SB 890 Summary

• Eliminates the 18-month coverage requirement and allows individuals to transfer between individual health plans without medical underwriting on their annual renewal date, effective January 1, 2011.

• Requires health care service plans and health insurers to categorize all individual market products into five tiers (Bronze, Silver, Gold, Platinum, and Catastrophic) based on actuarial value beginning July 1, 2011, with the Department of Managed Health Care and Department of Insurance adopting a common actuarial model by July 1, 2011.

• Mandates disclosure of actuarial value, estimated annual out-of-pocket expenses, and total annual costs in plan and policy disclosure forms, along with an explanation of actuarial value as a percentage of expenses paid by the plan versus out of pocket.

• Requires health care service plans and health insurers to comply with federal Patient Protection and Affordable Care Act provisions regarding lifetime and annual benefit limits (Section 2711) and rebate requirements (Section 2718).

• Excludes Medicare supplements, specialized coverage, and government program enrollees (Medi-Cal, Healthy Families, Access for Infants and Mothers) from the transfer and categorization requirements.