Health care coverage: lung cancer.

Plain English Breakdown

Checked against official source text during the last sync.

Health Care Coverage for Lung Cancer

The bill requires health insurance plans to cover follow-up screening and diagnostic services for lung cancer without charging extra fees, starting in 2027.

What This Bill Does

• Requires health care service plan contracts or health insurance policies issued, amended, or renewed on or after January 1, 2027, to provide coverage for follow-up screening or diagnostic services for lung cancer.
• Prohibits these plans from requiring copayments, coinsurance, deductibles, or other cost-sharing for the required lung cancer screenings and diagnostics.
• If a plan is a high deductible health plan (HDHP), it can only charge costs that do not conflict with federal HDHP rules.

Who It Names or Affects

• People who have health care service plans or health insurance policies in California.
• Health care providers offering lung cancer screening and diagnostic services.
• Insurance companies providing coverage for these services.

Terms To Know

High Deductible Health Plan (HDHP)

A type of health insurance plan with higher deductibles than traditional plans, designed to encourage policyholders to be more cost-conscious about their medical expenses.

Copayment

A fixed amount a patient pays for a medical service after the deductible has been met.

Limits and Unknowns

• The bill does not specify what happens if federal HDHP rules conflict with the new California requirements.
• It is unclear how insurance companies will implement these changes without causing conflicts with existing policies or federal regulations.

Official Summary Text

SB 1309, as amended, Rubio.
Health care coverage: lung cancer.
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 contract or health insurance policy to provide coverage for all generally medically accepted cancer screening tests.
This bill would require a health care service plan
contract
contract, except as specified,
or health insurance policy issued, amended, or renewed on or after January 1, 2027, to provide coverage for followup screening or diagnostic services for lung cancer, as specified. The bill would prohibit a contract or policy from imposing a copayment, coinsurance, deductible, or any other form of cost sharing for this coverage.
If a health care service plan contract is a high deductible health plan, the bill would prohibit the contract from imposing a deductible, coinsurance, or any other cost sharing on this coverage unless not imposing the deductible, coinsurance, or cost sharing would conflict with the federal requirements for high deductible health plans.
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.

Current Bill Text

Download Bill PDF