Vetoed by Governor Arnold Schwarzenegger

Vote Smart's Synopsis:

Vote to pass a bill that creates a standard for health care plans within the state.

Highlights:

• Requires that every health care plan provide disclosure forms or materials containing clear, organized information regarding the benefits, services, costs (including premiums and co-payments) and terms of the plan in readily understood language (Sec. 1).

• Specifies that only standardized benefit plan designs consisting of platinum, gold, silver, bronze, and catastrophic be offered in the state (Sec. 2).

• Establishes the Individual Insurance Market Reform Commission and authorizes it to develop a standard enrollment questionnaire for health service plans that provide individual coverage, and review and if necessary suggest changes to the standard benefit plan designs (Sec. 2).

• Requires that the Individual Insurance Market Reform Commission be made up of 9 members, 5 of whom are to be appointed by the governor and of those 5 there must be a health care economist and a representative for self-employed people (Sec. 2).

• Requires that after July 1, 2011, health care service plans participating in the individual market shall discontinue offering and selling health benefit plan designs other than those that meet the requirements of the standard benefit plan designs described in this article (Sec. 2).

• Authorizes individuals to change their health care plans if they wish to do so (Sec. 2).

• Establishes that after January 1, 2014 a health care service provider cannot seek to obtain a potential subscriber's medical history (Sec. 2).

• Requires that the annualized premium rate increase for a health care service plan contract issued by a health care service plan to an individual shall not vary by more than 10 percent above or below the weighted average premium rate increase when calculated across all of the health care service plan's health benefit plan designs (Sec. 2).

• Requires that the highest standard premium rate for a standard benefit plan design offered in the individual market by a health care service plan shall not exceed the lowest standard premium rate for a standard benefit plan design offered in the individual market by the health care service plan by more than 50 percent, after taking into consideration the actuarial difference of the standard benefit plan designs offered (Sec. 2).

• Specifies that in rating individuals, only the following characteristics of an individual shall be used: age, geographic region, and family composition, plus the health benefit plan design selected by the individual, except that health status may also be used until January 1, 2014 (Sec. 2).

• Requires that a full service health care service plan contract issued, amended, or renewed on or after January 1, 2011, have no annual or lifetime limits on basic health care services (Sec. 3).

• Requires that a health care service plan provide written notification at least thirty days in advance of a premium increase to an individual and specify the reasons for that increase (Sec. 5).

• Requires that after January 1, 2011 a health care insurer shall expend in benefits an amount no less than 80 percent of dues, fees, premiums, and other received payments for individual and small group coverage and no less than 85 percent for large group coverage (Sec. 7).

Full Bill Text