Today's Law As Amended

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AB-248 Health insurance: minimum value: large group market policies.(2015-2016)



SECTION 1.
 (a) The Legislature finds and declares that an employee of a large employer who accepts health coverage from his or her employer that is less than 60 percent minimum value is barred by federal guidance from obtaining federal tax credits for affordable health coverage through Covered California.
(b) It is the intent of the Legislature in enacting this act to ensure that employees of large employers who are offered health coverage by their employers are offered coverage that meets or exceeds 60 percent minimum value, the minimum standard for comprehensive employer coverage under federal law. This requirement applies if an employer purchases that health coverage from a health plan or health insurer regulated by the State of California.

SEC. 2.

 Section 1367.010 is added to the Health and Safety Code, to read:

1367.010.
 (a) (1) A nongrandfathered health care service plan, except a health care service plan offering a specialized health care service plan contract, that offers, amends, or renews a large group health care service plan contract shall not market, offer, amend, or renew a large group plan contract that provides a minimum value of less than 60 percent.
(2) This section shall not apply to limited wraparound coverage, consistent with Section 146.145(b) of Title 45 of the Code of Federal Regulations.
(b) For purposes of this section, a plan shall provide a minimum value of at least 60 percent, as described in Section 36B(c)(2)(C) of the federal Internal Revenue Code and any regulation or guidance adopted under that section.
(c) The following definitions apply for purposes of this section:
(1) “Large group health care service plan contract” means a group health care service plan contract other than a contract issued to a “small employer,” as defined in Section 1357, 1357.500, or 1357.600.
(2) “Plan year” has the meaning set forth in Section 144.103 of Title 45 of the Code of Federal Regulations.

SEC. 3.

 Section 10112.9 is added to the Insurance Code, to read:

10112.9.
 (a) (1) Notwithstanding Section 10273.4, an insurer, except an insurer issuing a specialized health insurance policy, issuing a policy or certificate of health insurance, as defined in subdivision (b) of Section 106, shall not market, offer, amend, issue, or renew a large group plan contract that provides a minimum value of less than 60 percent.
(2) This section shall not apply to limited wraparound coverage, that is consistent with Section 146.145(b) of Title 45 of the Code of Federal Regulations. This section also shall not apply to a policy that provides coverage of Medicare services pursuant to contracts with the United States government.
(3) This section shall not apply to a grandfathered health insurance policy that provides basic health care services, as defined in subdivision (b) of Section 1345 of the Health and Safety Code, without annual or lifetime limits for any of the basic health care services.
(b) For purposes of this section, a plan shall provide a minimum value of at least 60 percent, as described in Section 36B(c)(2)(C) of the federal Internal Revenue Code and any regulations or guidance adopted under that section.
(c) This section shall not apply to an insurer that is subject to the disclosure requirements described in Section 10198.61.
(d) For purposes of this section, the following definitions apply:
(1) “Large group” means a group that is not a “small employer,” as defined in Section 10753.
(2) “Plan year” has the meaning set forth in Section 144.103 of Title 45 of the Code of Federal Regulations.
SEC. 4.
 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.