Health care coverage: essential health benefits.
- Establishes legislative intent to review and create a new essential health benefits benchmark plan for California health insurance coverage starting in 2027.
- Limits the current Kaiser Foundation Health Plan Small Group HMO 30 benchmark plan to plan years through 2027.
- Maintains alignment with federal Affordable Care Act requirements while allowing for state-specific updates to required health benefits.
- Requires health insurers and plans to transition to the new benchmark standards while ensuring continuous essential health benefits coverage for individuals and small groups.
Assembly Member Bonta proposes updating California's essential health benefits benchmark plan, which determines minimum coverage requirements for individual and small group health insurance plans. The legislation signals intent to establish a new benchmark plan for the 2027 plan year while maintaining the current Kaiser Foundation Health Plan Small Group HMO 30 benchmark through 2026.
The bill amends both the Health and Safety Code and Insurance Code to limit the applicability of the existing benchmark, which has served as California's standard since 2017. Under current law, health insurers and plans must cover essential health benefits including ambulatory services, emergency care, hospitalization, maternity care, mental health treatment, prescription drugs, rehabilitative services, laboratory services, preventive care, and pediatric services including dental and vision coverage.
The Department of Managed Health Care and Department of Insurance would continue their regulatory oversight roles, ensuring health plans and insurers comply with essential health benefits requirements. The legislation maintains existing exemptions for specialized health plans, Medicare supplement plans, and grandfathered plans that predate the Affordable Care Act.
The bill preserves key consumer protections, including prohibitions against substituting required benefits and restrictions on how plans market their essential health benefits compliance. It also retains provisions preventing state cost obligations for benefits beyond federal requirements while ensuring continued alignment with the Patient Protection and Affordable Care Act.
 Cecilia Aguiar-CurryD Assembly Member | Committee Member |  Not Contacted | |
 Heath FloraR Assembly Member | Committee Member | Not Contacted | |
 Joaquin ArambulaD Assembly Member | Committee Member | Not Contacted | |
 Mia BontaD Assembly Member | Bill Author | Not Contacted | |
 Dawn AddisD Assembly Member | Committee Member | Not Contacted |
Email the authors or create an email template to send to all relevant legislators.
Introduced By
- Establishes legislative intent to review and create a new essential health benefits benchmark plan for California health insurance coverage starting in 2027.
- Limits the current Kaiser Foundation Health Plan Small Group HMO 30 benchmark plan to plan years through 2027.
- Maintains alignment with federal Affordable Care Act requirements while allowing for state-specific updates to required health benefits.
- Requires health insurers and plans to transition to the new benchmark standards while ensuring continuous essential health benefits coverage for individuals and small groups.
Email the authors or create an email template to send to all relevant legislators.
Introduced By
Assembly Member Bonta proposes updating California's essential health benefits benchmark plan, which determines minimum coverage requirements for individual and small group health insurance plans. The legislation signals intent to establish a new benchmark plan for the 2027 plan year while maintaining the current Kaiser Foundation Health Plan Small Group HMO 30 benchmark through 2026.
The bill amends both the Health and Safety Code and Insurance Code to limit the applicability of the existing benchmark, which has served as California's standard since 2017. Under current law, health insurers and plans must cover essential health benefits including ambulatory services, emergency care, hospitalization, maternity care, mental health treatment, prescription drugs, rehabilitative services, laboratory services, preventive care, and pediatric services including dental and vision coverage.
The Department of Managed Health Care and Department of Insurance would continue their regulatory oversight roles, ensuring health plans and insurers comply with essential health benefits requirements. The legislation maintains existing exemptions for specialized health plans, Medicare supplement plans, and grandfathered plans that predate the Affordable Care Act.
The bill preserves key consumer protections, including prohibitions against substituting required benefits and restrictions on how plans market their essential health benefits compliance. It also retains provisions preventing state cost obligations for benefits beyond federal requirements while ensuring continued alignment with the Patient Protection and Affordable Care Act.
Cecilia Aguiar-CurryD Assembly Member | Committee Member | Not Contacted | |
Heath FloraR Assembly Member | Committee Member | Not Contacted | |
Joaquin ArambulaD Assembly Member | Committee Member | Not Contacted | |
Mia BontaD Assembly Member | Bill Author | Not Contacted | |
Dawn AddisD Assembly Member | Committee Member | Not Contacted |