SB 1095

Bill Subjects

Abstract

Existing law establishes the California Major Risk Medical Insurance Program (MRMIP) that is administered by the Managed Risk Medical Insurance Board (MRMIB) to provide major risk medical coverage to residents, as defined, who, among other matters, have been rejected for coverage by at least one private health plan. Existing law requires MRMIB to provide that coverage through participating health plans, except as specified, and authorizes MRMIB to provide or purchase stop-loss coverage under which MRMIP and participating health plans share the risk for health plan expenses that exceed plan rates. Existing law requires that benefits under the program be subject to copayments and deductibles authorized by the board and sets forth certain maximum amounts for deductibles and copayments. The bill would require MRMIB to offer at least 4 different options for major risk medical coverage with varying deductibles and out-of-pocket maximums, as specified. The bill would require those options to include at least one Health Savings Account-compatible option and would authorize MRMIB to subsidize that option, as specified. The bill would also authorize MRMIB, until a specified date and if sufficient funds are available, to participate in deductible and out-of-pocket maximum reinsurance using specified products. The bill would require MRMIB to release all program actuarial data for 2004 to 2007, inclusive, to the Legislative Analyst's Office, as requested by that office.