Health care coverage: essential health benefits.

Assembly Member Bonta's proposal to revise California's essential health benefits benchmark plan would expand coverage requirements for individual and small group health insurance policies starting in 2027, pending federal approval. The legislation outlines new mandatory benefits including fertility treatments, specialized medical equipment, and hearing services.

The fertility coverage provisions encompass artificial insemination, gamete retrieval, embryo creation and storage, and surrogacy-related services. For durable medical equipment, the bill requires coverage of mobility devices, communication aids, respiratory equipment, and hospital beds. Hearing benefits would include annual exams and hearing aid coverage every three years.

These changes would modify the current benchmark plan, which is based on the Kaiser Foundation Health Plan Small Group HMO 30 plan from 2014. The Department of Insurance would issue implementation guidance by January 2027, in consultation with the Department of Managed Health Care. The expanded requirements would apply to all non-grandfathered individual and small group policies, whether offered through Covered California or the private market, while maintaining existing protections for state costs and federal compliance.