Health care coverage: disclosures.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and 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 also provides for the regulation of disability insurers by the Department of Insurance. Existing law requires health care service plans and disability insurers, and their employees or agents, when presenting a plan contract or policy for examination or sale to an individual purchaser or to the representative of a group consisting of 25 or fewer individuals, to make a written disclosure of the ratio of premium costs to health services paid, in the case of health care service plans, or of incurred claims to earned premiums, in the case of disability insurers, for the preceding year, as specified. This bill would instead require that this disclosure be made when presenting a plan contract or policy for examination or sale to an individual purchaser or to the representative of a group consisting of 50 or fewer individuals. The bill would make other technical, nonsubstantive changes. Because a willful violation of the bill's requirements with respect to health care service plans 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.