Health care coverage.

(1) Existing law requires the Managed Risk Medical Insurance Board to, by January 20, 2004, report specified information with regard to the State Children's Health Insurance Program. Existing law also requires the board to provide, by April 15, 1998, a proposal relating to drug and alcohol treatment programs for children. This bill would delete those obsolete provisions. (2) Existing law requires the Department of Managed Health Care and the Department of Insurance to maintain a joint senior level working group to ensure clarity for health care consumers about who enforces their patient rights and consistency in the regulations of these departments. Existing law requires the working group to report its findings to the Insurance Commissioner and the Director of the Department of Managed Health Care for review and approval and, commencing January 1, 2004, requires the commissioner and the director to submit the approved report to the Legislature every year for 5 years. This bill would delete that reporting requirement. (3) Existing law requires a health care service plan and a health insurer to comply with minimum medical loss ratios and to provide an annual rebate to each enrollee or insured if the medical loss ratio of the amount of the revenue expended by the plan or insurer on costs to the total amount of premium revenue is less than a certain percentage, as specified. Existing federal law authorizes an issuer of health care coverage to provide those premium rebates to its current enrollees by a premium credit, lump-sum check, or, if the enrollee paid the premium using a credit card or debit card, by a lump-sum reimbursement to the account used to pay the premium. Existing federal law requires an issuer of health care coverage to provide the premium rebate to its former enrollees in the form of a lump-sum check or lump-sum reimbursement using the same method that the former enrollee used for payment of the premium. This bill would make these provisions of federal law applicable to a health care service plan and health insurer with respect to the method by which it provides premium rebates to current and former enrollees or insureds, as specified. The bill would require a health care service plan and health insurer to make a good faith effort to locate its former enrollees or insureds who are entitled to the rebate. (4) Existing law requires the executive board of the California Health Benefit Exchange to establish a navigator program in accordance with the federal Patient Protection and Affordable Care Act to conduct public education activities and distribute information on qualified health care plans. Existing law also creates the California Health Trust Fund, a continuously appropriated fund, within the State Treasury for purposes of the provisions establishing the exchange. This bill would create the Health Care Coverage Information, Enrollment, and Eligibility Assistance Account within the California Health Trust Fund. The bill would require a health care service plan and health insurer that is unable to locate its former enrollees or insureds who are entitled to a premium rebate to cause those rebate funds to be deposited in the account to be continuously appropriated for purposes of distributing funding for health care coverage information, enrollment, and eligibility assistance. Because this bill would cause additional moneys to be deposited into a continuously appropriated fund, the bill would make an appropriation. (5) Under existing law, a willful violation of the Knox-Keene Health Care Service Plan Act of 1975 is a crime. Because a willful violation of the bill's requirements with respect to a health care service plan would be a crime, this 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.