Health insurance: prohibition on health insurance sales: health care service plans.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975 (Knox-Keene) , 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. Under existing law, a person who transacts disability insurance without a valid and unrevoked certificate of authority from the Insurance Commissioner is generally guilty of a misdemeanor. Under existing law, a nonprofit hospital corporation regulated under Knox-Keene that substantially indemnified subscribers and enrollees and was operating in 1965 under specified provisions of the Insurance Code enjoys the privileges that would have been available had it been registered under the Knox-Mills Health Plan Act and applied for a license under Knox-Keene in 1976. This bill would repeal the latter provision. The bill would further prohibit an entity licensed under Knox-Keene from offering, marketing, or selling health insurance, whether issued on a group or individual basis, to an existing or new customer. By expanding the scope of an existing crime, the bill would impose a state-mandated local program. Under existing law, a person or other entity that provides coverage in this state for medical, surgical, chiropractic, physical therapy, speech pathology, audiology, professional mental health, dental, hospital, or optometric services, whether by direct payment, reimbursement, or otherwise, and that enters into an arrangement or contract with, or underwrites, a preferred provider organization or specified arrangement, is subject to the jurisdiction of the Department of Insurance. Under existing law, a person or entity subject to regulation under Knox-Keene is not subject to the jurisdiction of the department. This bill would delete the latter provision that excludes a person or entity subject to regulation under Knox-Keene from the jurisdiction of the department. 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.