Limitations on cost sharing: family coverage.

Existing federal law, the Patient Protection and Affordable Care Act (PPACA) , enacts various health care coverage market reforms that take effect January 1, 2014. Among other things, PPACA establishes annual limits on specified forms of cost sharing, including deductibles, on all essential health benefits for nongrandfathered individual and group health insurance 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 also provides for the regulation of health insurers by the Department of Insurance. Existing law requires a plan contract or policy and, commencing January 1, 2017, for a large group market health plan contract or policy, for family coverage that includes a deductible and is a high deductible health plan, as defined in federal law, to include a deductible for each individual covered by the plan contract or policy that is equal to either the amount set forth in a specified provision of federal law or the deductible for individual coverage under the plan contract or policy, whichever is greater. This bill would instead prohibit a large group market health plan contract or policy for family coverage that is a high deductible health plan, as defined in federal law, and that includes a deductible for individual coverage from subjecting an individual covered by the plan contract or policy to a deductible that is greater than the deductible for individual coverage under the plan contract or policy if the deductible for individual coverage is greater than or equal to the amount set forth in the provision of federal law described above. Because a willful violation of this prohibition by 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.