AB 156 — Individual market: enrollment periods.

Summary

(1) Existing federal law, the Patient Protection and Affordable Care Act (PPACA) , effective June 19, 2017, requires an American Health Benefit Exchange that facilitates the purchase of qualified health plans by qualified individuals and qualified small employers to provide for the individual market an annual open enrollment period for policy years beginning on or after January 1, 2018, to begin on November 1 and extend through December 15 of the calendar year preceding the benefit year. Existing federal law establishes special enrollment periods during which a qualified individual may enroll in a qualified health plan when specified triggering events occur, such as when the qualified individual losses minimum essential coverage, as defined. Existing federal regulatory authority authorizes a state to establish additional special enrollment periods to supplement these special enrollment periods provided for under federal law under certain circumstances. Existing law establishes the California Health Benefit Exchange within state government for the purpose of facilitating the purchase of qualified health plans through the Exchange by qualified individuals and qualified small employers. 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 health care service plan and health insurer, on and after October 1, 2013, to offer, market, and sell all of the plan's or health insurer's health benefit plans that are sold in the individual market for policy years on or after January 1, 2014, to all individuals and dependents in each service area in which the plan or insurer provides or arranges for the provision of health care services, as specified, but requires plans and insurers to limit enrollment in individual health benefit plans offered both through and outside of the Exchange to specified open enrollment and special enrollment periods. Existing law requires a plan and health insurer to provide an annual enrollment period for policy years beginning on or after January 1, 2016, from November 1, of the preceding calendar year, to January 31 of the benefit year, inclusive. Existing law requires a plan and health insurer, annually on or before October 1, to issue a notice to a subscriber and policyholder, as applicable, enrolled in any individual health benefit plan offered outside of the Exchange, and requires this notice to inform the subscriber and policyholder of, among other things, the applicable open enrollment period provided through the Exchange. This bill would instead require, with respect to individual health benefit plans offered outside of the Exchange, that the annual open enrollment period for policy years beginning on or after January 1, 2019, extend from October 15 of the preceding calendar year, to January 15 of the benefit year, inclusive. The bill would instead require, with respect to individual health benefit plans offered through the Exchange, that the annual open enrollment period for policy years beginning on or after January 1, 2019, extend from November 1 to December 15 of the preceding calendar year, inclusive. The bill would require a health care service plan and a health insurer, with respect to individual health benefit plans offered through the Exchange, for policy years beginning on or after January 1, 2019, to provide a special enrollment period that will allow individuals to enroll in individual health benefit plans through the Exchange from October 15 to October 31 of the preceding calendar year, inclusive, and from December 16, of the preceding calendar year, to January 15 of the benefit year, inclusive, and would require an application for a health benefit plan submitted during this special enrollment period to be treated the same as an application submitted during the annual open enrollment period. The bill would require a plan and health insurer to also include in the annual notice described above information regarding the applicable special enrollment periods. The bill would make conforming changes. Because a willful violation of that requirement by a health care service plan would be a crime, this bill would impose a state-mandated local program. (2) The PPACA creates various premium stabilization programs, such as the transitional reinsurance program and the risk adjustment program, to stabilize premiums in the individual market inside and outside of the Exchanges. Under the transitional reinsurance program, contributions are collected from contributing entities to fund reinsurance payments to issuers of nongrandfathered reinsurance-eligible individual market plans and the administrative costs of operating the reinsurance program for the 2014, 2015, and 2016 benefit years. Existing law requires a health care service plan and health insurer to consider the claims experience of all enrollees and all insureds in all nongrandfathered individual health benefit plans offered by that plan or insurer in this state as a single risk pool for rating purposes in the individual market and to consider the claims experience of all enrollees and all insureds in all nongrandfathered small group market plans offered by that plan or insurer in this state as a single risk pool for rating purposes in the small market. Existing law requires a plan and health insurer to establish, each calendar year, an index rate for those markets in the state based on the total combined claims costs for providing essential health benefits, as defined, within the single risk pool and requires the index rate to be adjusted on a marketwide basis based on the total expected marketwide payments and charges under the risk adjustment and reinsurance programs established for the state under the federal provisions described above and the Exchange user fees. Existing law requires the premium rate for all of the individual health benefit plans and small employer health benefit plans within the single risk pool to use the applicable marketwide adjusted index rate, as specified. This bill would delete the reference to the federal transitional reinsurance program in these provisions. (3) 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.

Bill Text

• Chaptered 10/04/17 - Chaptered Current pdf October 04, 2017
• Enrolled 09/19/17 - Enrolled pdf September 19, 2017
• Amended 09/08/17 - Amended Senate pdf September 08, 2017
• Amended 08/31/17 - Amended Senate pdf August 31, 2017
• Introduced 01/12/17 - Introduced pdf January 12, 2017
• AB156 View text html

Action History

1. October 04, 2017

   Chaptered by Secretary of State - Chapter 468, Statutes of 2017.

2. October 04, 2017

   Approved by the Governor.

3. September 27, 2017

   Enrolled and presented to the Governor at 4 p.m.

4. September 16, 2017

   Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 74. Noes 0. Page 3541.).

5. September 16, 2017

   Assembly Rule 63 suspended. (Page 3535.)

6. September 16, 2017

   In Assembly. Concurrence in Senate amendments pending.

7. September 15, 2017

   Read third time. Passed. Ordered to the Assembly. (Ayes 38. Noes 0. Page 3001.).

8. September 15, 2017

   Ordered to third reading.

9. September 15, 2017

   Pursuant to Senate Rule 28.8

10. September 11, 2017

    Re-referred to Com. on APPR. pursuant to Joint Rule 10.5.

11. September 11, 2017

    Read second time. Ordered to third reading.

12. September 08, 2017

    Read third time and amended. Ordered to second reading.

13. September 05, 2017

    From committee: That the measure be returned to Senate Floor for consideration. (Ayes 9. Noes 0.) (September 5)

14. September 01, 2017

    From committee: Be re-referred to Com. on HEALTH pursuant to Senate Rule 29.10(b). (Ayes 5. Noes 0.) Re-referred to Com. on HEALTH.

15. September 01, 2017

    Re-referred to Com. on RLS. pursuant to Senate Rule 29.10(b).

16. September 01, 2017

    Read second time. Ordered to third reading.

17. August 31, 2017

    Read third time and amended. Ordered to second reading.

18. July 20, 2017

    Read second time. Ordered to third reading.

19. July 19, 2017

    From committee: Do pass. (Ayes 8. Noes 0.) (July 19).

20. May 18, 2017

    Referred to Com. on HEALTH.

21. May 04, 2017

    In Senate. Read first time. To Com. on RLS. for assignment.

22. May 04, 2017

    Read third time. Passed. Ordered to the Senate. (Ayes 76. Noes 0. Page 1387.)

23. April 27, 2017

    Read second time. Ordered to Consent Calendar.

24. April 26, 2017

    From committee: Do pass. To Consent Calendar. (Ayes 15. Noes 0.) (April 25).

25. January 30, 2017

    Referred to Com. on HEALTH.

26. January 13, 2017

    From printer. May be heard in committee February 12.

27. January 12, 2017

    Read first time. To print.

Sponsors

• Wood · Primary

Votes

Subjects