Health care coverage: essential health benefits.

Removed the phrase 'For plan years on or before the 2027 plan year' from both Section 1367.005 (Health and Safety Code, governing health care service plans) and Section 10112.27 (Insurance Code, governing health insurance policies). The current Kaiser Foundation Health Plan Small Group HMO 30 benchmark no longer has an explicit statutory end date, so it continues to apply indefinitely unless replaced by a new HHS-approved benchmark.

Section 1 legislative intent now reads 'establish a new benchmark plan for the 2027 plan year for health care service plans,' narrowing the stated purpose of the new benchmark specifically to health care service plans rather than applying broadly to all covered products.

Added new subdivision (n) to Section 1367.005 authorizing the Department of Managed Health Care to issue compliance guidance to health care service plans on or before January 1, 2027 (not subject to the Administrative Procedure Act), to promulgate regulations under the APA to implement the section, and requiring consultation with the Department of Insurance in both processes.

The state-mandated local program designation in the digest changed from 'no' to 'yes,' likely reflecting the new regulatory and guidance provisions that impose obligations on local agencies or plans.

The entire amendment to Section 10112.27 of the Insurance Code was removed. This section would have required individual and small group health insurance policies (regulated by the Department of Insurance) to cover the same essential health benefits as health care service plans, including fertility services, durable medical equipment, hearing aids, habilitative services, pediatric vision care, and pediatric oral care starting January 1, 2027.

The bill's title was narrowed from amending both the Health and Safety Code and the Insurance Code to amending only Section 1367.005 of the Health and Safety Code.

The definition of 'small group health insurance policy' (referencing Section 10753(q) of the Insurance Code) was removed along with the Insurance Code section.

Exemptions specific to health insurance policies were removed, including the exemption for policies providing 'excepted benefits' under Sections 2722 and 2791 of the federal Public Health Service Act, and the provision that the section would not impose cost-sharing or network limitations from benchmark plans on insurance policies.

The enforcement provision requiring compliance to be enforced in the same manner as Section 790.03 of the Insurance Code (including Sections 790.035 and 790.05) was removed with the Insurance Code section.

Header changed from bill passage dates and blank Governor receipt fields to official chapter designation (Chapter 739) and approved date of October 13, 2025.

Page numbering format changed from 'SB 62' to 'Ch. 739' throughout the document.

Blank 'Approved ___, 2025' signature line at the end was replaced with the Governor's initial, indicating the bill was signed into law.

A new paragraph (2)(E) is added to both the health care service plan section and the insurance policy section, requiring that if HHS approves a new benchmark plan for California in 2025, the 2027 benchmark must include additional benefits beyond what the current Kaiser Foundation Health Plan Small Group HMO 30 plan covers.

Comprehensive infertility treatment coverage is mandated starting in the 2027 plan year, including artificial insemination, three attempts to retrieve gametes, three attempts to create embryos, three rounds of pretransfer testing, cryopreservation of gametes and embryos, two years of embryo storage, unlimited gamete storage, unlimited embryo transfers, two vials of donor sperm, ten donor eggs, surrogacy coverage for the listed services, and health testing of the surrogate for each attempted round.

Durable medical equipment coverage is mandated starting in the 2027 plan year, including mobility devices (walkers, manual and power wheelchairs, scooters), augmented communication devices (speech-generating devices, communication boards, computer applications), CPAP machines, portable oxygen, and hospital beds.

Hearing services are mandated starting in the 2027 plan year: an annual hearing exam and one hearing aid per ear every three years.

The state-mandated local program designation changes from 'no' to 'yes' because a violation of the bill by a health care service plan would be a crime, triggering constitutional reimbursement requirements for local agencies and school districts.

A provision is added stating that no state reimbursement is required under this act for a specified reason, addressing the California Constitution's requirement to reimburse local agencies for state-mandated costs.