Today's Law As Amended

PDF |Add To My Favorites |Track Bill | print page

AB-1246 Health care coverage: basic health care services.(2019-2020)



SECTION 1.

 Section 10112.285 is added to the Insurance Code, immediately following Section 10112.28, to read:

10112.285.
 (a) A large group health insurance policy issued, amended, or renewed on or after July 1, 2020, shall include coverage for medically necessary basic health care services. “Basic health care services” means all of the following:
(1) Physician services, including consultation and referral.
(2) Hospital inpatient services and ambulatory care services.
(3) Diagnostic laboratory and diagnostic and therapeutic radiologic services.
(4) Home health services.
(5) Preventive health services.
(6) Emergency health care services, including ambulance and ambulance transport services and out-of-area coverage. “Basic health care services” includes ambulance and ambulance transport services provided through the “911” emergency response system.
(7) Hospice care that is, at a minimum, equivalent to hospice care provided by the federal Medicare Program pursuant to Title XVIII of the Social Security Act (42 U.S.C. Sec. 1395 et seq.) and implementing regulations adopted for hospice care under Title XVIII of the Social Security Act in Part 418 of Chapter IV of Title 42 of the Code of Federal Regulations except Subparts A, B, G, and H, and any amendments or successor provisions.
(b) A large group health insurance policy issued, amended, or renewed on or after July 1, 2020, shall not impose annual or lifetime dollar limits on basic health care services or medically necessary prescription drugs covered pursuant to Section 10123.201.
(c) This section does not prohibit a large group health insurance policy from covering additional benefits.
(d) This section does not apply to a specialized health insurance policy that covers only dental or vision services.
(e) The department may adopt regulations pursuant to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) to implement this section. The department shall consult with the Department of Managed Health Care to develop the regulations implementing this section.
(f) It is the intent of the Legislature that, in implementing this section, the department shall harmonize its implementation with that of the Department of Managed Health Care and relevant case law to the extent practical.