Health insurance: large group health insurance.
(1) Existing law requires the regulation of health insurance policies by the Department of Insurance under the guidance of the Insurance Commissioner. Under existing law, the department regulates individual, small employer, and large employer health insurance policies, as defined. Existing law requires an individual or small group health insurance policy issued to include coverage for essential health benefits, as defined.
This bill would require a large group health insurance policy issued, amended, or renewed on or after July 1, 2022, to cover medically necessary basic health care services, as defined. The bill would authorize the commissioner to adopt regulations to implement these provisions. The bill would require these provisions to apply to an individual, group, or blanket disability insurance policy if a specified condition is met.
(2) Existing law prohibits a health insurer or agent or broker from, directly or indirectly, from among other things, employing marketing practices or benefit designs that will have the effect of discouraging the enrollment of individuals with significant health needs or discriminating based on an individual’s race, color, national origin, present or predicted disability, age, sex, gender identity, sexual orientation, expected length of life, degree of medical dependency, quality of life, or other health conditions.
This bill would, with respect to large group health insurance, prohibit an insurer and its officials, employees, agents, and representatives from directly or indirectly employing marketing practices or benefit designs that have the effect of discouraging the enrollment of individual on the above-described protected classifications. An insurer that violates this provision would be liable for an administrative penalty of not more than $2,500 for the first violation, and not more than $5,000 for the second. The bill would also subject an insurer that violates this provision with a frequency that indicates a general practice or commits a knowing violation to an administrative penalty of not less than $15,000, and not more than $100,000 for each violation.