Today's Law As Amended


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SB-1095 California Major Risk Medical Insurance Program. (2009-2010)



As Amends the Law Today


SECTION 1.

 Section 12712.5 is added to the Insurance Code, to read:

12712.5.
 The board shall release to the Legislative Analyst’s Office all program actuarial data for 2004 to 2007, inclusive, as requested by that office.

SEC. 2.

 Section 12715.5 is added to the Insurance Code, to read:

12715.5.
 (a) Notwithstanding Section 12712.5 or 12723, the board shall offer at least four different options for major risk medical coverage pursuant to this part, including at least one Health Savings Account-compatible option. These options shall provide for both of the following:
(1) Varying annual deductibles ranging from five hundred dollars ($500) to two thousand five hundred dollars ($2,500) per individual and one thousand dollars ($1,000) to four thousand dollars ($4,000) per family.
(2) Varying annual out-of-pocket maximums ranging from two thousand five hundred dollars ($2,500) to five thousand dollars ($5,000) per individual and four thousand dollars ($4,000) to seven thousand five hundred dollars ($7,500) per family.
(b) Beginning January 1, 2011, if the board determines that sufficient program funding is available, the board may subsidize the Health Savings Account-compatible option offered pursuant to subdivision (a) on a sliding scale based on income.

SEC. 3.

 Section 12718 of the Insurance Code is amended to read:

12718.
 Benefits under this chapter or Chapter 5 (commencing with Section 12720) shall be subject to required subscriber copayments and deductibles as the board may authorize, as limited by Section 12715.5. Any authorized copayments shall not exceed 25 percent. However, health plans not utilizing a deductible may be authorized to charge an office visit copayment of up to twenty-five dollars ($25). If the board contracts with participating health plans pursuant to Chapter 5 (commencing with Section 12720), copayments or deductibles shall be authorized in a manner consistent with the basic method of operation of the participating health plans, subject to Section 12715.5.

SEC. 4.

 Section 12721.5 is added to the Insurance Code, to read:

12721.5.
 (a) If the board determines there are sufficient funds available, it may participate, on a sliding scale based on income, in deductible and out-of-pocket maximum reinsurance using products such as health reimbursement arrangements, critical insurance policies, and accident insurance policies.
(b) This section shall remain in effect only until January 1, 2015, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2015, deletes or extends that date.

SEC. 5.

 Section 12727 of the Insurance Code is amended to read:

12727.
 The program shall make available to applicants eligible to enroll in the program sufficient information to make an informed choice among the options provided pursuant to Section 12715.5. Each applicant shall be issued an appropriate document setting forth or summarizing the services to which an enrollee is entitled, procedures for obtaining major risk medical coverage, a list of contracting health plans and providers, and a summary of grievance procedures.