Health care coverage: essential health benefits.

Assembly Member Bonta's proposal to update California's essential health benefits benchmark plan would expand healthcare coverage requirements starting in 2027, pending federal approval. The legislation modifies both the Health and Safety Code and Insurance Code to mandate coverage for specific fertility treatments, durable medical equipment, and hearing services.

The bill requires health plans to cover a defined set of fertility services, including artificial insemination, three attempts each at gamete retrieval and embryo creation, cryopreservation with specified storage periods, and surrogacy-related care. For durable medical equipment, plans must cover mobility devices like wheelchairs and walkers, communication devices, CPAP machines, portable oxygen, and hospital beds. The legislation also mandates coverage for annual hearing exams and hearing aids every three years.

These expanded benefits would take effect only if the U.S. Department of Health and Human Services approves California's new benchmark plan submission in 2025. The Department of Managed Health Care and Department of Insurance would oversee implementation through emergency regulations, with violations by health plans constituting criminal offenses. The requirements apply to individual and small group health plans but exempt specialized plans, Medicare supplements, and grandfathered policies.

The measure establishes a state-mandated local program for enforcement but specifies that no state reimbursement is required, as the changes relate to criminal provisions under existing constitutional guidelines. Health plans retain limited flexibility to substitute prescription drug formularies if federal requirements are met and no additional state costs result.