SB 959 Summary

• Requires health insurers and health care service plans to adjust index rates based on Exchange user fees in addition to risk adjustment and reinsurance payments when establishing premium rates for individual and small group markets.

• Modifies notice requirements for individual health insurance policy changes to require notice at least 15 days prior to the start of annual enrollment period or 60 days prior to renewal, whichever is earlier.

• Removes requirement that insurers provide written reasons for denying individual coverage or charging higher rates; instead requires informing certain denied applicants about California Major Risk Medical Insurance Program and Covered California coverage options.

• Eliminates requirement that rate filings be concurrent with subscriber notices; clarifies that geographic regions for rate data must correspond with regions used by plans to establish premium rates.

• Specifies that health plans in the SHOP Program need only offer four levels of coverage (platinum, gold, silver, bronze) rather than five, and clarifies standardized product requirements apply only to individual and small group markets.