CDCAN Advocacy Without Borders :: One Community

Summary

Prohibits health plans and health insurers from charging a premium, price, or charge differential for health care coverage because of the sex of the prospective subscriber, enrollee, policyholder, or insured.

Senate Amendments

1. Make this bill effective January 1, 2011.
2. Make technical, clarifying changes and add co-authors.

Existing Law

1. Provides for the regulation of health plans by the Department of Managed Health Care (DMHC) under Knox-Keene and regulation of disability insurers selling health insurance (health insurers) by the California Department of Insurance (CDI) under the Insurance Code.
2. Prohibits, under Knox-Keene, a health plan from refusing to contract, canceling, or declining to renew or reinstate any health plan contract because of the race, color, national origin, ancestry, religion, sex, marital status, sexual orientation, or age of any contracting party, prospective contracting party, subscriber, enrollee, member, or otherwise.
3. Prohibits, in Knox-Keene, modification of benefits, coverage, or the inclusion of any limitations, exceptions, exclusions, reductions, copayments, coinsurance, deductibles, reservations, or premium, price, or charge differentials because of the race, color, national origin, ancestry, religion, sex, marital status, sexual orientation, or age of any contracting party, prospective contracting party, subscriber, enrollee, member, or otherwise.
4. Establishes in Knox-Keene, for individual coverage, an exception to 3) above for premium, price or charge differentials because of the sex or age of any individual, when based on objective, valid, and up-to-date statistical and actuarial data.
5. Prohibits life and disability insurers, including health insurers, from using race, color, religion, sex, national origin, ancestry, or sexual orientation in determining whether to offer insurance.
6. Prohibits life and disability insurers, including health insurers, from using race, color, religion, national origin, ancestry, or sexual orientation as a condition or risk for which a higher rate, premium, or charge may be required to be paid by an insured, but does not include sex in the prohibited list of conditions or risks.
7. Authorizes in the Insurance Code, for life and disability policies, including health insurance, premium, price, or charge differentials because of the sex of the individual when based on objective, valid, and up-to-date statistical and actuarial date or sound underwriting practices.

Fiscal Effect

According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.

Analysis Prepared by : Deborah Kelch / HEALTH / (916) 319-2097