Health care coverage: waiting periods.

Existing law, the federal Patient Protection and Affordable Care Act (PPACA) , enacts various health care coverage market reforms that take effect with respect to plan years on or after January 1, 2014. Among other things, PPACA prohibits a group health plan and a health insurance issuer offering group health insurance coverage from applying a waiting period that exceeds 90 days. 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 health insurers by the Department of Insurance. Existing law authorizes a group health care service plan contract and a group health insurance policy, as defined, to apply a waiting period of up to 60 days as a condition of employment if applied equally to all eligible employees and dependents. This bill would prohibit those group contracts and policies from imposing any waiting or affiliation period, as defined, and would make related conforming changes. Because a willful violation of the bill's requirements by a health care service plan would be a crime, the bill would impose a state-mandated local program. Existing law provides for the regulation of grandfathered small employer health care service plan contracts and health insurance policies, as defined. Existing law requires that those contracts and policies be fairly and affirmatively renewed and prohibits construing the provisions regulating those contracts and policies from limiting enrollment in a contract or policy to open enrollment periods, as specified. Existing law requires the employer offering the plan to send a written notice to an eligible employee or dependent who fails to enroll during an open enrollment period that he or she may be excluded from coverage for a specified period of time. This bill would instead require the notice to inform the eligible employee or dependent that he or she may be excluded from eligibility for coverage until the next open enrollment period. 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 incorporate additional changes to Section 10753.05 of the Insurance Code proposed by SB 959 that would become operative if this bill and SB 959 are both enacted and this bill is enacted last.