Health care coverage: essential health benefits.

Healthcare

Enacted

This bill passed the Legislature and reached final enactment based on the latest official action.

Sponsor: Bonta
Last action: 2025-10-13
Official status: Chaptered by Secretary of State - Chapter 680, Statutes of 2025.
Effective date: Not listed

Plain English Breakdown

The bill expresses intent rather than mandates specific actions.

Health Care Coverage: Essential Health Benefits

This law expresses the intent of the Legislature to review California's existing essential health benefits benchmark plan and establish a new one for 2027, which must include additional benefits like fertility services and durable medical equipment if approved by federal authorities.

What This Bill Does

Expresses the intent of the Legislature to review California’s existing essential health benefits benchmark plan.
Establishes a new benchmark plan for health insurers starting in 2027, contingent on approval from the United States Department of Health and Human Services.
Adds certain benefits, such as fertility services and specific durable medical equipment, if approved by federal authorities.

Who It Names or Affects

Health insurers in California
People with individual or small group health insurance policies

Terms To Know

Essential Health Benefits: A set of health care services that must be covered by most health plans under federal law.
Benchmark Plan: The specific plan used as a reference to determine the essential health benefits for other insurance policies.

Limits and Unknowns

The new benchmark plan will only take effect if approved by the United States Department of Health and Human Services.
It is not clear what additional benefits will be included beyond fertility services and durable medical equipment.

Bill History

2025-10-13 California Legislative Information
Chaptered by Secretary of State - Chapter 680, Statutes of 2025.
2025-10-13 California Legislative Information
Approved by the Governor.
2025-09-15 California Legislative Information
Enrolled and presented to the Governor at 4:30 p.m.
2025-09-08 California Legislative Information
Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 71. Noes 0. Page 3013.).
2025-09-03 California Legislative Information
In Assembly. Concurrence in Senate amendments pending.
2025-09-03 California Legislative Information
Read third time. Passed. Ordered to the Assembly. (Ayes 40. Noes 0. Page 2464.).
2025-08-29 California Legislative Information
Read second time. Ordered to third reading.
2025-08-29 California Legislative Information
From committee: Do pass. (Ayes 7. Noes 0.) (August 29).
2025-08-18 California Legislative Information
In committee: Referred to suspense file.
2025-07-17 California Legislative Information
From committee: Do pass and re-refer to Com. on APPR. (Ayes 10. Noes 0.) (July 16). Re-referred to Com. on APPR.
2025-07-08 California Legislative Information
From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH.
2025-06-11 California Legislative Information
Referred to Com. on HEALTH.
2025-05-29 California Legislative Information
In Senate. Read first time. To Com. on RLS. for assignment.
2025-05-29 California Legislative Information
Read third time. Passed. Ordered to the Senate. (Ayes 60. Noes 1. Page 1782.)
2025-05-27 California Legislative Information
Read second time. Ordered to third reading.
2025-05-23 California Legislative Information
From committee: Do pass. (Ayes 11. Noes 0.) (May 23).
2025-05-14 California Legislative Information
In committee: Set, first hearing. Referred to suspense file.
2025-04-30 California Legislative Information
From committee: Do pass and re-refer to Com. on APPR. (Ayes 14. Noes 0.) (April 29). Re-referred to Com. on APPR.
2025-04-24 California Legislative Information
Re-referred to Com. on HEALTH.
2025-04-23 California Legislative Information
From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended.
2025-02-03 California Legislative Information
Referred to Com. on HEALTH.
2025-01-10 California Legislative Information
From printer. May be heard in committee February 9.
2025-01-09 California Legislative Information
Read first time. To print.

Official Summary Text

AB 224, Bonta.
Health care coverage: essential health benefits.
Existing law requires the Department of Insurance to regulate health insurers. Existing law requires an individual or small group health insurance policy issued, amended, or renewed on or after January
1, 2017, to include, at a minimum, coverage for essential health benefits pursuant to the federal Patient Protection and Affordable Care Act. Existing law requires a
health insurance policy to cover the same health benefits that the benchmark plan, the Kaiser Foundation Health Plan Small Group HMO 30 plan, offered during the first quarter of 2014, as specified.
This bill would express the intent of the Legislature to review California’s essential health benefits benchmark plan and establish a new benchmark plan for the 2027 plan year for health insurers. The bill would require, commencing January 1, 2027, if the United States Department of Health and Human Services approves a new essential health benefits benchmark plan for the state, as specified, the benchmark plan
for health insurers to include certain additional benefits, including coverage for specified fertility services and specified durable medical equipment.

Current Bill Text

Read the full stored bill text

Download Bill PDF