Signed by Governor Arnold Schwarzenegger

Vote Smart's Synopsis:

Vote to pass a bill that prohibits the denial of health care coverage for children with preexisting conditions.

Highlights:

• Defines "preexisting condition provision" as a contract provision that excludes coverage for charges or expenses incurred during a specific period following the individual's effective date of coverage, as to a condition for which medical advice, diagnosis, care or treatment was recommended or received during a specified period immediately preceding the effective date of coverage (Sec. 1).

• Defines "risk adjustment factor" as the percentage adjustment to be applied equally to each standard risk rate for a particular child, based upon any expected deviations from standard cost of services (Sec. 1).

• Specifies that the risk adjustment factor cannot be more than 120 percent or less than 80 percent until January 1, 2012; that from January 1, 2012 and thereafter it cannot be more than 110 percent or less than 90 percent; and that beginning January 1, 2014 these rates will apply to all plans sold to individuals for children (Sec. 1).

• Specifies that until January 1, 2014 the only age categories that may be used in determining premium rates are under age 5, age 5-15 and age 15-19 (Sec. 1).

• Prohibits premium rates from varying more than 2 to 1 for children (Sec. 1).

• Requires that any health care service plan that offers coverage to children provide coverage to the responsible party for any child that seeks coverage, effective January 1, 2011 (Sec. 1).

• Requires that any health care service plan that offers coverage to individuals provide coverage to any individuals who seek it, effective January 1, 2014 (Sec. 1).

• Prohibits any health care service provider from denying or limiting coverage to individuals because of preexisting conditions, effective January 1, 2014 (Sec. 1).

• Prohibits health care service plans or solicitors from discouraging responsible parties for children from applying for coverage, or encouraging them to apply for coverage from a different plan because of the child's health status, claims experience, industry, occupation, or geographic location, as long as it is within the plan's service area (Sec. 1).

• Prohibits health care service plans from entering into any contract with a solicitor that results in varied compensation because of health status, claims experience, industry, occupation or geographic location of an individual or child (Sec. 1).

• Prohibits health care service plans that cannot offer coverage to individual applicants in a specified area of the approved service area due to insufficient delivery resources from offering coverage to a new employer group in the same area without first notifying the director that it is now able to provide coverage to individual applicants within the area (Sec. 1).

• Authorizes the director of a health care service plan to discontinue the offering of contracts or acceptance of applications if the plan would not be able to continue providing coverage to its enrollees (Sec. 1).

• Requires all health care contracts to be renewable at the option of the enrollee, unless the enrollee has failed to pay dues, has committed fraud, or unless the plan ceases to provide new individual contracts in the state (Sec. 1).

• Prohibits the risk adjustment factor for children from increasing more than 10 percentage points from the risk adjustment factor applied to the previous rating period (Sec. 1).

• Requires health care service plans to disclose the following information when soliciting or offering a contract (Sec. 1):
• the extent to which premium rates are adjusted based on actual or expected variation of service costs or health condition of the child;
• the contract's provisions enabling the plan to change premium rates; -provisions relating to the plan's guaranteed issue and renewal;
• provisions about the child's right to apply for any contract written, issued or administered by the plan at the time of application for a new health care service plan or for renewal of a health care service plan; and
• the availability of a list of all the plan's contracts and benefit plan designs offered for children, along with the rates for each contract.

• Requires health care service plans to file a notification of changes to risk categories, risk adjustment factors or standard risk rates and to wait at least 45 days before implementing the changes (Sec. 1).

Full Bill Text