AB 1907: California Health Benefit Exchange.

Existing law creates the California Health Benefit Exchange (Exchange), also known as Covered California, to facilitate the enrollment of qualified individuals and qualified small employers in qualified health plans as required under the federal Patient Protection and Affordable Care Act. Existing law requires the Exchange to enroll an individual in the lowest cost silver plan or another plan, as specified, upon receiving the individual’s electronic account from an insurance affordability program. Existing law requires enrollment to occur before coverage through the insurance affordability program is terminated and prohibits the premium due date from being sooner than the last day of the first month of enrollment.

This bill would, commencing July 1, 2027, additionally authorize the Exchange to enroll an individual in the plan in which other members of the individual’s household are enrolled, as specified, or the lowest cost plan available to an Indian who is eligible for specified reduced cost sharing, as determined by the Exchange, and would require the Exchange to enroll an individual in any of the plans described above upon receipt of a complete application for an insurance affordability program submitted through the Statewide Automated Welfare System. The bill would require the Exchange to enroll the individual either before coverage through the insurance affordability program is terminated as described above or upon the receipt of a complete application for an insurance affordability program through the Statewide Automated Welfare System as described above.

Existing law requires the Exchange to provide an individual who is enrolled in a plan described above with a notice that includes specified information, including a statement that services received during the first month of enrollment will only be covered by the plan if the premium is paid by the due date.

This bill would require the Exchange to provide the notice described above prior to the individual’s effective date of coverage, and to provide, instead of the statement described above, instructions on how to effectuate coverage in the selected plan, including by paying the premium on or before the due date, or, if there is no premium due, instructions on how to opt into the selected plan.

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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer to provide an annual enrollment period for individual health benefit plans offered through the Exchange from November 1 of the preceding calendar year to January 31 of the benefit year, inclusive. Existing law specifies that the effective date of coverage for individual health benefit plans offered outside and through the Exchange be no later than January 1 of the benefit year for plan selection made from November 1 to December 31 of the preceding calendar year, inclusive, and be no later than February 1 of the benefit year for plan selection made from January 1 to January 31 of the benefit year, inclusive.

This bill would require a health care service plan or health insurer to provide the annual enrollment period and effective dates of coverage described above, except to the extent that those provisions are inconsistent with federal law, as specified. If inconsistent, the bill would require the plan or insurer to provide the annual enrollment period and effective dates of coverage required by federal law. Because a willful violation of these provisions 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.