Health insurance.
Existing law provides for the regulation of health insurers by the Department of Insurance. Existing federal law, the Patient Protection and Affordable Care Act (PPACA), enacts various health care market reforms. Existing law requires an individual or small group health insurance policy issued, amended, or renewed on or after January 1, 2017, to cover essential health benefits as prescribed, and provides that these provisions shall be implemented only to the extent essential health benefits are required pursuant to PPACA.
This bill would delete the provision that conditions the implementation of that provision only to the extent essential health benefits are required pursuant to PPACA, and would make technical, nonsubstantive changes to that provision.
Existing law prohibits a nongrandfathered health benefit plan for individual coverage from imposing a preexisting condition provision or waivered condition provision upon a person, and makes this provision inoperative if prescribed federal law on minimum essential coverage is repealed or amended.
This bill would delete the conditional operation of that provision.
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 coverage, and prohibits discriminatory premium rates, as specified. PPACA also requires applicable individuals to maintain minimum essential coverage, and imposes a shared responsibility penalty on an applicable individual who does not maintain minimum essential coverage. This provision is referred to as the individual mandate.
Existing law requires a carrier to fairly and affirmatively offer, market, and sell all of the carrier’s health benefit plans that are sold to, offered through, or sponsored by, small employers or associations that include small employers for plan years on or after January 1, 2014, to all small employers in each geographic region in which the carrier makes coverage available or provides benefits. Existing law provides that the premium rate for a small employer health benefit plan issued, amended, or renewed on or after January 1, 2014, shall vary with respect to the particular coverage involved only by age, geographic region, and whether the contract covers an individual or family, as specified. Under existing law, these provisions would become inoperative 12 months after the repeal of the federal coverage guarantee and premium rate regulation provisions, as prescribed.
This bill would delete the conditional operation of the above-described provisions based on the continued operation of the federal coverage guarantee and premium rate regulation provisions in the small employer market.
For policy years on or after January 1, 2014, existing law requires a health insurer to fairly and affirmatively offer, market, and sell all of its health benefit plans that are sold in the individual market to all individuals and dependents in each service area in which the insurer provides or arranges for the provision of health care services, and prohibits an individual health benefit plan issued, amended, or renewed on or after January 1, 2014, from imposing a preexisting condition provision upon an individual. Existing law requires a health insurer to use only age, geographic region, and whether the contract covers an individual or family in setting premium rates for nongrandfathered small employer and individual health benefit plans issued, amended, or renewed on or after January 1, 2014. Under existing law, these provisions would become inoperative 12 months after the repeal of the federal individual mandate or its amendment to no longer apply to the individual market.
This bill would delete the conditional operation of the above-described provisions based on the continued operation of the federal individual mandate and its applicability to the individual market.