Health care coverage: essential health benefits.
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Majority
Fiscal committee
No
Appropriation
No
Current location
Chaptered
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Overview
This bill aims to update California’s essential health benefits benchmark plan, which is used as a standard for health insurance policies. It directs the state to review the current benchmark plan and establish a new one for 2027. Starting in 2027, if federal guidelines approve a new benchmark plan, the state’s health insurance policies would need to include additional benefits, specifically covering fertility services and certain durable medical equipment. The bill also clarifies the requirements for coverage of these benefits and outlines the process for establishing a new benchmark plan.
Key provisions
- Directs the Department of Insurance to review and establish a new essential health benefits benchmark plan for 2027.
- Requires a new benchmark plan to include coverage for specified fertility services (e.g., artificial insemination, embryo storage).
- Requires a new benchmark plan to include coverage for specified durable medical equipment (e.g., mobility devices, communication devices).
- Mandates that if a federal benchmark plan is approved, the state’s policies must include those additional benefits.
- Specifies coverage for pediatric vision and oral care, aligning with the federal Employees Health Benefits Program.
- Clarifies the definition of ‘essential health benefits’ and references relevant federal laws.
- Establishes a process for the Commissioner of Insurance to issue guidance and regulations regarding compliance.
- Addresses grandfathered plans and exemptions related to pre-2011 mandates.
Bill text
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