Preexisting conditions.

Existing law provides for licensing and regulation of health care service plans by the Department of Managed Health Care. Existing law provides for the regulation of health insurers by the Insurance Commissioner. Existing law authorizes a health care service plan or health insurer to exclude an applicant from coverage for a specified time for preexisting conditions. A willful violation of provisions governing health care service plans is a crime. This bill would prohibit an individual health care service plan contract or health insurance policy from denying coverage to, or excluding coverage for, an enrollee or insured due to a preexisting condition provision or otherwise, as specified, due to a mental or physical condition that is not life threatening nor chronic or severe, that is not considered to be a present condition at the time of enrollment, and for which the enrollee or insured has not received treatment for the past 12 months. By imposing a new requirement on health care service plans, the willful violation of which would be a crime, the bill would impose a state-mandated local program. 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.