements for purposes of compliance with PPACA through issuance of all-plan letters until January 1, 2015.

(3)The bill would provide that it shall become operative only if SB 961 of the 2011–12 Regular Session is also enacted.

(4)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. Hide

Learn More

At LegInfo.ca.gov

Title

An Act to Amend Sections 1363 and 1399.829 Of, to Amend the Heading of Article 11.7 (Commencing with Section 1399.825) of Chapter 2.2 of Division 2 Of, to Add Section 1399.836 To, to Add Article 11.8 (Commencing with Section 1399.845) to Chapter 2.2 of Division 2 Of, and to Repeal Section 1399.816 Of, the Health and Safety Code, and to Amend Section 10965.3 of the Insurance Code, Relating to Health Care Coverage.

Author(s)

Bill Monning

Co-Authors

• Ed Hernandez

Subjects

• Individual health care coverage

Major Actions

Introduced	1/09/2012
Referred to Committee
Passed Assembly Committee on Health	4/17/2012
Passed Assembly Committee on Appropriations	5/25/2012
Passed Assembly	5/29/2012
Passed Senate Committee on Health	6/27/2012
Passed Senate Committee on Appropriations	8/06/2012
Passed Senate Committee on Appropriations	8/16/2012
Passed Senate	8/29/2012
Passed Assembly	8/31/2012
Presented to the governor (enrolled)	9/13/2012
Vetoed by Governor	9/30/2012
Vetoed by Governor	9/30/2012

Bill History

• All Votes
• All Actions

	Chamber/Committee	Motion	Date	Result
select this vote	Assembly Committee on Health	Do pass and be re-referred to the Committee on Appropriations.	4/17/2012	This motion PASSED the Assembly Committee on Health 13 voted YES 6 voted NO 0 voted present/not voting
currently selected	Assembly Committee on Appropriations	Do pass.	5/25/2012	This motion PASSED the Assembly Committee on Appropriations 12 voted YES 5 voted NO 0 voted present/not voting
select this vote	Assembly	AB 1461 MONNING Assembly Third Reading	5/29/2012	This bill PASSED the Assembly 50 voted YES 27 voted NO 3 voted present/not voting
select this vote	Senate Committee on Health	Do pass, but re-refer to the Committee on Appropriations.	6/27/2012	This motion PASSED the Senate Committee on Health 6 voted YES 3 voted NO 0 voted present/not voting
select this vote	Senate Committee on Appropriations	Placed on Appropriations Suspense file.	8/06/2012	This motion PASSED the Senate Committee on Appropriations 7 voted YES 0 voted NO 0 voted present/not voting
select this vote	Senate Committee on Appropriations	Do pass as amended.	8/16/2012	This motion PASSED the Senate Committee on Appropriations 5 voted YES 2 voted NO 0 voted present/not voting
select this vote	Senate	Assembly 3rd Reading AB1461 Monning By Hernandez	8/29/2012	This bill PASSED the Senate 23 voted YES 12 voted NO 5 voted present/not voting
select this vote	Assembly	AB 1461 MONNING Concurrence in Senate Amendments	8/31/2012	This bill PASSED the Assembly 51 voted YES 27 voted NO 2 voted present/not voting

	Action	Date	Description
	Introduced	1/09/2012
		1/09/2012	Read first time. To print.
		1/10/2012	From printer. May be heard in committee February 9.
		1/19/2012	Referred to Com. on HEALTH.
		4/09/2012	From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.
		4/10/2012	Re-referred to Com. on HEALTH.
select this vote	Vote	4/17/2012	Do pass and be re-referred to the Committee on Appropriations.
		4/18/2012	From committee: Do pass and re-refer to Com. on APPR. (Ayes 13. Noes 6.) (April 17). Re-referred to Com. on APPR.
		4/25/2012	In committee: Set, first hearing. Referred to APPR. suspense file.
currently selected	Vote	5/25/2012	Do pass.
		5/25/2012	From committee: Do pass. (Ayes 12. Noes 5.) (May 25). Read second time. Ordered to third reading.
		5/29/2012	Read third time. Passed. Ordered to the Senate. (Ayes 50. Noes 27. Page 5039.)
		5/29/2012	In Senate. Read first time. To Com. on RLS. for assignment.
select this vote	Assembly Vote on Passage	5/29/2012	AB 1461 MONNING Assembly Third Reading
		6/07/2012	Referred to Com. on HEALTH.
select this vote	Vote	6/27/2012	Do pass, but re-refer to the Committee on Appropriations.
		6/28/2012	From committee: Do pass and re-refer to Com. on APPR. (Ayes 6. Noes 3.) (June 27). Re-referred to Com. on APPR.
select this vote	Vote	8/06/2012	Placed on Appropriations Suspense file.
		8/06/2012	In committee: Referred to APPR. suspense file.
select this vote	Vote	8/16/2012	Do pass as amended.
		8/20/2012	From committee: Do pass as amended. (Ayes 5. Noes 2.) (August 16).
		8/21/2012	Read second time and amended. Ordered to third reading.
		8/24/2012	Read third time and amended. Ordered to second reading.
		8/27/2012	Read second time. Ordered to third reading.
		8/29/2012	Read third time. Passed. Ordered to the Assembly. (Ayes 23. Noes 12. Page 4934.).
select this vote	Senate Vote on Passage	8/29/2012	Assembly 3rd Reading AB1461 Monning By Hernandez
		8/30/2012	In Assembly. Concurrence in Senate amendments pending.
		8/31/2012	Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 51. Noes 27. Page 6748.).
select this vote	Assembly Vote on Passage	8/31/2012	AB 1461 MONNING Concurrence in Senate Amendments
		9/13/2012	Enrolled and presented to the Governor at 12:15 p.m.
	Vetoed	9/30/2012	Vetoed by Governor.
		9/30/2012	Consideration of Governor's veto pending.