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 require a health care service plan and health insurer, excluding for a specialized health care service plan or specialized health care policy, 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, and for rates effective during the 12-month period ending January 1 of the following year, on specified information, including premiums, cost sharing, benefits, enrollment, and trend factors, and would exclude prescribed information from the reporting requirements until January 1, 2023. The bill would also require a health care service plan and health insurer, excluding a specialized health care service plan or specialized health care policy, to annually report to the Department of Managed Health Care and the Department of Insurance, respectively, the above-described information for all grandfathered and nongrandfathered products, as specified. The bill would require each department, beginning in 2022, to annually present the reported information at various meetings, as specified. 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. The bill would also authorize the Department of Managed Health Care to implement, interpret, or make specific these provisions by means of all-plan letters, forms, or similar instructions, without taking regulatory action until January 1, 2024. The bill would exempt the Department of Insurance from the Administrative Procedure Act in order to issue guidance to health insurers regarding compliance with these provisions until January 1, 2024.

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.