SB 1045 Summary

• Extends dependent child health insurance coverage until age 26 for individual and group health plans, eliminating the previous condition that coverage terminated if the dependent obtained coverage through their own employment.

• Requires stepchildren and other dependent children receive the same insurance coverage as biological children under individual and group health policies.

• Limits step therapy for prescription drugs to 60 days maximum for any drug, and prohibits step therapy entirely for behavioral health conditions or chronic, disabling, or life-threatening conditions if the prescribed drug complies with FDA approval.

• Expands qualifications for clinical peers conducting utilization reviews to include specialists in substance use disorder and mental health treatment for both children and adults, with specific board certification or doctoral degree requirements.

• Establishes a rebuttable presumption that health care services ordered by health care professionals are medically necessary, shifting the burden to insurance carriers to prove medical necessity, and grants clinical peers authority to reverse initial adverse determinations during peer conferences.