Bill Text: CA AB460 | 2013-2014 | Regular Session | Amended

California Assembly Bill 460 (Prior Session Legislation)

NOTE: There are more recent revisions of this legislation. Read Latest Draft

Bill Title: Health care coverage: infertility.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Passed) 2013-10-08 - Chaptered by Secretary of State - Chapter 644, Statutes of 2013. [AB460 Detail]

Download: California-2013-AB460-Amended.html

BILL NUMBER: AB 460	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JUNE 5, 2013

INTRODUCED BY   Assembly Member Ammiano
    (   Coauthor:   Assembly Member  
Atkins   ) 

                        FEBRUARY 19, 2013

   An act to amend Section 1374.55 of the Health and Safety Code, and
to amend Section 10119.6 of the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 460, as amended, Ammiano. Health care coverage: infertility.
   (1) 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 also imposes
various requirements and restrictions on health care service plans
and health insurers, including, among other things, a requirement
that every health care service plan contract or health insurance
policy that is issued, amended, or renewed on or after January 1,
1990, offer coverage for the treatment of infertility, except in
vitro fertilization, under those terms and conditions as may be
agreed upon between the group subscriber or the group policyholder
and the plan or the insurer, except as provided.
   This bill would require that the coverage for the treatment of
infertility be offered and  , if purchased,  provided
without discrimination on the basis of age, ancestry, color,
disability, domestic partner status, gender, gender expression,
gender identity, genetic information, marital status, national
origin, race, religion, sex, or sexual orientation. Because a willful
violation of the bill's provisions by a health care service plan
would be a crime, the bill would impose a state-mandated local
program.
   (2) 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.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1374.55 of the Health and Safety Code is
amended to read:
   1374.55.  (a)  On and after January 1, 1990, every health care
service plan contract that is issued, amended, or renewed that covers
hospital, medical, or surgical expenses on a group basis, where the
plan is not a health maintenance organization as defined in Section
1373.10, shall offer coverage for the treatment of infertility,
except in vitro fertilization, under those terms and conditions as
may be agreed upon between the group subscriber and the plan. Every
plan shall communicate the availability of that coverage to all group
contractholders and to all prospective group contractholders with
whom they are negotiating.
   (b)  For purposes of this section, "infertility" means either (1)
the presence of a demonstrated condition recognized by a licensed
physician and surgeon as a cause of infertility, or (2) the inability
to conceive a pregnancy or to carry a pregnancy to a live birth
after a year or more of regular sexual relations without
contraception. "Treatment for infertility" means procedures
consistent with established medical practices in the treatment of
infertility by licensed physicians and surgeons including, but not
limited to, diagnosis, diagnostic tests, medication, surgery, and
gamete intrafallopian transfer. "In vitro fertilization" means the
laboratory medical procedures involving the actual in vitro
fertilization process.
   (c)  On and after January 1, 1990, every health care service plan
that is a health maintenance organization, as defined in Section
1373.10, and that issues, renews, or amends a health care service
plan contract that provides group coverage for hospital, medical, or
surgical expenses shall offer the coverage specified in subdivision
(a), according to the terms and conditions that may be agreed upon
between the group subscriber and the plan to group contractholders
with at least 20 employees to whom the plan is offered. The plan
shall communicate the availability of the coverage to those group
contractholders and prospective group contractholders with whom the
plan is negotiating.
   (d)  This section shall not be construed to deny or restrict in
any way any existing right or benefit to coverage and treatment of
infertility under an existing law, plan, or policy.
   (e)  This section shall not be construed to require any employer
that is a religious organization to offer coverage for forms of
treatment of infertility in a manner inconsistent with the religious
organization's religious and ethical principles.
   (f)   (1)    This section shall not be construed
to require any plan, which is a subsidiary of an entity whose owner
or corporate member is a religious organization, to offer coverage
for treatment of infertility in a manner inconsistent with that
religious organization's religious and ethical principles. 
    For 
    (2)     For  purposes of this
subdivision, "subsidiary" of a specified corporation means a
corporation more than 45 percent of the voting power of which is
owned directly, or indirectly through one or more subsidiaries, by
the specified corporation.
   (g) Coverage for the treatment of infertility shall be offered and
 , if purchased,  provided without discrimination on the
basis of age, ancestry, color, disability, domestic partner status,
gender, gender expression, gender identity, genetic information,
marital status, national origin, race, religion, sex, or sexual
orientation.  Nothing in this subdivision shall be construed to
interfere with the clinical judgment of a physician and surgeon.

  SEC. 2.  Section 10119.6 of the Insurance Code is amended to read:
   10119.6.  (a) On and after January 1, 1990, every insurer issuing,
renewing, or amending a policy of disability insurance that covers
hospital, medical, or surgical expenses on a group basis shall offer
coverage of infertility treatment, except in vitro fertilization,
under those terms and conditions as may be agreed upon between the
group policyholder and the insurer. Every insurer shall communicate
the availability of that coverage to all group policyholders and to
all prospective group policyholders with whom they are negotiating.
   (b) For purposes of this section, "infertility" means either (1)
the presence of a demonstrated condition recognized by a licensed
physician and surgeon as a cause of infertility, or (2) the inability
to conceive a pregnancy or to carry a pregnancy to a live birth
after a year or more of regular sexual relations without
contraception. "Treatment for infertility" means procedures
consistent with established medical practices in the treatment of
infertility by licensed physicians and surgeons, including, but not
limited to, diagnosis, diagnostic tests, medication, surgery, and
gamete intrafallopian transfer. "In vitro fertilization" means the
laboratory medical procedures involving the actual in vitro
fertilization process.
   (c) This section shall not be construed to deny or restrict in any
way any existing right or benefit to coverage and treatment of
infertility under an existing law, plan, or policy.
   (d) This section shall not be construed to require any employer
that is a religious organization to offer coverage for forms of
treatment of infertility in a manner inconsistent with the religious
organization's religious and ethical principles.
   (e)  (1)    This section shall not be construed
to require any insurer, which is a subsidiary of an entity whose
owner or corporate member is a religious organization, to offer
coverage for treatment of infertility in a manner inconsistent with
that religious organization's religious and ethical principles.

    For 
    (2)    For  purposes of this
subdivision, "subsidiary" of a specified corporation means a
corporation more than 45 percent of the voting power of which is
owned directly, or indirectly through one or more subsidiaries, by
the specified corporation.
   (f) This section applies to every disability insurance policy that
is issued, amended, or renewed to residents of this state regardless
of the situs of the contract.
   (g) Coverage for the treatment of infertility shall be offered and
 , if purchased,  provided without discrimination on the
basis of age, ancestry, color, disability, domestic partner status,
gender, gender expression, gender identity, genetic information,
marital status, national origin, race, religion, sex, or sexual
orientation.  Nothing in this subdivision shall be construed to
interfere with the clinical judgment of a physician and surgeon.

  SEC. 3.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.