Signed by Governor Arnold Schwarzenegger

Vote Smart's Synopsis:

Vote to pass a bill that extends the limiting age and coverage for dependent children for health care service plan contracts and individual and group health insurance policies.

Highlights:

• Specifies that a plan contract may not provide an exception for other coverage if the other coverage is entitlement to Medi-Cal benefits or Medicaid benefits (Sec. 1).

• Prohibits insurers that provide coverage for sterilization procedures from imposing any disclaimer, restriction or limitation on coverage of an individual's sterilization procedure based on the individual's reason for sterilization (Sec. 1).

• Requires that every plan contract that provides coverage to the spouse or dependent(s) of the subscriber or spouse grant immediate accident and sickness coverage (Sec. 1).

• Prohibits any plan that contains a disclaimer, waiver or other limitation on coverage of newborn infants, or children placed for adoption with, the subscriber or the subscriber's spouse (Sec. 1). -Requires every plan contract that provides coverage of a dependent child of a subscriber to be terminated once they reach the limiting age for coverage unless both of the following criteria apply (Sec. 1):
• The child is incapable of self-sustaining employment by reason of a physically or mentally disabling injury, illness, or condition; and
• The child is entirely dependent on the subscriber for support and maintenance.

• Authorizes the plan to request information about a dependent child if the plan approves continuation of coverage (Sec. 1).

• Establishes that if a subscriber changes carriers to another plan or to a health insurer, the new plan or insurer will continue to provide coverage for the dependent child, though information may be requested initially to determine if the dependent child continues to satisfy the stated criteria (Sec. 1).

• Specifies that plans be not required to make coverage available for a child of a child receiving dependent coverage (Sec. 1).

• Requires plans that cover employees and provide extension of coverage for any period of time after employment terminates also provide extended coverage to the employee's dependents for the same time period (Sec. 1).

• Prohibits group contracts from discriminating against handicapped persons or against groups containing handicapped persons (Sec. 1).

• Requires health care service plans to inform prospective group contract holders if they do not cover services for the treatment of mental or nervous disorders (Sec. 1).

• Defines "marriage and family therapist" as a licensed marriage and family therapist who has received specific instruction in assessment, diagnosis, prognosis, and counseling, and psychotherapeutic treatment of premarital marriage, family, and child relationship dysfunctions (Sec. 1).

• Mandates that when the plan utilizes arbitration to settle disputes, the plan contract dictates what type of disputes are subject to arbitration, the process to be utilized, and how it is to be initiated (Sec. 1).

• Permits dependent children over 26 years of age and enrolled as full-time students at a secondary or postsecondary educational institution to continue coverage under their health care service plan (Sec. 1).

• Requires those children taking leaves of absence from school to provide documentation or certification of the medical reason for taking the leave and to submit the documentation to the plan at least 30 days prior if it is a foreseeable situation, or 30 days after the start date of the medical leave of absence if it is unforeseeable if coverage is to continue (Sec. 1).

Full Bill Text