Health care coverage: essential health benefits.

Senator Menjivar's proposal to revise California's essential health benefits benchmark plan would expand required health insurance coverage starting in 2027, pending federal approval. The legislation modifies the existing Kaiser Foundation Health Plan Small Group HMO 30 benchmark by adding comprehensive fertility services, including artificial insemination, gamete retrieval, embryo creation, cryopreservation, and surrogacy-related care.

The bill mandates coverage for specific durable medical equipment, including mobility devices, communication aids, respiratory support equipment, and hospital beds. It also requires health plans to cover annual hearing exams and hearing aids every three years. These additions would apply to individual and small group health care service plans, with exemptions for specialized plans, Medicare supplements, and grandfathered coverage.

The Department of Managed Health Care would oversee implementation through guidance and regulations developed in consultation with the Department of Insurance. The legislation maintains existing prohibitions on benefit substitutions and treatment limitations while preserving the relationship between state requirements and federal health care law.