Medicare supplement coverage.

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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires plans and insurers that issue Medicare supplement contracts or policies, as defined, to comply with specified requirements. Existing law requires issuers to make available to specified individuals who are 64 years of age or younger and who do not have end-stage renal disease, Medicare supplement benefit plans A, B, C, and F, and Medicare supplement benefit plan H, I, or J, or Medicare supplement benefit plan K or L, as specified. Existing federal law prohibits the issuance of new Medicare supplement plans H, I, and J, and instead authorizes the issuance of Medicare supplement plans M and N, as specified. This bill would delete from those provisions obsolete references to plans H, I, and J, and instead require the issuer to make available Medicare supplement benefit plans A, B, C, and F, and Medicare supplement benefit plan K or L, or Medicare supplement benefit plan M or N, as specified. Existing law prohibits an issuer from denying Medicare supplement coverage to an eligible individual who is guaranteed issue under specified circumstances. Existing law requires certain eligible individuals to be guaranteed issue of Medicare supplement plan A, B, C, F (including a high deductible plan F) , K, or L. This bill would add to that guaranteed issue requirement Medicare supplement plans M and N. Existing law provides that an individual enrolled in a Medicare Advantage plan (Medicare Part C) that reduces any of its benefits, or increases cost sharing, or terminates certain relationships with providers, is eligible for Medicare supplement coverage that is issued by the same issuer of his or her Medicare Advantage plan or by a subsidiary of, or a network that contracts with, the parent company of that issuer. This bill would extend that eligibility to an individual enrolled in a Medicare Advantage plan that increases its premium. The bill would provide that an individual enrolled in a Medicare Advantage plan is eligible for specified Medicare supplement coverage from any issuer under the circumstances described above if the issuer of his or her Medicare Advantage plan, or the subsidiary or network of the parent company, does not offer any other Medicare supplement coverage and only offers a Medicare Advantage plan or plans, and other specified conditions are met. 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.