California Insurance Code

§ 12693.615

INS § 12693.615 Effective Mar 24, 2011Div. 2 · Part 6.2 · Ch. 5

Statute text

(a)The board shall establish the required subscriber copayment levels for specific benefits consistent with the limitations of Section 2103 of Title XXI of the Social Security Act. The copayment levels established by the board shall, to the extent possible, reflect the copayment levels established for state employees, effective January 1, 1998, through the Public Employees’ Retirement System. Except as otherwise provided in this section, under no circumstances shall copayments exceed the copayment level established for state employees for the most recent plan year preceding the applicable program plan year through the Public Employees’ Retirement System. Total annual copayments charged to subscribers shall not exceed two hundred fifty dollars ($250) per family. The board shall instruct participating health plans to work with their provider networks to provide for extended payment plans for subscribers utilizing a significant number of health services for which copayments are charged. The board shall track the number of subscribers who meet the copayment maximum in each year and make adjustments in the amount if a significant number of subscribers reach the copayment maximum.

(b)No deductibles shall be charged to subscribers for health benefits.

(c)Coverage provided to subscribers shall not contain any preexisting condition exclusion requirements.

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Legislative history

Amended by Stats. 2011, Ch. 3, Sec. 1.7. (AB 97) Effective March 24, 2011.