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AB-2118 Health care service plans and health insurers: reporting requirements.(2019-2020)

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Date Published: 05/20/2020 09:00 PM
AB2118:v97#DOCUMENT

Revised  June 04, 2020
Amended  IN  Assembly  May 20, 2020
Amended  IN  Assembly  May 11, 2020

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 2118


Introduced by Assembly Member Kalra
(Coauthor: Assembly Member Gonzalez)

February 06, 2020


An act to add Section 1385.043 to the Health and Safety Code and to add Section 10181.46 to the Insurance Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


AB 2118, as amended, Kalra. Health care service plans and health insurers: reporting requirements.
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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer offering a contract or policy in the individual, small, and large group markets to file specified information, including total earned premiums and total incurred claims for each contract or policy form, with the appropriate department at least 120 days before implementing a rate change. Existing law requires a large group market health care service plan or insurer to report additional information relating to cost sharing and specified aggregate rate information. Existing law requires the Department of Managed Health Care and the Department of Insurance to conduct an annual public meeting regarding large group rates.
This bill would expand reporting requirements for health care service plans and health insurers, for products in the individual and small group markets to include, for rates effective during the 12-month period ending January 1 of the following year, specified information on premiums, cost sharing, benefits, enrollment, and trend factors as reported in all rate filings for the health care service plan or insurer, including both price and utilization. The bill would exclude specified information from the reporting requirements until January 1, 2023. The bill would require each department, beginning in 2022, to annually present the information required by the bill at the meeting regarding large group rates and at a public meeting of the board of Covered California, as specified.
Because a violation of the bill 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 1385.043 is added to the Health and Safety Code, to read:

1385.043.
 (a) A health care service plan shall report to the department the following information for all products that the plan offers and sells in the individual and small group markets, including both on-exchange and off-exchange enrollment, for rates effective during the 12-month period ending January 1 of the following year:
(1) Information on premiums, including share of premium if applicable, average weighted weighted average premium, and average rate change.
(2) Cost sharing, including deductibles, maximum out-of-pocket limit, copayments, coinsurance, and any other cost sharing for covered benefits as well as high deductible health plans.
(3) Benefits, including those in addition to essential health benefits or basic health care services and those offered in products subject to the standard benefit design that are in addition to benefits offered in the standard benefit design.
(4) Standard and nonstandard benefit designs, including on-exchange and off-exchange nonstandard benefit designs.
(5) Enrollment by actuarial value tier, product, benefit design and premiums, including both of the following:
(A) Enrollment in products with zero deductibles, high deductibles as defined in this section, and deductibles between zero and high.
(B) Enrollment by premium or share of premium, if applicable.
(b) Trend factors as reported in all rate filings for the health care service plan, including both price and utilization, as required in Section 1385.03.
(c) Beginning in 2022, the department shall present annually the information reported under this section in the meeting specified in Section 1385.045 or a meeting of the Financial Solvency Standards Board. The department also shall present the information at a public meeting of the board of Covered California.
(d) The following definitions apply for purposes of this section:
(1) “Average weighted “Weighted average premium” means the following:
(A) For the individual market, the average premium shall be weighted by the number of individual enrollees in the plan’s individual market and adjusted to the most commonly sold individual market benefit design plan, by enrollment, during the 12-month period.
(B) For the small group market, the average premium shall be weighted by the number of enrollees in each small group benefit design in the plan’s small group market and adjusted to the most commonly sold small group benefit design plan, by enrollment, during the 12-month period.
(2) “Benefit design” means the cost sharing for covered benefits.
(3) “High deductible” has the same meaning as defined in Section 223(c)(2)(A) of Title 26 of the United States Code.
(4) “Standard benefit design” means the standardized product consistent with Section 1366.6 of this code and subdivision (c) of Section 100504 of the Government Code.
(e) Until January 1, 2023, a health care service plan shall not be required to report the following information:
(1) Share of premium paid by enrollee.
(2) Covered benefits that differ from essential health benefits, or for a qualified health plan, benefits in addition to those required in the standard benefit design.
(3) Enrollment by benefit design, deductible, or share of premium.

SEC. 2.

 Section 10181.46 is added to the Insurance Code, to read:

10181.46.
 (a) A health insurer shall report to the department the following information for all products that the insurer offers and sells in the individual and small group markets, including both on-exchange and off-exchange enrollment, for rates effective during the 12-month period ending January 1 of the following year:
(1) Information on premiums, including share of premium if applicable, average weighted weighted average premium, and average rate change.
(2) Cost sharing, including deductibles, maximum out-of-pocket limit, copayments, coinsurance and any other cost sharing for covered benefits as well as high deductible health plans.
(3) Benefits, including those in addition to essential health benefits or basic health care services and those offered in products subject to the standard benefit design that are in addition to benefits offered in the standard benefit design.
(4) Standard and nonstandard benefit designs, including on-exchange and off-exchange nonstandard benefit designs.
(5) Enrollment by actuarial value tier, product, benefit design and premiums, including both of the following:
(A) Enrollment in products with zero deductibles, high deductibles as defined in this section, and deductibles between zero and high.
(B) Enrollment by premium or share of premium, if applicable.
(b) Trend factors as reported in all rate filings for the health insurer, including both price and utilization, as required in Section 10181.3.
(c) Beginning in 2022, the department shall present annually the information reported under this section in the meeting specified in Section 10181.45. The department also shall present this information at a public meeting of the board of Covered California.
(d) For purposes of this section, the following definitions apply:
(1) “Average weighted “Weighted average premium” means both of the following:
(A) For the individual market, the average premium shall be weighted by the number of individual insureds in the plan’s individual market and adjusted to the most commonly sold individual market benefit design plan, by enrollment during the 12-month period.
(B) For the small group market, the average premium shall be weighted by the number of insureds in each small group benefit design in the insurer’s small group market and adjusted to the most commonly sold small group benefit design plan, by enrollment during the 12-month period.
(2) “Benefit design” means the cost sharing for covered benefits.
(3) “High deductible” has the same meaning as defined in Section 223(c)(2)(A) of Title 26 of the United States Code.
(4) “Standard benefit design” means the standardized product, consistent with Section 10112.3 of this code and subdivision (c) of Section 100504 of the Government Code.
(e) Until January 1, 2023, a health insurer shall not be required to report the following information:
(1) Share of premium paid by insured.
(2) Covered benefits that differ from essential health benefits or for a qualified health plan, benefits in addition to those required in the standard benefit design.
(3) Enrollment by benefit design, deductible, or share of premium.

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.
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REVISIONS:
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