Signed by Governor Arnold Schwarzenegger

Vote Smart's Synopsis:

Vote to pass a bill that amends various statues related to health care and health insurance coverage.

Highlights:

• Establishes the California Patient Protection and Affordable Care Act (Sec. 1).

• Requires the California Health Benefit Exchange (the Exchange) to be governed by an executive board that is responsible for implementing Section 1311 of the federal Patient Protection and Affordable Care Act, as follows (Sec. 3):
• Implement procedures for the certification, re-certification, and de-certification for health plans deemed qualified health plans;
• Provide a toll-free telephone hotline for assistance;
• Maintain a website where enrollees and prospective enrollees can obtain information on those plans;
• Assign a rating to each qualified health plan offered through the Exchange;
• Utilize a standardized format for presenting health benefits plan options in the Exchange;
• Inform individuals of eligibility requirements for the Medi-Cal program, the Healthy Families Program, or any applicable state or local public program and through an application screening, determine whether an individual is eligible and if so, enroll that individual in the program; and -Establishes and publishes electronically, a calculator determining the actual cost of coverage after the application of any premium tax credit.

• Authorizes an individual to become exempt from the individual requirement or penalty imposed under Section 5000A of the Internal Revenue Code of 1986 because of any of the following (Sec. 3):
• There is no affordable qualified health plan available through the Exchange or the individual's employer covering the individual; and
• The individual meets the requirements for any other exemption from the individual responsibility requirement or penalty.

• Establishes the California Health Trust Fund in the state treasury, and states that the California Health Benefit exchange will establish and maintain a reserve in the fund (Sec. 4).

• Prohibits any group or individual health care service plan contract that is issued, amended, renewed, or delivered on or after September 23, 2010 from establishing lifetime limits on the dollar value of benefits for any participant or beneficiary (Sec. 5)

• Establishes a minimum of coverage that must be provided by insurers as of September 23, 2010 that includes the following (Sec. 5):
• Evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force;
• Immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention;
• With respect to infants, children, and adolescents, evidence-informed preventive care and screenings; and -With respect to women, any additional preventive care and screenings.

• Establishes that on or after September 23, 2010, a group or individual health care service plan contract may not exclude any enrollee under 19 years of age for coverage under a plan on the basis of a preexisting condition (Sec. 5).

• Specifies that a plan contract may not provide an exception for other coverage if the other coverage is entitlement to Medi-Cal benefits or Medicaid benefits (Sec. 6).

• Requires that every plan contract that provides coverage to a spouse or dependent(s) of the subscriber or spouse grant immediate accident and sickness coverage (Sec. 6).

• Requires every plan contract that provides coverage of a dependent child of a subscriber to be terminated once they reach the limiting age for coverage unless both of the following criteria apply (Sec. 6):
• The child is incapable of self-sustaining employment by reason of a physically or mentally disabling injury, illness, or condition; and
• The child is entirely dependent on the subscriber for support and maintenance.

• Requires that the limiting age not be less than 26 years of age, except in relation to employment contracts subject to collective bargaining effective prior to September 23, 2010 (Sec. 6).

• Requires plans that cover employees and provide extension of coverage for any period of time after employment terminates also provide extended coverage to the employee's dependents for the same time period (Sec. 6).

• Authorizes dependent children over 18 years of age and enrolled as full-time students at a secondary or postsecondary educational institution to continue coverage under their health care service plan (Sec. 6).

• Requires those children taking leaves of absence from school to provide documentation or certification of the medical reason for taking the leave and to submit the documentation to the plan at least 30 days prior if it is a foreseeable situation, or 30 days after the start date of the medical leave of absence if it is unforeseeable, if coverage is to continue (Sec. 6).

Full Bill Text