Bill Text: CA SB155 | 2011-2012 | Regular Session | Amended

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

---

Bill Title: Maternity services.

Spectrum: Partisan Bill (Democrat 7-0)

Status: (Engrossed - Dead) 2011-08-25 - Hearing postponed by committee. [SB155 Detail]

Download: California-2011-SB155-Amended.html

---

BILL NUMBER: SB 155	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MAY 4, 2011

INTRODUCED BY   Senator Evans

                        FEBRUARY 2, 2011

   An act to add Section 10123.865 to the Insurance Code, relating to
health care coverage.


	LEGISLATIVE COUNSEL'S DIGEST


   SB 155, as amended, Evans. Maternity services.
   Existing law provides for the regulation of health insurers by the
Department of Insurance. Under existing law, a health insurer that
provides maternity coverage may not restrict inpatient hospital
benefits, as specified, and is required to provide notice of the
maternity services coverage.
   This bill would require new forms for health insurance policies
submitted to the department after January 1, 2012, to provide
coverage for maternity services, as defined. With respect to policy
forms on file with the department as of January 1, 2012, the bill
would require health insurers to submit to the department, on or
before March 1, 2012, revised policy forms that provide coverage for
maternity services and would require insurers to include that
coverage in the corresponding policies that are issued, amended, or
renewed following the department's approval of the revised forms, as
specified.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


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

  SECTION 1.  The Legislature finds and declares the following:
   (a) In actual practice, health care service plans have been
required by the Knox-Keene Health Care Service Plan Act of 1975
(Chapter 2.2 (commencing with Section 1340) of Division 2 of the
Health and Safety Code) to provide maternity services as a basic
health care benefit.
   (b) At the same time, existing law does not require health
insurers to provide designated basic health care services and,
therefore, health insurers are not required to provide coverage for
maternity services.
   (c) Therefore, it is essential to clarify that all health care
coverage made available to California consumers, whether issued by
health care service plans regulated by the Department of Managed
Health Care or by health insurers regulated by the Department of
Insurance, must include maternity services.
  SEC. 2.  Section 10123.865 is added to the Insurance Code, to read:

   10123.865.  (a) With respect to a pending or approved individual
or group health insurance policy form on file with the department as
of January 1, 2012, a health insurer shall submit to the department,
on or before March 1, 2012, a revised policy form that provides
coverage for maternity services. The corresponding policy issued,
amended, or renewed on or after 30 days following the department's
approval of the revised form shall include coverage for maternity
services.
   (b) New forms for individual or group policies of health insurance
submitted to the department after January 1, 2012, shall provide
coverage for maternity services.
   (c) For purposes of this section, "maternity services" include
prenatal care, ambulatory care maternity services, involuntary
complications of pregnancy, neonatal care, and inpatient hospital
maternity care, including labor and delivery and postpartum care.
 This definition of "m   aternity services" shall remain
in effect until such time as federal regulations and guidance issued
pursuant to the federal Patient Protection and Affordable Care Act
(Public Law 111-148) define the scope of benefits to be provided
under the maternity benefit requirement of that act, after which time
the definition of that term under the federal act and associated
regulations and guidance shall apply for purposes of this section.

   (d) This section shall not apply to specialized health insurance,
Medicare supplement insurance, short-term limited duration health
insurance, CHAMPUS-supplement insurance, or TRI-CARE supplement
insurance, or to hospital indemnity, accident-only, or specified
disease insurance.