Health insurance: dental services: reporting and disclosures.

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. The federal Patient Protection and Affordable Care Act requires a health insurance issuer issuing health insurance coverage to comply with minimum medical loss ratios and to provide an annual rebate to each insured if the medical loss ratio of the amount of the revenue expended by the issuer on costs to the total amount of premium revenue is less than a certain percentage, as specified. Existing law requires a health care service plan or health insurer to provide certain disclosures of the benefits, services, and terms of a contract or policy. This bill would require a health care service plan or a health insurer that issues, sells, renews, or offers a health care service plan contract or insurance policy that covers dental services in California, in addition to any other applicable disclosure requirements, to utilize a uniform benefits and coverage disclosure matrix, with specified contents. The bill would require the Department of Managed Health Care and the Department of Insurance to develop the uniform benefits and disclosure matrix in consultation with stakeholders. The bill would require the Department of Managed Health Care and the Department of Insurance to implement the bill's provisions relating to the benefits and coverage disclosure matrix through emergency regulations, as specified. The benefits and coverage disclosure matrix requirements would take effect for plan or policy years on and after January 1, 2021, or 12 months after adoption of the emergency regulations, whichever occurs later. Existing law requires a health care service plan or health insurer that issues, sells, renews, or offers a specialized health care service plan contract or health insurance policy covering dental services, no later than September 30, 2015, and each year thereafter, to file a report known as the Medical Loss Ratio (MLR) annual report, with the Department of Managed Health Care or the Department of Insurance, respectively, that is organized by market and product type. This bill would require the MLR annual report to be filed with the Department of Managed Health Care or the Department of Insurance by July 31 of each year. The bill would require the respective department to post a health care service plan's or health insurer's MLR annual report on its Internet Web site within 45 days after receiving the report. The bill would authorize the respective departments to issue guidance to specialized health care service plans and health insurers regarding compliance with these provisions until regulations are adopted. Because a willful violation of these requirements with respect to health care service plans 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.