Issue briefs

This issue brief is part of a two-brief series that provides background on EHBs in California and how they could change in future years.

This issue brief is part of a two-brief series that provides background on EHBs in California and how they may change in future years. This brief provides an overview of how EHBs are defined at the federal level and in California, including how HHS regulations allow a state to alter its selection of its benchmark plan and thus make some alterations to its definition of EHBs.

This issue brief discusses the medical necessity determination process, which may involve multiple clinicians, for enrollees in health plans and health policies regulated by the Department of Managed Health Care (DMHC) or the California Department of Insurance (CDI).

This issue brief discusses laws and regulations that prohibit out-of-network (OON) providers from issuing surprise bills to enrollees in plans or policies regulated by DMHC or CDI.

This issue brief discusses cost sharing laws and limits that are applicable to outpatient prescription drug benefits regulated by the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI). This brief also discusses pharmacy benefits, cost sharing, and the laws that are relevant to them.

This issue brief includes background information on genetic biomarker testing for Californians with advanced cancer, and, where possible, the presence and the impact of prior authorization on such testing.

This issue brief analyzes and compares the health services covered by the ten plans available to California as options for California's Essential Health Benefit (EHB) benchmark effective January 1, 2017.

This issue brief describes the choices California has made to comply with the Affordable Care Act's (ACA) pediatric dental and pediatric vision Essential Health Benefit (EHB) requirement.

This issue brief provides an example of how state benefit mandates could exceed Essential Health Benefits (EHBs) and how evidence-based analysis may inform discussions of whether to keep or repeal state benefit mandates that exceed EHBs, specifically looking at immunization coverage requirements.

This issue brief demonstrates how state benefit mandates may exceed Essential Health Benefits (EHBs) and how evidence-based analysis of the impacts of such mandates may inform discussions of whether to keep or repeal them.