Health care coverage: essential health benefits.

Senator Menjivar's proposal to update California's essential health benefits benchmark plan would expand coverage requirements for health insurers and plans beginning in 2027, pending federal approval. The legislation mandates inclusion of comprehensive fertility services, including artificial insemination, embryo creation and storage, surrogacy coverage, and associated testing.

The bill also requires coverage of specific durable medical equipment, including mobility devices, communication aids, respiratory equipment, and hospital beds. Additionally, plans must provide annual hearing exams and hearing aids every three years. These new requirements would apply to individual and small group health insurance policies.

The changes would take effect only if the U.S. Department of Health and Human Services approves California's updated benchmark plan submission in 2025. Health insurers and plans would be prohibited from marketing or selling policies that do not include the expanded benefits. The legislation maintains existing exemptions for specialized health plans, Medicare supplement coverage, and grandfathered plans that predate the Affordable Care Act.

While establishing these new coverage mandates, the bill specifies that the state is not obligated to defray costs for benefits beyond federal essential health benefit requirements. The Department of Managed Health Care and Department of Insurance would oversee implementation and compliance through their existing regulatory frameworks.