AB 1876

AB1876:v99#DOCUMENT

Bill Start

CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION

Assembly Bill

No. 1876

An act to add Section 1367.0435 to the Health and Safety Code, and to add Section 10133.135 to the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL'S DIGEST

AB 1876, as introduced, Addis. Health care coverage: nondiscrimination.

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’s requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers, as specified, within 6 months after the relevant department issues specified guidance, or no later than March 1, 2025, to require all of their staff who are in direct contact with enrollees or insureds in the delivery of care or enrollee or insured services to complete evidence-based cultural competency training for the purpose of providing trans-inclusive health care for individuals who identify as transgender, gender diverse, or intersex.

This bill would prohibit a subscriber, enrollee, policyholder, or insured from being excluded from enrollment or participation in, being denied the benefits of, or being subjected to discrimination by, any health care service plan or health insurer licensed in this state, on the basis of race, color, national origin, age, disability, or sex. The bill would define discrimination on the basis of sex for those purposes to include, among other things, sex characteristics, including intersex traits, pregnancy, and gender identity. The bill would prohibit a health care service plan or health insurer from taking specified actions relating to providing access to health programs and activities, including, but not limited to, denying or limiting health care services to an individual based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded. The bill would prohibit a health care service plan or health insurer, in specified circumstances, from taking various actions, including, but not limited to, denying, canceling, limiting, or refusing to issue or renew health care service plan enrollment, health insurance coverage, or other health-related coverage, or denying or limiting coverage of a claim, or imposing additional cost sharing or other limitations or restrictions on coverage, on the basis of race, color, national origin, sex, age, disability, as specified. Because a violation of the bill’s requirements by a health care service plan 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.

Digest Key

Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES

Bill Text

The people of the State of California do enact as follows:

SECTION 1.

Section 1367.0435 is added to the Health and Safety Code, to read:

1367.0435.

(a) A subscriber or enrollee shall not be excluded from enrollment or participation in, be denied the benefits of, or be subjected to discrimination by, any health care service plan licensed in this state on the basis of race, color, national origin, age, disability, or sex.

(b) (1) For purposes of this section, discrimination on the basis of sex includes, but is not limited to, discrimination on the basis of any of the following:

(A) Sex characteristics, including intersex traits.

(B) Pregnancy or related conditions.

(C) Sexual orientation.

(D) Gender identity.

(E) Sex stereotypes.

(2) In providing access to health programs and activities, including arranging for the provision of health care services, a health care service plan shall not do any of the following:

(A) Deny or limit health care services, including those that have been typically or exclusively provided to, or associated with, individuals of one sex, to an individual based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded.

(B) Deny or limit, on the basis of an individual’s sex assigned at birth, gender identity, or gender otherwise recorded, a health care professional’s ability to provide health care services if the denial or limitation has the effect of excluding individuals from participation in, denying them the benefits of, or otherwise subjecting them to discrimination on the basis of sex under a covered health care service plan.

(C) Adopt or apply any policy or practice of treating individuals differently or separating them on the basis of sex in a manner that subjects any individual to more than de minimis harm, including by adopting a policy or engaging in a practice that prevents an individual from participating in a health care service plan consistent with the individual’s gender identity.

(D) Deny or limit health care services sought for purpose of gender transition or other gender-affirming care that the health care service plan would otherwise cover if that denial or limitation is based on an individual’s sex assigned at birth, gender identity, or gender otherwise recorded.

(3) A health care service plan, in providing or arranging for the provision of health care services or other health-related coverage, shall not do any of the following:

(A) Deny, cancel, limit, or refuse to issue or renew health care service plan enrollment or other health-related coverage, or deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, on the basis of race, color, national origin, sex, age, disability, or any combination thereof.

(B) Have or implement marketing practices or benefit designs that discriminate on the basis of race, color, national origin, sex, age, disability, or any combination thereof, in health care service plan coverage or other health-related coverage.

(C) Deny or limit coverage, deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, to an individual based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded.

(D) Have or implement a categorical coverage exclusion or limitation for all health care services related to gender transition or other gender-affirming care.

(E) Otherwise deny or limit coverage, deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, for specific health care services related to gender transition or other gender-affirming care if such denial, limitation, or restriction results in discrimination on the basis of sex.

(F) Have or implement benefit designs that do not provide or administer health care service plan coverage or other health-related coverage in the most integrated setting appropriate to the needs of qualified individuals with disabilities, including practices that result in the serious risk of institutionalization or segregation.

(c) This section does not require access to, or coverage of, a health care service for which the health care service plan has a legitimate, nondiscriminatory reason for denying or limiting access to, or coverage of, the health care service or determining that the health care service is not clinically appropriate for a particular individual, or fails to meet applicable coverage requirements, including reasonable medical management techniques, such as medical necessity requirements. A health care service plan’s determination under this subdivision shall not be based on unlawful animus or bias, or constitute a pretext for discrimination.

(d) This section does not prohibit a health care service plan from imposing an open enrollment period for coverage.

(e) A health care service plan’s evidences of coverage, disclosure form, and combined evidence of coverage and disclosure form shall include all of the following information in a notice to enrollees regarding the coverage requirements pursuant to subdivision (a):

(1) A statement that the health care service plan does not discriminate on the basis of a characteristic protected under applicable state law, including this section.

(2) How to file a grievance regarding discrimination pursuant to Section 1368.

(3) The health care service plan’s internet website where an enrollee may file a grievance, if available.

(4) The health care service plan’s telephone number that an enrollee may use to file a grievance regarding discrimination.

(f) This section does not limit the director’s authority, a health care service plan’s duties, or enrollees’ rights pursuant to this chapter.

(g) The rights, remedies, and penalties established by this section are cumulative and do not supersede the rights, remedies, or penalties established under other laws, including Article 9.5 (commencing with Section 11135) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code and Section 51 of the Civil Code, and any implementing regulations.

SEC. 2.

Section 10133.135 is added to the Insurance Code, to read:

10133.135.

(a) A policyholder or insured shall not be excluded from enrollment or participation in, be denied the benefits of, or be subjected to discrimination by, any health insurer licensed in this state on the basis of race, color, national origin, age, disability, or sex.

(b) (1) For purposes of this section, discrimination on the basis of sex includes, but is not limited to, discrimination on the basis of any of the following:

(A) Sex characteristics, including intersex traits.

(B) Pregnancy or related conditions.

(C) Sexual orientation.

(D) Gender identity.

(E) Sex stereotypes.

(2) In providing access to health programs and activities, a health insurer shall not do any of the following:

(A) Deny or limit health care services, including those that have been typically or exclusively provided to, or associated with, individuals of one sex, to an individual based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded.

(B) Deny or limit, on the basis of an individual’s sex assigned at birth, gender identity, or gender otherwise recorded, a health care professional’s ability to provide health care services if the denial or limitation has the effect of excluding individuals from participation in, denying them the benefits of, or otherwise subjecting them to discrimination on the basis of sex under a covered health insurance policy.

(C) Adopt or apply any policy or practice of treating individuals differently or separating them on the basis of sex in a manner that subjects any individual to more than de minimis harm, including by adopting a policy or engaging in a practice that prevents an individual from participating in a health insurance policy or activity consistent with the individual’s gender identity.

(D) Deny or limit health care services sought for purpose of gender transition or other gender-affirming care that the health insurance policy would otherwise cover if that denial or limitation is based on an individual’s sex assigned at birth, gender identity, or gender otherwise recorded.

(3) A health insurer, in providing or administering health insurance coverage or other health-related coverage, shall not do any of the following:

(A) Deny, cancel, limit, or refuse to issue or renew health insurance coverage or other health-related coverage, or deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, on the basis of race, color, national origin, sex, age, disability, or any combination thereof.

(B) Have or implement marketing practices or benefit designs that discriminate on the basis of race, color, national origin, sex, age, disability, or any combination thereof, in health insurance coverage or other health-related coverage.

(C) Deny or limit coverage, deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, to an individual based upon the individual’s sex assigned at birth, gender identity, or gender otherwise recorded.

(D) Have or implement a categorical coverage exclusion or limitation for all health care services related to gender transition or other gender-affirming care.

(E) Otherwise deny or limit coverage, deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, for specific health care services related to gender transition or other gender-affirming care if such denial, limitation, or restriction results in discrimination on the basis of sex.

(F) Have or implement benefit designs that do not provide or administer health insurance coverage or other health-related coverage in the most integrated setting appropriate to the needs of qualified individuals with disabilities, including practices that result in the serious risk of institutionalization or segregation.

(c) This section does not require access to, or coverage of, a health care service for which the health insurer has a legitimate, nondiscriminatory reason for denying or limiting access to, or coverage of, the health care service or determining that the health care service is not clinically appropriate for a particular individual, or fails to meet applicable coverage requirements, including reasonable medical management techniques, such as medical necessity requirements. A health insurer’s determination under this subdivision shall not be based on unlawful animus or bias, or constitute a pretext for discrimination.

(d) This section does not prohibit a health insurer from imposing an open enrollment period for coverage.

(e) A health insurer’s evidences of coverage, disclosure form, and combined evidence of coverage and disclosure form shall include all of the following information in a notice to insureds regarding the coverage requirements pursuant to subdivision (a):

(1) A statement that the health insurer does not discriminate on the basis of a characteristic protected under applicable state law, including this section.

(2) How to file a grievance regarding discrimination.

(3) The health insurer’s internet website where an insured may file a grievance, if available.

(4) The health insurer’s telephone number that an insured may use to file a grievance regarding discrimination.

(f) This section does not limit the commissioner’s authority, a health insurer’s duties, or insureds’ rights pursuant to this division.

(g) The rights, remedies, and penalties established by this section are cumulative and do not supersede the rights, remedies, or penalties established under other laws, including Article 9.5 (commencing with Section 11135) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code and Section 51 of the Civil Code, and any implementing regulations.

SEC. 3.

No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.

___________________

REVISIONS: Heading—Line 2.

___________________