Health care coverage cost sharing.

The bill now applies only to 'large group health care service plan contracts' and 'large group health insurance policies' instead of all health care service plan contracts and disability health insurance policies. This is a major narrowing that excludes small group plans, individual plans, and self-funded arrangements from the cost-sharing prohibition.

In the Insurance Code section (Section 2), 'disability health insurance policy' was replaced with 'large group health insurance policy.' This both broadens coverage beyond just disability policies to all large group health insurance, while simultaneously narrowing it by adding the large group requirement.

The effective date for contracts issued, amended, or renewed changed from January 1, 2026 to January 1, 2027, giving insurers an additional year before the cost-sharing prohibition takes effect.

The billing prohibition in both sections now explicitly identifies who cannot be billed: 'an enrollee or contractholder of a large group health care service plan contract' and 'an insured or policyholder of a large group health insurance policy,' adding clarity to the prior less specific language.

The prohibition on deductibles, coinsurance, copayments, and other cost-sharing for enrollees/insureds under 21 now applies only to 'in-network health care services' instead of all services. This is the most significant change in the amendment.

A new subdivision (e) clarifies that the bill does not expand the scope of required coverage for out-of-network emergency services, except that cost-sharing for covered out-of-network emergency services still cannot be imposed on enrollees/insureds under 21.

A new definition of 'in-network health care services' is added (subdivision (d) in both sections), covering: (1) services by a contracting provider, (2) services from a contracting facility where a noncontracting provider treats the patient, (3) covered emergency services, and (4) services by a noncontracting provider when no contracting provider is available per timely access requirements.

The term 'disability insurance policy' is changed to 'disability health insurance policy' throughout the bill, narrowing the type of policies covered.