Health care coverage: catastrophic plans.

Existing law, the federal Patient Protection and Affordable Care Act (PPACA) , enacts various health care coverage market reforms that take effect January 1, 2014. Among other things, PPACA requires applicable individuals to maintain minimum essential coverage and requires health insurance issuers that offer coverage in the individual or small group market to ensure that the coverage includes the essential health benefits package, which is defined to mean coverage that, among other things, provides the bronze, silver, gold, and platinum level of coverage, as specified. PPACA exempts from this requirement a catastrophic plan that meets specified requirements and is sold only to an individual under 30 years of age or an individual who is exempt from the PPACA requirement to obtain minimum coverage because he or she cannot afford coverage or has suffered a hardship, as specified. 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 defines bronze, silver, gold, and platinum levels of coverage for the nongrandfathered individual market consistent with the definitions in PPACA and authorizes a catastrophic plan to be offered in the individual market only if the individual purchasing the plan is under 30 years of age or the individual has a certificate of exemption pursuant to PPACA because the individual is not offered affordable coverage or because the individual faces hardship. The bill would, to the extent permitted by PPACA, require that an individual be deemed to face hardship for purposes of this provision if his or her coverage was withdrawn from the market between December 1, 2013, and March 31, 2014, as specified. Because a willful violation of this requirement by a health care service plan 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. This bill would declare that it is to take effect immediately as an urgency statute.