Home Health Bill Text – AB-2530 California Health Benefit Exchange: financial assistance. – California Legislative Information

Bill Text – AB-2530 California Health Benefit Exchange: financial assistance. – California Legislative Information

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 (a) The Exchange shall administer a program of financial assistance to help Californians obtain and maintain health benefits through the Exchange if they lose employer-provided health care coverage as a result of a labor dispute.

(1) An individual who has lost minimum essential coverage from an employer or joint labor management trust fund as a result of a strike, lockout, or other labor dispute is a prospective enrollee for purposes of financial assistance, including premium assistance and cost-sharing reduction subsidies. Any household income of the prospective enrollee in excess of 133 percent of the federal poverty level for a family of the prospective enrollee’s size shall not be taken into account for the prospective enrollee and the members of their tax household.
(2) An individual described in paragraph (1) shall receive subsidies for health insurance premiums and cost-sharing reductions that provide the same assistance that is provided to other individuals with incomes of 133 percent of the federal poverty level who qualify for financial assistance through the Exchange. The cost-sharing reductions shall have an actuarial value of 94 percent or greater, and the program design shall have zero deductibles for any covered benefit.
(3) The modified adjusted gross income or household income of an individual described in paragraph (1) shall not be calculated to include strike benefits, lockout benefits, or unemployment compensation.
(4) The state-funded advance premium tax credit of an individual described in paragraph (1) shall be reconciled based on this section.
(b) (1) To receive financial assistance pursuant to this section, an individual shall provide a self-attestation regarding the loss of minimum essential coverage as a result of a dispute. If further documentation is required, the Exchange shall contact the affected collective bargaining agent and may contact the employer.
(2) Notwithstanding Sections 1399.848 and 1399.849 of the Health and Safety Code, and Sections 10965.3 and 10965.4 of the Insurance Code, the effective date of coverage shall be the date of the completed application or a later date, at the discretion of the enrollee.
(c) The Exchange, on a monthly basis, shall notify an enrollee receiving financial assistance pursuant to this section that the enrollee is required to notify the Exchange if their household income changes or minimum essential coverage provided by the enrollee’s employer is reinstated.
(d) (1) The Exchange shall maximize federal affordability assistance for an individual enrolled pursuant to this section.
(2) Financial assistance provided pursuant to this section shall be funded upon appropriation by the Legislature.
(e) For purposes of this section, “members of the tax household” includes individuals offered minimum essential coverage by an employer, whether or not the coverage is affordable coverage of minimum value, as defined in subsection (c) of Section 36B of the Internal Revenue Service Code.

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