Health care coverage: lung cancer., the official text

An act to add Section 1367.58 to the Health and Safety Code, and to add Section 10123.78 to the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL'S DIGEST

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, except as specified, that is 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 or health insurance policy is a high deductible health plan, the bill would prohibit the contract or policy 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.

The people of the State of California do enact as follows:

SECTION 1.
Section 1367.58 is added to the Health and Safety Code, to read:
1367.58.
(a) A health care service plan contract, excluding a specialized health care service plan contract, issued, amended, or renewed on or after January 1, 2027, shall provide coverage for followup screening or diagnostic services for lung cancer recommended by a health care provider acting within the scope of their practice.
(b) (1) Coverage required pursuant to this section shall not be subject to copayment, coinsurance, deductible, or any other form of cost sharing.
(2) Notwithstanding paragraph (1), if a health care service plan contract is a high deductible health plan, as defined in Section 223(c)(2) of Title 26 of the United States Code, the contract shall not impose a deductible, coinsurance, or any other cost sharing on the coverage required pursuant to this section unless not imposing the deductible, coinsurance, or cost sharing would conflict with the federal requirements for high deductible health plans, including those requirements defining exempt preventive care.
(c) For purposes of this section, “followup screening or diagnostic services for lung cancer” means a service provided after an initial abnormal or indeterminate test result, including, but not limited to, a diagnostic computed tomography scan, positron emission tomography/computed tomography scan, tissue sampling, biopsy, bronchoscopy, pathology, and surgical consultation.

SEC. 2.
Section 10123.78 is added to the Insurance Code, to read:
10123.78.
(a) A health insurance policy issued, amended, or renewed on or after January 1, 2027, shall provide coverage for followup screening or diagnostic services for lung cancer recommended by a health care provider acting within the scope of their practice.
(b) (1) Coverage required pursuant to this section shall not be subject to copayment, coinsurance, deductible, or any other form of cost sharing.
(2) Notwithstanding paragraph (1), if a health insurance policy is a high deductible health plan, as defined in Section 223(c)(2) of Title 26 of the United States Code, the policy shall not impose a deductible, coinsurance, or any other cost sharing on the coverage required pursuant to this section unless not imposing the deductible, coinsurance, or cost sharing would conflict with the federal requirements for high deductible health plans, including those requirements defining exempt preventive care.
(c) For purposes of this section, “followup screening or diagnostic services for lung cancer” means a service provided after an initial abnormal or indeterminate test result, including, but not limited to, a diagnostic computed tomography scan, positron emission tomography/computed tomography scan, tissue sampling, biopsy, bronchoscopy, pathology, and surgical consultation.
(d) This section does not apply to a specialized health insurance policy that covers only dental, mental health, or vision benefits.

SEC. 3.
No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.