Triggering event: loss of minimum essential coverage.

Plain English Breakdown

The bill summary text and digest do not mention updates to the annual notice for behavioral health and wellness screenings, only that it makes a technical change.

Triggering Event: Loss of Minimum Essential Coverage

AB-2165 requires health care service plans and insurers to notify individuals about potential loss of essential coverage due to the termination of joint agreements in medically underserved areas.

What This Bill Does

• Defines losing minimum essential coverage as including when a joint agreement between health care providers in medically underserved areas ends.
• Requires health care service plans or insurers to give written or electronic notices at least 60 days before such agreements end, warning about potential loss of coverage.

Who It Names or Affects

• Health care service plans
• Health insurers
• People in medically underserved areas who may lose their health coverage due to joint agreements ending

Terms To Know

Minimum essential coverage

The basic level of health insurance that meets federal requirements.

Medically underserved area

A region where the demand for medical and dental care exceeds available local resources.

Limits and Unknowns

• Does not specify what happens if a provider fails to give the required notice.
• The bill's impact on people outside medically underserved areas is unclear.

Official Summary Text

AB 2165, as amended, Macedo.
Behavioral health and wellness screenings.
Triggering event: loss of minimum essential coverage.
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 or health insurer to allow an individual to enroll in or change their health benefit plan as a result of a specified triggering event, including when the individual or the individual’s dependent loses minimum essential coverage, as provided.
This bill, for purposes of the above, would specify that loss of minimum essential coverage includes loss of coverage due to circumstances in which a joint
agreement between health care service plans or health insurers, or between a health care service plan and a health insurer, to provide coverage to an enrollee or insured located in a medically underserved area expires, dissolves, or is otherwise terminated. The bill would require a health care service plan or health insurer to provide a written or electronic notice to enrollees or insureds at least 60 days before the effective date of the expiration, dissolution, or other termination of that joint agreement and would require the notice to additionally indicate that the expiration, dissolution, or other termination of the joint agreement may constitute a loss of minimum essential coverage. 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.
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. Existing law requires a health care service plan to annually provide to enrollees a written or electronic notice regarding the benefits of a behavioral health and wellness screening for children and adolescents 8 to 18 years of age.
This bill would make a technical, nonsubstantive change to that provision.

Current Bill Text

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