SB 1313

Bill Subjects

Abstract

Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene Act) , 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 also provides for the regulation of health insurers by the Department of Insurance. Existing law prohibits a health care service plan from publishing or distributing an advertisement unless a copy thereof has first been filed with the Director of the Department of Managed Health Care at least 30 days prior to that use and the director has not found the advertisement to be untrue, misleading, deceptive, or in violation of the Knox-Keene Act within those 30 days, except as specified. Under existing law, if an advertisement fails to comply with the Knox-Keene Act, the director has the authority to require a plan to publish a correction or retraction of an untrue, misleading, or deceptive statement contained in the advertisement and to prohibit the plan from publishing the advertisement or a material revision thereof without filing a copy with the director, as specified. Existing law authorizes the director to exempt a plan or advertisement from these requirements. This bill would, until January 1, 2020, authorize the director to extend this period of review by an additional 90 days. The bill would also require health insurers to comply with similar advertising requirements. Existing law prohibits a plan, solicitor, solicitor firm, or representative from using any advertising or solicitation, or making or permitting the use of any verbal statement, that is untrue or misleading or any form of evidence of coverage that is deceptive, as specified. Existing law prohibits an insurer, agent, or broker from causing to be issued a misrepresentation of the terms of the policy issued by the insurer, among other things, and makes a violation of that requirement a crime. Existing law, the federal Patient Protection and Affordable Care Act (PPACA) , enacts various health care coverage market reforms. Among other things, commencing January 1, 2014, PPACA requires every individual to be covered under minimum essential coverage, as specified, and requires every health insurance issuer offering coverage in the individual or small group markets to ensure that the coverage includes a specified essential health benefits package. This bill would prohibit an insurer or agent from using any advertising or solicitation, or making or permitting the use of any verbal statement, that is untrue or misleading or any form of evidence of coverage that is deceptive, as specified. The bill would prohibit a health care service plan, insurer, and specified persons from making any statement to a person that is known, or should have been known, to be deceptive or a misrepresentation regarding the requirements of PPACA. The bill would prohibit a specialized health care service plan, with certain exceptions, from offering, issuing, selling, or renewing an individual or group plan contract that does not, at a minimum, cover basic health care services unless the individual or group has proof of enrollment in minimum essential coverage, as defined. The bill would also prohibit a discount health plan that arranges for the provision of health care services from offering or selling a product to an individual or group unless the individual enrollee has proof of enrollment in minimum essential coverage. The bill would prohibit a health insurer, a specialized health insurer, or an insurer offering policies or certificates of specified disease or hospital confinement indemnity insurance from offering, issuing, selling, or renewing an individual or small group health insurance policy that does not, at a minimum, cover essential health benefits, as defined, unless the individual or group has proof of enrollment in minimum essential coverage, as defined, with certain exceptions. The bill would require a health care service plan or health insurer that offers, issues, or sells a plan contract or health insurance policy that provides coverage that does not constitute minimum essential coverage to include in all solicitations, marketing materials, and the evidence of coverage a clear and easily identified disclosure to that effect, as specified. The bill would enact other related provisions. Existing law requires the Department of Managed Health Care and the Department of Insurance to adopt regulations establishing standards and requirements to provide enrollees and insureds with appropriate access to language assistance in obtaining health care services, as specified. Existing law requires plans and insurers to translate specified vital documents into a language when a certain proportion of its enrollees or insureds indicate a preference for written materials in that language. Under this bill, if a solicitor or an insurance agent advertises or markets health care service plan contracts or health insurance policies in a language other than English, the plan or insurer would be required to comply with those language assistance requirements. The bill would require a solicitor, solicitor firm, or insurance agent to disclose to the plan or insurer the non-English languages in which the solicitor, solicitor firm, or insurance agent markets, advertises, negotiates, or solicits contracts or policies offered by the plan or insurer, as specified. The bill would require a health care service plan or health insurer that advertises or markets in a language in which vital documents do not have to be translated to translate certain documents into that language. These provisions would not apply to the Medi-Cal program or the Healthy Families Program. Because a violation of certain of the bill's requirements 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.