AB 1800 - Fair Out-of-Pocket Expenses
Author: Fiona Ma, San Francisco and San Mateo county
Beginning January 1, 2013, AB 1800 establishes a single deductible for all covered benefits and an annual cap on all OOP costs for covered benefits. The OOP cap will include consumer costs for hospitalization, physician visits, prescription drugs, co-payments, deductibles, and any other form of cost sharing.
This approach provides transparency so patients will know each year the maximum they will be expected to pay for their health coverage and benefits. The cap in this bill aligns with federal health care reform, $5,950 for individuals and $11,900 for families. Aligning the costs with the federal law also ensures that the protections in AB 1800 stay intact regardless of threats to the future of federal health care reform. The bill also goes into effect a full year earlier than federal health reform.
In addition, AB 1800 strengthens the Independent Medical Review process to help patients who are denied access to needed prescription medications by the health plan.
Read the AB 1800 issue paper for more information.
Read Melanie Rowen's testimony which was read in the Health Assembly Committee on April 24, 2012.