Existing law, the federal Patient Protection and Affordable Care Act, requires each state to, by January 1, 2014, establish an American Health Benefit Exchange that makes available qualified health plans to qualified individuals and small employers. Existing state law establishes the California Health Benefit Exchange within state government, specifies the powers and duties of the board governing the Exchange relative to determining eligibility for enrollment in the Exchange and arranging for coverage under qualified health plans, and requires the board to facilitate the purchase of qualified health plans through the Exchange by qualified individuals and small employers by January 1, 2014.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the 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 imposes specified requirements on health care service plans and health insurers that provide medical and hospital coverage under an employer-sponsored group plan for an employer, employee association, or other entity subject to requirements under COBRA or Cal-COBRA, as defined, and imposes specified requirements on those employers, employee associations, or other entities to notify its current and former employees or members and dependents of continuation coverage and conversion coverage options upon specified events. Existing law sets forth procedures related to a petition for dissolution of marriage,
nullity of marriage, or legal separation, or a petition for adoption.
This bill would require the disclosure of information on health care coverage through the California Health Benefit Exchange, under specified circumstances, by health care service plans, health insurers, employers, employee associations or other entities, or, on and after January 1, 2013, by the court, upon the filing of a petition for dissolution of marriage, nullity of marriage, legal separation, or adoption.
On and after January 1, 2014, this bill would also require specified health care service plans and health insurers to, upon the failure of an enrollee or insured to renew his or her health coverage, as specified, or upon termination of coverage under an employer-sponsored group
plan, transfer specified information to the California Health Benefit Exchange for purposes of enrolling those individuals in the Exchange. The bill would make the automatic enrollment of those individuals in the Exchange subject to the plan or insurer, or employer, employee association, or other entity, obtaining the written consent of the individual at the time the individual or employer-sponsored group plan contract or policy is issued, amended, delivered, or renewed, as specified, or upon a qualifying event, as defined. The bill would allow an individual whose information has been transferred to the Exchange under those provisions to discontinue his or her application for enrollment with the Exchange, as specified.
Because a willful violation of the bills provisions relative to health care service plans 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.
