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AB-2752 Health care coverage: continuity of care.(2015-2016)

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AB2752:v97#DOCUMENT

Amended  IN  Assembly  April 26, 2016
Amended  IN  Assembly  April 12, 2016

CALIFORNIA LEGISLATURE— 2015–2016 REGULAR SESSION

Assembly Bill No. 2752


Introduced by Assembly Member Nazarian

February 19, 2016


An act to add Section 1399.7 to the Health and Safety Code, and to add Section 10133.58 to the Insurance Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


AB 2752, as amended, Nazarian. Health care coverage: continuity of care.
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 also provides for the regulation of health insurers by the Insurance Commissioner.
This bill would require a health care service plan or a health insurer, for a health care service plan contract or a health insurance policy that is issued, renewed, or amended on or after January 1, 2017, to notify an enrollee or insured in annual renewal materials that the enrollee’s or insured’s enrollees or insureds in annual renewal materials that a prescription drug is no longer covered by the plan or policy or has changed tiers in the plan’s or insurer’s drug formulary, if that is the case. The bill would exempt a specialized health care service plan that covers dental or vision services from that requirement. The bill would also require a health care service plan or health insurer, for a health care service plan contract or a health insurance policy that is issued, renewed, or amended on or after January 1, 2017, to include in annual renewal materials information regarding the plan’s provider directory or directories. Because a willful violation of that requirement 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.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1399.7 is added to the Health and Safety Code, to read:

1399.7.
 (a) (1) A health care service plan, for a health care service plan contract that is issued, renewed, or amended on or after January 1, 2017, shall include in annual renewal materials a notice to an enrollee that the enrollee’s current enrollees that a prescription drug is no longer covered by the plan or has changed tiers in the plan’s drug formulary, if that is the case.
(2) This subdivision does not apply to a specialized health care service plan that covers dental or vision services.
(b) A health care service plan, for a health care service plan contract that is issued, renewed, or amended on or after January 1, 2017, shall include in annual renewal materials information regarding the health care service plan’s provider directory or directories.

SEC. 2.

 Section 10133.58 is added to the Insurance Code, to read:

10133.58.
 (a) (1) A health insurer, for a health insurance policy that is issued, renewed, or amended on or after January 1, 2017, shall include in annual renewal materials a notice to an insured that the insured’s current insureds that a prescription drug is no longer covered by the policy or has changed tiers in the insurer’s drug formulary, if that is the case.
(2) This subdivision does not apply to a specialized health insurance policy that covers dental or vision services.
(b) A health insurer, for a health insurance policy that is issued, renewed, or amended on or after January 1, 2017, shall include in annual renewal materials information regarding the health insurer’s provider directory or directories.

SEC. 3.

 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.