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<ns0:Id>20250SB__103799INT</ns0:Id>
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<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2026-02-11</ns0:ActionDate>
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<ns0:SessionYear>2025</ns0:SessionYear>
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<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Senator Weber Pierson</ns0:AuthorText>
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<ns0:Legislator>
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<ns0:House>SENATE</ns0:House>
<ns0:Name>Weber Pierson</ns0:Name>
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<ns0:Title> An act to amend Section 1367.035 of the Health and Safety Code, and to amend Section 10181.35 of the Insurance Code, relating to health care coverage. </ns0:Title>
<ns0:RelatingClause>health care coverage</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Health care coverage: rate review. </ns0:Subject>
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<html:p>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 provides for the regulation of health insurers by the Department of Insurance. Existing law requires that health care service plans and health insurers submit rates to their regulating entity for review and to demonstrate the impact of any changes in the rate of growth of health care costs resulting from health care cost targets.</html:p>
<html:p>This bill would require the Department of Managed Health Care and the Department of Insurance, in collaboration with the Office of Health Care Affordability, to each conduct an enhanced rate review to determine if health care premiums are affordable for individual and group purchasers.</html:p>
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<ns0:Appropriation>NO</ns0:Appropriation>
<ns0:FiscalCommittee>YES</ns0:FiscalCommittee>
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<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
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<ns0:Num>SECTION 1.</ns0:Num>
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Section 1385.035 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_E46AB6B5-3EBF-4FA9-B92F-0D3A8A0F3BF3">
<ns0:Num>1385.035.</ns0:Num>
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(a)
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It is the intent of the Legislature in enacting this section to ensure that enrollees and subscribers benefit from reductions in the rate of growth in health care costs as a result of the establishment of the Office of Health Care Affordability.
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(b)
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In submitting rates for review consistent with this article, a health care service plan shall demonstrate the impact of any changes in the rate of growth in health care costs resulting from the health care cost targets set pursuant to Chapter 2.6 (commencing with Section 127500) of Part 2 of Division 107.
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(c)
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In determining whether a rate is unreasonable or not justified, the director shall consider the impact on changes in health care costs as a
result of the health care cost targets set pursuant to Chapter 2.6 (commencing with Section 127500) of Part 2 of Division 107.
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(d)
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The department, in collaboration with the Office of Health Care Affordability, shall conduct an enhanced rate review to determine if health care premiums are affordable for individual and group purchasers.
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<ns0:Num>SEC. 2.</ns0:Num>
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Section 10181.35 of the
<ns0:DocName>Insurance Code</ns0:DocName>
is amended to read:
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<ns0:Num>10181.35.</ns0:Num>
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(a)
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It is the intent of the Legislature in enacting this section to ensure that insureds benefit from reductions in the rate of growth in health care costs as a result of the establishment of the Office of Health Care Affordability.
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(b)
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In submitting rates for review consistent with this article, a health insurer shall demonstrate the impact of any changes in the rate of growth in health care costs resulting from the health care cost targets set pursuant to Chapter 2.6 (commencing with Section 127500) of Part 2 of Division 107 of the Health and Safety Code.
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<html:p>
(c)
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In determining whether a rate is unreasonable or not justified, the commissioner shall consider the impact on changes in health care costs
as a result of the health care cost targets set pursuant to Chapter 2.6 (commencing with Section 127500) of Part 2 of Division 107 of the Health and Safety Code.
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<html:p>
(d)
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The department, in collaboration with the Office of Health Care Affordability, shall conduct an enhanced rate review to determine if health care premiums are affordable for individual and group purchasers.
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