Triggering event: pregnancy.
AB 2066
California Bills
20250AB__206699INT INTRODUCED 2026-02-18 REVISED 2026-03-25 2025 AB INT Introduced by Assembly Member Celeste Rodriguez (Principal coauthor: Senator Wahab) (Coauthors: Assembly Members Addis, Aguiar-Curry, Bonta, Pacheco, Patel, Rogers, and Stefani) LEAD_AUTHOR ASSEMBLY Celeste Rodriguez PRINCIPAL_COAUTHOR SENATE Wahab COAUTHOR ASSEMBLY Addis COAUTHOR ASSEMBLY Aguiar-Curry COAUTHOR ASSEMBLY Bonta COAUTHOR ASSEMBLY Pacheco COAUTHOR ASSEMBLY Patel COAUTHOR ASSEMBLY Rogers COAUTHOR ASSEMBLY Stefani
An act to amend
Section 1399.849 of the Health and Safety Code, and to amend
Section 10965.3 of the Insurance Code, relating to health care coverage. health care coverage Triggering event: pregnancy. 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 disability insurers by the Department of Insurance.
Existing law requires a health care service plan or disability insurer to allow an individual to enroll in or change their health benefit plan as a result of a specified triggering event. This bill would make pregnancy a triggering event for purposes of enrollment or changing a health benefit plan. Because a willful violation of this provision 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. MAJORITY NO YES YES NO NO NO NO NO NO NO The people of the State of California do enact as follows:
SECTION
Section 1399.849 of the Health and Safety Code is amended to read: 1399.849. (a)
(1) On and after October 1, 2013, a plan shall fairly and affirmatively offer, market, and sell all of the plan’s health benefit plans that are sold in the individual market for policy years on or after January 1, 2014, to all individuals and dependents in each service area in which the plan provides or arranges for the provision of health care services. A plan shall limit enrollment in individual health benefit plans to open enrollment periods, annual enrollment periods, and special enrollment periods as provided in subdivisions (
c) and (d).
(2) A plan shall allow the subscriber of an individual health benefit plan to add a dependent to the subscriber’s plan at the option of the subscriber, consistent with the open enrollment, annual enrollment, and special enrollment period requirements in this section. (
b) An individual health benefit plan issued, amended, or renewed on or after January 1, 2014, shall not impose any preexisting condition provision upon any individual. (c)
(1) With respect to individual health benefit plans offered outside of the Exchange, a plan shall provide an initial open enrollment period from October 1, 2013, to March 31, 2014, inclusive, an annual enrollment period for the policy year beginning on January 1, 2015, from November 15, 2014, to February 15, 2015, inclusive, annual enrollment periods for policy years beginning on or after January 1, 2016, to December 31, 2018, inclusive, from November 1, of the preceding calendar year, to January of the benefit year, inclusive, and annual enrollment periods for policy years beginning on or after January 1, 2019, from October 15, of the preceding calendar year, to January of the benefit year, inclusive.
(2) With respect to individual health benefit plans offered through the Exchange, a plan shall provide an annual enrollment period for the policy years beginning on January 1, 2016, to December 31, 2018, inclusive, from November 1, of the preceding calendar year, to January of the benefit year, inclusive, and annual enrollment periods for policy years beginning on or after January 1, 2019, from November to December of the preceding calendar year, inclusive.
(3) With respect to individual health benefit plans offered through the Exchange, for policy years beginning on or after January 1, 2019, a plan shall provide a special enrollment period for all individuals selecting an individual health benefit plan through the Exchange from October to October of the preceding calendar year, inclusive, and from December 16, of the preceding calendar year, to January of the benefit year, inclusive.
An application for a health benefit plan submitted during these two special enrollment periods shall be treated the same as an application submitted during the annual open enrollment period. The effective date of coverage for plan selections made between October and October 31, inclusive, shall be January of the benefit year, and for plan selections made from December to January 15, inclusive, shall be no later than February of the benefit year.
(4) Pursuant to
Section 147.104(b)(2) of Title of the Code of Federal Regulations, for individuals enrolled in noncalendar year individual health plan contracts, a plan shall also provide a limited open enrollment period beginning on the date that is calendar days prior to the date the policy year ends in 2014. (d)
(1) Subject to paragraph (2), commencing January 1, 2014, a plan shall allow an individual to enroll in or change individual health benefit plans as a result of the following triggering events: (
A) The individual or the individual’s dependent loses minimum essential coverage. For purposes of this paragraph, the following
definitions shall apply: (i) “Minimum essential coverage” has the same meaning as that term is defined in
Section 1345.5 or subsection (
f) of
Section 5000A of the Internal Revenue Code (26 U.S.C.
Sec. 5000A). (ii) “Loss of minimum essential coverage” includes, but is not limited to, loss of that coverage due to the circumstances described in
Section 54.9801-6(a)(3)(
i) to (iii), inclusive, of Title of the Code of Federal Regulations and the circumstances described in
Section of Title of the United States Code. “Loss of minimum essential coverage” also includes loss of that coverage for a reason that is not due to the fault of the individual. (iii) “Loss of minimum essential coverage” does not include loss of that coverage due to the individual’s failure to pay premiums on a timely basis or situations allowing for a rescission, subject to clause (ii) and Sections 1389.7 and 1389.21. (
B) The individual gains a dependent or becomes a dependent. (
C) The individual is mandated to be covered as a dependent pursuant to a valid state or federal court order. (
D) The individual has been released from incarceration. (
E) The individual’s health coverage issuer substantially violated a material provision of the health coverage contract. (
F) The individual gains access to new health benefit plans as a result of a permanent move. (
G) The individual was receiving services from a contracting provider under another health benefit plan, as defined in
Section 1399.845 of this code or
Section of the Insurance Code, for one of the conditions described in subdivision (
c) of
Section 1373.96 of this code and that provider is no longer participating in the health benefit plan. (
H) The individual demonstrates to the Exchange, with respect to health benefit plans offered through the Exchange, or to the department, with respect to health benefit plans offered outside the Exchange, that the individual did not enroll in a health benefit plan during the immediately preceding enrollment period available to the individual because the individual was misinformed that the individual was covered under minimum essential coverage. (
I) The individual is a member of the reserve forces of the United States military returning from active duty or a member of the California National Guard returning from active duty service under Title of the United States Code. (
J) The individual is pregnant. (J)</xhtml:p>"?> (
K) With respect to individual health benefit plans offered through the Exchange, in addition to the triggering events listed in this paragraph, any other events listed in
Section 155.420(
d) of Title of the Code of Federal Regulations.
(2) With respect to individual health benefit plans offered outside the Exchange, an individual shall have days from the date of a triggering event identified in paragraph (1) to apply for coverage from a health care service plan subject to this section. With respect to individual health benefit plans offered through the Exchange, an individual shall have days from the date of a triggering event identified in paragraph (1) to select a plan offered through the Exchange, unless a longer period is provided in
Part 155 (commencing with
Section 155.10) of Subchapter B of Subtitle A of Title of the Code of Federal Regulations. (
e) With respect to individual health benefit plans offered through the Exchange, the effective date of coverage required pursuant to this
section shall be consistent with the dates specified in
Section 155.410 or 155.420 of Title of the Code of Federal Regulations, as applicable. A dependent who is a registered domestic partner pursuant to
Section of the Family Code shall have the same effective date of coverage as a spouse. (
f) With respect to individual health benefit plans offered outside the Exchange, the following provisions shall apply:
(1) After an individual submits a completed application form for a plan contract, the health care service plan shall, within days, notify the individual of the individual’s actual premium charges for that plan established in accordance with
Section 1399.855. The individual shall have days in which to exercise the right to buy coverage at the quoted premium charges.
(2) With respect to an individual health benefit plan for which an individual applies during the initial open enrollment period described in paragraph (1) of subdivision (c), when the subscriber submits a premium payment, based on the quoted premium charges, and that payment is delivered or postmarked, whichever occurs earlier, by December 15, 2013, coverage under the individual health benefit plan shall become effective no later than January 1, 2014.
When that payment is delivered or postmarked within the first days of any subsequent month, coverage shall become effective no later than the first day of the following month. When that payment is delivered or postmarked between December 16, 2013, to December 31, 2013, inclusive, or after the 15th day of any subsequent month, coverage shall become effective no later than the first day of the second month following delivery or postmark of the payment.
(3) With respect to an individual health benefit plan for which an individual applies during the annual open enrollment period described in paragraph (1) of subdivision (c), when the individual submits a premium payment, based on the quoted premium charges, and that payment is delivered or postmarked, whichever occurs later, by December of the preceding calendar year, coverage shall become effective on January of the benefit year. When that payment is delivered or postmarked within the first days of any subsequent month, coverage shall become effective no later than the first day of the following month.
When that payment is delivered or postmarked between December to December 31, inclusive, or after the 15th day of any subsequent month, coverage shall become effective no later than the first day of the second month following delivery or postmark of the payment.
(4) With respect to an individual health benefit plan for which an individual applies during a special enrollment period described in subdivision (d), the following provisions shall apply: (
A) When the individual submits a premium payment, based on the quoted premium charges, and that payment is delivered or postmarked, whichever occurs earlier, within the first days of the month, coverage under the plan shall become effective no later than the first day of the following month. When the premium payment is neither delivered nor postmarked until after the 15th day of the month, coverage shall become effective no later than the first day of the second month following delivery or postmark of the payment. (
B) Notwithstanding subparagraph (A), in the case of a birth, adoption, or placement for adoption, the coverage shall be effective on the date of birth, adoption, or placement for adoption. (
C) Notwithstanding subparagraph (A), in the case of marriage or becoming a registered domestic partner or in the case where a qualified individual loses minimum essential coverage, the coverage effective date shall be the first day of the month following the date the plan receives the request for special enrollment. (g)
(1) A health care service plan shall not establish rules for eligibility, including continued eligibility, of any individual to enroll under the terms of an individual health benefit plan based on any of the following factors: (
A) Health status. (
B) Medical condition, including physical and mental illnesses. (
C) Claims experience. (
D) Receipt of health care. (
E) Medical history. (
F) Genetic information. (
G) Evidence of insurability, including conditions arising out of acts of domestic violence. (
H) Disability. (
I) Any other health status-related factor as determined by any federal regulations, rules, or guidance issued pursuant to
Section of the federal Public Health Service Act (Public Law 78-410).
(2) Notwithstanding
Section 1389.1, a health care service plan shall not require an individual applicant or the applicant’s dependent to fill out a health assessment or medical questionnaire prior to enrollment under an individual health benefit plan. A health care service plan shall not acquire or request information that relates to a health status-related factor from the applicant or the applicant’s dependent or any other source prior to enrollment of the individual. (h)
(1) A health care service plan shall consider as a single risk pool for rating purposes in the individual market the claims experience of all insureds and all enrollees in all nongrandfathered individual health benefit plans offered by that health care service plan in this state, whether offered as health care service plan contracts or individual health insurance policies, including those insureds and enrollees who enroll in individual coverage through the Exchange and insureds and enrollees who enroll in individual coverage outside of the Exchange. Student health insurance coverage, as that coverage is defined in
Section 147.145(
a) of Title of the Code of Federal Regulations, shall not be included in a health care service plan’s single risk pool for individual coverage.
(2) Each calendar year, a health care service plan shall establish an index rate for the individual market in the state based on the total combined claims costs for providing essential health benefits, as defined pursuant to
Section of PPACA, within the single risk pool required under paragraph (1). The index rate shall be adjusted on a marketwide basis based on the total expected marketwide payments and charges under the risk adjustment program established for the state pursuant to
Section of PPACA and Exchange user fees, as described in subdivision (
d) of
Section 156.80 of Title of the Code of Federal Regulations. The premium rate for all of the health benefit plans in the individual market within the single risk pool required under paragraph (1) shall use the applicable marketwide adjusted index rate, subject only to the adjustments permitted under paragraph (3).
(3) A health care service plan may vary premium rates for a particular health benefit plan from its index rate based only on the following actuarially justified plan-specific factors: (
A) The actuarial value and cost-sharing design of the health benefit plan. (
B) The health benefit plan’s provider network, delivery system characteristics, and utilization management practices. (
C) The benefits provided under the health benefit plan that are in addition to the essential health benefits, as defined pursuant to
Section of PPACA and
Section 1367.005. These additional benefits shall be pooled with similar benefits within the single risk pool required under paragraph (1) and the claims experience from those benefits shall be utilized to determine rate variations for plans that offer those benefits in addition to essential health benefits. (
D) With respect to catastrophic plans, as described in subsection (
e) of
Section of PPACA, the expected impact of the specific eligibility categories for those plans. (
E) Administrative costs, excluding user fees required by the Exchange. (
i) This
section shall only apply with respect to individual health benefit plans for policy years on or after January 1, 2014. (
j) This
section shall not apply to a grandfathered health plan.
SEC.
Section 10965.3 of the Insurance Code is amended to read: 10965.3. (a)
(1) On and after October 1, 2013, a health insurer shall fairly and affirmatively offer, market, and sell all of the insurer’s health benefit plans that are sold in the individual market for policy years on or after January 1, 2014, to all individuals and dependents in each service area in which the insurer provides or arranges for the provision of health care services. A health insurer shall limit enrollment in individual health benefit plans to open enrollment periods, annual enrollment periods, and special enrollment periods as provided in subdivisions (
c) and (d).
(2) A health insurer shall allow the policyholder of an individual health benefit plan to add a dependent to the policyholder’s health benefit plan at the option of the policyholder, consistent with the open enrollment, annual enrollment, and special enrollment period requirements in this section. (
b) An individual health benefit plan issued, amended, or renewed on or after January 1, 2014, shall not impose any preexisting condition provision upon any individual. (c)
(1) With respect to individual health benefit plans offered outside of the Exchange, a health insurer shall provide an initial open enrollment period from October 1, 2013, to March 31, 2014, inclusive, an annual enrollment period for the policy year beginning on January 1, 2015, from November 15, 2014, to February 15, 2015, inclusive, annual enrollment periods for policy years beginning on or after January 1, 2016, to December 31, 2018, inclusive, from November 1, of the preceding calendar year, to January of the benefit year, inclusive, and annual enrollment periods for policy years beginning on or after January 1, 2019, from October of the preceding calendar year, to January of the benefit year, inclusive.
(2) With respect to individual health benefit plans offered through the Exchange, a health insurer shall provide an annual enrollment period for the policy years beginning on January 1, 2016, to December 31, 2018, inclusive, from November 1, of the preceding calendar year, to January of the benefit year, inclusive, and annual enrollment periods for policy years beginning on or after January 1, 2019, from November to December of the preceding calendar year, inclusive.
(3) With respect to individual health benefit plans offered through the Exchange, for policy years beginning on or after January 1, 2019, a health insurer shall provide a special enrollment period for all individuals selecting an individual health benefit plan through the Exchange from October to October of the preceding calendar year, inclusive, and from December 16, of the preceding calendar year, to January of the benefit year, inclusive.
An application for a health benefit plan submitted during these two special enrollment periods shall be treated the same as an application submitted during the annual open enrollment period. The effective date of coverage for plan selections made between October and October 31, inclusive, shall be January of the benefit year, and for plan selections made from December to January 15, inclusive, shall be no later than February of the benefit year.
(4) Pursuant to
Section 147.104(b)(2) of Title of the Code of Federal Regulations, for individuals enrolled in noncalendar year individual health plan contracts, a health insurer shall also provide a limited open enrollment period beginning on the date that is calendar days prior to the date the policy year ends in 2014. (d)
(1) Subject to paragraph (2), commencing January 1, 2014, a health insurer shall allow an individual to enroll in or change individual health benefit plans as a result of the following triggering events: (
A) The individual or the individual’s dependent loses minimum essential coverage. For purposes of this paragraph, both of the following
definitions shall apply: (i) “Minimum essential coverage” has the same meaning as that term is defined in
Section 1345.5 of the Health and Safety Code or subsection (
f) of
Section 5000A of the Internal Revenue Code (26 U.S.C.
Sec. 5000A). (ii) “Loss of minimum essential coverage” includes, but is not limited to, loss of that coverage due to the circumstances described in
Section 54.9801-6(a)(3)(
i) to (iii), inclusive, of Title of the Code of Federal Regulations and the circumstances described in
Section of Title of the United States Code. “Loss of minimum essential coverage” also includes loss of that coverage for a reason that is not due to the fault of the individual. (iii) “Loss of minimum essential coverage” does not include loss of that coverage due to the individual’s failure to pay premiums on a timely basis or situations allowing for a rescission, subject to clause (ii) and Sections 10119.2 and 10384.17. (
B) The individual gains a dependent or becomes a dependent. (
C) The individual is mandated to be covered as a dependent pursuant to a valid state or federal court order. (
D) The individual has been released from incarceration. (
E) The individual’s health coverage issuer substantially violated a material provision of the health coverage contract. (
F) The individual gains access to new health benefit plans as a result of a permanent move. (
G) The individual was receiving services from a contracting provider under another health benefit plan, as defined in
Section of this code or
Section 1399.845 of the Health and Safety Code, for one of the conditions described in subdivision (
a) of
Section 10133.56 of this code and that provider is no longer participating in the health benefit plan. (
H) The individual demonstrates to the Exchange, with respect to health benefit plans offered through the Exchange, or to the department, with respect to health benefit plans offered outside the Exchange, that the individual did not enroll in a health benefit plan during the immediately preceding enrollment period available to the individual because the individual was misinformed that the individual was covered under minimum essential coverage. (
I) The individual is a member of the reserve forces of the United States military returning from active duty or a member of the California National Guard returning from active duty service under Title of the United States Code. (
J) The individual is pregnant. (J)</xhtml:p>"?> (
K) With respect to individual health benefit plans offered through the Exchange, in addition to the triggering events listed in this paragraph, any other events listed in
Section 155.420(
d) of Title of the Code of Federal Regulations.
(2) With respect to individual health benefit plans offered outside the Exchange, an individual shall have days from the date of a triggering event identified in paragraph (1) to apply for coverage from a health care service plan subject to this section. With respect to individual health benefit plans offered through the Exchange, an individual shall have days from the date of a triggering event identified in paragraph (1) to select a plan offered through the Exchange, unless a longer period is provided in
Part 155 (commencing with
Section 155.10) of Subchapter B of Subtitle A of Title of the Code of Federal Regulations. (
e) With respect to individual health benefit plans offered through the Exchange, the effective date of coverage required pursuant to this
section shall be consistent with the dates specified in
Section 155.410 or 155.420 of Title of the Code of Federal Regulations, as applicable. A dependent who is a registered domestic partner pursuant to
Section of the Family Code shall have the same effective date of coverage as a spouse. (
f) With respect to an individual health benefit plan offered outside the Exchange, the following provisions shall apply:
(1) After an individual submits a completed application form for a plan, the insurer shall, within days, notify the individual of the individual’s actual premium charges for that plan established in accordance with
Section 10965.9. The individual shall have days in which to exercise the right to buy coverage at the quoted premium charges.
(2) With respect to an individual health benefit plan for which an individual applies during the initial open enrollment period described in paragraph (1) of subdivision (c), when the policyholder submits a premium payment, based on the quoted premium charges, and that payment is delivered or postmarked, whichever occurs earlier, by December 15, 2013, coverage under the individual health benefit plan shall become effective no later than January 1, 2014.
When that payment is delivered or postmarked within the first days of any subsequent month, coverage shall become effective no later than the first day of the following month. When that payment is delivered or postmarked between December 16, 2013, to December 31, 2013, inclusive, or after the 15th day of any subsequent month, coverage shall become effective no later than the first day of the second month following delivery or postmark of the payment.
(3) With respect to an individual health benefit plan for which an individual applies during the annual open enrollment period described in paragraph (1) of subdivision (c), when the individual submits a premium payment, based on the quoted premium charges, and that payment is delivered or postmarked, whichever occurs later, by December of the preceding calendar year, coverage shall become effective on January of the benefit year. When that payment is delivered or postmarked within the first days of any subsequent month, coverage shall become effective no later than the first day of the following month.
When that payment is delivered or postmarked between December to December 31, inclusive, or after the 15th day of any subsequent month, coverage shall become effective no later than the first day of the second month following delivery or postmark of the payment.
(4) With respect to an individual health benefit plan for which an individual applies during a special enrollment period described in subdivision (d), the following provisions shall apply: (
A) When the individual submits a premium payment, based on the quoted premium charges, and that payment is delivered or postmarked, whichever occurs earlier, within the first days of the month, coverage under the plan shall become effective no later than the first day of the following month. When the premium payment is neither delivered nor postmarked until after the 15th day of the month, coverage shall become effective no later than the first day of the second month following delivery or postmark of the payment. (
B) Notwithstanding subparagraph (A), in the case of a birth, adoption, or placement for adoption, the coverage shall be effective on the date of birth, adoption, or placement for adoption. (
C) Notwithstanding subparagraph (A), in the case of marriage or becoming a registered domestic partner or in the case where a qualified individual loses minimum essential coverage, the coverage effective date shall be the first day of the month following the date the insurer receives the request for special enrollment. (g)
(1) A health insurer shall not establish rules for eligibility, including continued eligibility, of any individual to enroll under the terms of an individual health benefit plan based on any of the following factors: (
A) Health status. (
B) Medical condition, including physical and mental illnesses. (
C) Claims experience. (
D) Receipt of health care. (
E) Medical history. (
F) Genetic information. (
G) Evidence of insurability, including conditions arising out of acts of domestic violence. (
H) Disability. (
I) Any other health status-related factor as determined by any federal regulations, rules, or guidance issued pursuant to
Section of the federal Public Health Service Act (Public Law 78-410).
(2) Notwithstanding subdivision (
c) of
Section 10291.5, a health insurer shall not require an individual applicant or the applicant’s dependent to fill out a health assessment or medical questionnaire prior to enrollment under an individual health benefit plan. A health insurer shall not acquire or request information that relates to a health status-related factor from the applicant or the applicant’s dependent or any other source prior to enrollment of the individual. (h)
(1) A health insurer shall consider as a single risk pool for rating purposes in the individual market the claims experience of all insureds and enrollees in all nongrandfathered individual health benefit plans offered by that insurer in this state, whether offered as health care service plan contracts or individual health insurance policies, including those insureds and enrollees who enroll in individual coverage through the Exchange and insureds and enrollees who enroll in individual coverage outside the Exchange. Student health insurance coverage, as such coverage is defined in
Section 147.145(
a) of Title of the Code of Federal Regulations, shall not be included in a health insurer’s single risk pool for individual coverage.
(2) Each calendar year, a health insurer shall establish an index rate for the individual market in the state based on the total combined claims costs for providing essential health benefits, as defined pursuant to
Section of PPACA, within the single risk pool required under paragraph (1). The index rate shall be adjusted on a marketwide basis based on the total expected marketwide payments and charges under the risk adjustment program established for the state pursuant to
Section of PPACA and Exchange user fees, as described in subdivision (
d) of
Section 156.80 of Title of the Code of Federal Regulations. The premium rate for all of the health benefit plans in the individual market within the single risk pool required under paragraph (1) shall use the applicable marketwide adjusted index rate, subject only to the adjustments permitted under paragraph (3).
(3) A health insurer may vary premium rates for a particular health benefit plan from its index rate based only on the following actuarially justified plan-specific factors: (
A) The actuarial value and cost-sharing design of the health benefit plan. (
B) The health benefit plan’s provider network, delivery system characteristics, and utilization management practices. (
C) The benefits provided under the health benefit plan that are in addition to the essential health benefits, as defined pursuant to
Section of PPACA and
Section 10112.27. These additional benefits shall be pooled with similar benefits within the single risk pool required under paragraph (1) and the claims experience from those benefits shall be utilized to determine rate variations for plans that offer those benefits in addition to essential health benefits. (
D) With respect to catastrophic plans, as described in subsection (
e) of
Section of PPACA, the expected impact of the specific eligibility categories for those plans. (
E) Administrative costs, excluding any user fees required by the Exchange. (
i) This
section shall only apply with respect to individual health benefit plans for policy years on or after January 1, 2014. (
j) This
section shall not apply to a grandfathered health plan.
SEC. 3. No reimbursement is required by this act pursuant to
Section 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