Health care coverage: lung cancer.

Plain English Breakdown

The bill summary does not specify the exact services covered under follow-up screening or diagnostic services for lung cancer.

Health Care Coverage for Lung Cancer

The bill requires health insurance plans to cover follow-up screening and diagnostic services for lung cancer without additional costs like copayments, coinsurance, or deductibles.

What This Bill Does

• Requires health care service plan contracts and health insurance policies issued, amended, or renewed on or after January 1, 2027, that provide coverage for hospital, medical, or surgical expenses to cover follow-up screening or diagnostic services for lung cancer.
• Prohibits these plans from charging copayments, coinsurance, deductibles, or any other form of cost sharing for the required lung cancer screenings and diagnostics.

Who It Names or Affects

• People with health insurance in California who need lung cancer screening or diagnostic services.
• Health care service plans and insurers operating in California.

Terms To Know

Copayment

A fixed amount you pay for a medical service after your insurance pays its share.

Coinsurance

The percentage of the health care costs that you pay after your plan has paid its portion.

Limits and Unknowns

• Does not specify what follow-up screening and diagnostic services are covered.
• Does not provide details on how to enforce these requirements or penalties for non-compliance beyond criminal charges.
• The bill does not require reimbursement from the state, but it doesn't explain why.

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 or health insurance policy issued, amended, or renewed on or after January 1, 2027,
that provides coverage for hospital, medical, or surgical expenses
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. 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