Health care coverage: essential health benefits.

The legislative intent statement and digest now specify that the new benchmark plan for the 2027 plan year applies 'for health insurers,' narrowing the scope of the transition to regulated insurance policies rather than all plans.

The phrase 'For plan years on or before the 2027 plan year' was removed from both Health and Safety Code Section 1367.005(a)(2)(A) and Insurance Code Section 10112.27(a)(2)(A). This removes the explicit time limit that had restricted the Kaiser Foundation HMO 30 benchmark to pre-2027 plan years, meaning the Kaiser benchmark continues as the baseline without a stated expiration.

New Insurance Code Section 10112.27(n) gives the Insurance Commissioner authority to issue compliance guidance to health insurers by January 1, 2027 (not subject to the Administrative Procedure Act), promulgate regulations under the APA to implement the section, and requires consultation with the Department of Managed Health Care in both activities.

The state-mandated local program determination was changed from 'no' to 'yes,' meaning the bill now triggers reimbursement obligations for costs imposed on local agencies and school districts under Article XIII B of the California Constitution.

Starting January 1, 2027 (if HHS approves a new benchmark plan), individual and small group health plans must cover infertility services including artificial insemination, three attempts to retrieve gametes, three attempts to create embryos, three rounds of pretransfer testing, cryopreservation of gametes and embryos, two years of embryo storage, unlimited gamete storage, unlimited embryo transfers, two vials of donor sperm, ten donor eggs, surrogacy coverage, and surrogate health testing.

Starting January 1, 2027 (if HHS approves a new benchmark plan), plans must cover specified durable medical equipment: mobility devices (walkers, manual and power wheelchairs, scooters), augmented communication devices (speech-generating devices, communication boards, computer applications), CPAP machines, portable oxygen, and hospital beds.

Starting January 1, 2027 (if HHS approves a new benchmark plan), plans must cover an annual hearing exam and one hearing aid per ear every three years.

The state-mandated local program designation changed from 'no' to 'yes' because a violation of the essential health benefits requirements by a health care service plan is a crime. The bill provides that no reimbursement is required for this mandate.

All new benefit requirements are conditional on HHS approval of a new essential health benefits benchmark plan for California based on submissions made in 2025, with an effective date of January 1, 2027. The current Kaiser Foundation Health Plan Small Group HMO 30 benchmark applies only to plan years on or before 2027.

All amendments to Section 1367.005 of the Health and Safety Code were removed. Health care service plans (HMOs, PPOs, etc.) regulated by the Department of Managed Health Care are no longer subject to this bill's requirements for expanded essential health benefits.

The bill's title was changed from amending both the Health and Safety Code and the Insurance Code to amending only Section 10112.27 of the Insurance Code, limiting applicability to health insurers.

The state-mandated local program designation and related reimbursement language were removed from the legislative digest, consistent with the removal of the DMHC-regulated plan provisions.

The bill transitioned from its enrolled format (with passage dates, clerk signature lines, and 'Assembly Bill No. 224' header) to the official chaptered format with 'STATE OF CALIFORNIA AUTHENTICATED ELECTRONIC LEGAL MATERIAL' header, Chapter 680 designation, and Governor approval date of October 13, 2025.

Page numbering changed from page 96 to page 95, and running headers/footers changed from 'AB 224' to 'Ch. 680' throughout the document.