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SB-368 Health care coverage: deductibles and out-of-pocket expenses.(2021-2022)

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Date Published: 02/10/2021 09:00 PM
SB368:v99#DOCUMENT


CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Senate Bill
No. 368


Introduced by Senator Limón

February 10, 2021


An act to add Section 1367.0061 to the Health and Safety Code, and to add Section 10112.281 to the Insurance Code, relating to health care coverage.


LEGISLATIVE COUNSEL'S DIGEST


SB 368, as introduced, Limón. Health care coverage: deductibles and out-of-pocket expenses.
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. A willful violation of the act is a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law sets limits on the amount of the deductible and out-of-pocket expenses that may be included in specified health care service plan contracts and health insurance policies.
This bill, for a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2022, in the individual or group market, would require the health care service plan or health insurer to monitor an enrollee’s or insured’s accrual balance toward their annual deductible and out-of-pocket maximum, if any. The bill would require a health care service plan or health insurer to provide an enrollee or insured with their accrual balance toward their annual deductible and out-of-pocket maximum on a monthly basis during any month in which benefits were used, and would allow an enrollee or insured to request their most up-to-date accrual balances from their health care service plan or health insurer at any time. Because a willful violation of the bill’s provisions 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 1367.0061 is added to the Health and Safety Code, immediately following Section 1367.006, to read:

1367.0061.
 (a) For a health care service plan contract issued, amended, or renewed on or after January 1, 2022, in the individual or group market, a health care service plan shall monitor an enrollee’s accrual toward their annual deductible, if any, for covered benefits.
(1) A health care service plan shall provide an enrollee with their accrual balance toward their annual deductible on a monthly basis during any month in which benefits were used.
(2) An enrollee may request their most up-to-date accrual balance toward their annual deductible from their health care service plan at any time.
(b) For a health care service plan contract issued, amended, or renewed on or after January 1, 2022, in the individual or group market, a health care service plan shall monitor an enrollee’s accrual toward their annual out-of-pocket maximum, if any, for covered benefits.
(1) A health care service plan shall provide an enrollee with their accrual balance toward their annual out-of-pocket maximum on a monthly basis during any month in which benefits were used.
(2) An enrollee may request their most up-to-date accrual balance toward their annual out-of-pocket maximum from their health care service plan at any time.

SEC. 2.

 Section 10112.281 is added to the Insurance Code, immediately following Section 10112.28, to read:

10112.281.
 (a) For a health insurance policy issued, amended, or renewed on or after January 1, 2022, in the individual or group market, a health insurer shall monitor an insured’s accrual toward their annual deductible, if any, for covered benefits.
(1) A health insurer shall provide an insured with their accrual balance toward their annual deductible on a monthly basis during any month in which benefits were used.
(2) An insured may request their most up-to-date accrual balance toward their annual deductible from their health insurer at any time.
(b) For a health insurance policy issued, amended, or renewed on or after January 1, 2022, in the individual or group market, an insurer shall monitor an insured’s accrual balance toward their annual out-of-pocket maximum, if any, for covered benefits.
(1) A health insurance policy shall provide an insured with their accrual balance toward their annual out-of-pocket maximum on a monthly basis during any month in which benefits were used.
(2) An insured may request their most up-to-date accrual balance toward their annual out-of-pocket maximum from their health insurer at any time.

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.