Health care coverage: continuity of care.

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 Insurance Commissioner. This bill would require a health care service plan or a health insurer, for a health care service plan contract or a health insurance policy that is issued, renewed, or amended on or after January 1, 2017, to notify enrollees or insureds in annual renewal materials that a prescription drug is no longer covered by the plan or policy or has changed tiers in the plan's or insurer's drug formulary, if that is the case. The bill would exempt a specialized health care service plan that covers dental or vision services from that requirement. The bill would also require a health care service plan or health insurer, for a health care service plan contract or a health insurance policy that is issued, renewed, or amended on or after January 1, 2017, to include in annual renewal materials information regarding the plan's provider directory or directories. Because a willful violation of that 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.