AMENDED IN SENATE SEPTEMBER 3, 2025

AMENDED IN SENATE AUGUST 29, 2025

AMENDED IN SENATE JULY 7, 2025

AMENDED IN ASSEMBLY MAY 1, 2025

CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION

94

URGENCY STATUTE

Introduced by Assembly Member Caloza

February 11, 2025

An act to add Section 1368.8 to the Health and Safety Code, and to add Section 10112.96 to the Insurance Code, relating to health care coverage, and declaring the urgency thereof, to take effect immediately.

Vote: 2/3   Appropriation: no   Fiscal committee: yes   Local program: yes

LEGISLATIVE COUNSEL’S DIGEST

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act’s requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law sets forth specified coverage requirements for plan contracts and insurance policies, and limits the copayment, coinsurance, deductible, and other cost sharing that may be imposed for specified health care services.

This bill would require a large group health care service plan contract or large group health insurance policy, except a specialized health care service plan contract or health insurance policy, that is issued, amended, or renewed on or after January 1, 2026, to include coverage for one portable high-efficiency particulate air (HEPA) purifier for an enrollee or insured who is pregnant or diagnosed with asthma or chronic obstructive pulmonary disease if the enrollee or insured is residing in or displaced from a county where a local or state emergency has been declared due to wildfires and the HEPA purifier is prescribed by the enrollee’s or insured’s health care provider. The bill would prohibit the cost of the HEPA purifier from exceeding $500, adjusted for inflation, as specified.

Because a willful violation of these provisions by a health care service plan would be a crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

This bill would declare that it is to take effect immediately as an urgency statute.

The people of the State of California do enact as follows:

SECTION 1.

Section 1368.8 is added to the Health and Safety Code, to read:

1368.8.

(a) (1) A large group health care service plan contract, except a specialized health care service plan contract, that is issued, amended, or renewed on or after January 1, 2026, shall include coverage for one portable high-efficiency particulate air (HEPA) purifier for an enrollee who is pregnant or diagnosed with asthma or chronic obstructive pulmonary disease (COPD) if the enrollee is residing in or displaced from a county where a local or state emergency has been declared due to wildfires and the HEPA purifier is prescribed by the enrollee’s health care provider.

(2) An enrollee is entitled to the benefit specified in paragraph (1) for a declaration made on or after January 1, 2025.

(3) The cost of the HEPA purifier specified in paragraph (1) shall not exceed five hundred dollars ($500), adjusted for inflation, only when the lowest cost HEPA purifier that meets the requirements of this section exceeds this amount.

(4) Upon implementation of this section or within 30 days of when a local or state emergency has been declared due to wildfires, the health care service plan shall provide notice of this provision to affected enrollees.

(b) For purposes of this section, a portable HEPA purifier uses a mechanical air filter that can remove at least 99 percent of airborne particles that are 10 microns in size.

(c) This section is applicable to both of the following:

(1) A health care benefit plan or contract entered into with the Board of Administration of the Public Employees’ Retirement System pursuant to the Public Employees’ Medical and Hospital Care Act (Part 5 (commencing with Section 22750) of Division 5 of Title 2 of the Government Code).

(2) Members of the State Teachers’ Retirement System (CalSTRS).

(d) (1) This section shall not apply to a Medicare supplement policy.

(2) This section shall not apply to Medi-Cal managed care plans that contract with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000) of, and Chapter 8 (commencing with Section 14200) of, Part 3 of Division 9 of the Welfare and Institutions Code.

(e) The department may issue guidance to health care service plans until the emergency is terminated. This guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).

(f) This section shall not be construed to limit the Governor’s authority under the California Emergency Services Act (Chapter 7 (commencing with Section 8550) of Division 1 of Title 2 of the Government Code), or the director’s authority under this chapter.

(g) For the purposes of this section, “local or state emergency” means an emergency declared pursuant to Article 14 (commencing with Section 8630) of Chapter 7 of Division 1 of Title 2 of the Government Code or a declaration by the Governor pursuant to Section 8625 of the Government Code.

SEC. 2.

Section 10112.96 is added to the Insurance Code, to read:

10112.96.

(a) (1) A large group health insurance policy, except a specialized health insurance policy, that is issued, amended, or renewed on or after January 1, 2026, shall include coverage for one portable high-efficiency particulate air (HEPA) purifier for an insured who is pregnant or diagnosed with asthma or chronic obstructive pulmonary disease (COPD) if the insured is residing in or displaced from a county where a local or state emergency has been declared due to wildfires and the HEPA purifier is prescribed by the insured’s health care provider.

(2) An insured is entitled to the benefit specified in paragraph (1) for a declaration made on or after January 1, 2025.

(3) The costs of the HEPA purifier specified in paragraph (1) shall not exceed five hundred dollars ($500), adjusted for inflation, only when the lowest cost HEPA purifier that meets the requirements of this section exceeds this amount.

(4) Upon implementation of this section or within 30 days of when a local or state emergency has been declared due to wildfires, the health insurer shall provide notice of this provision to affected insureds.

(b) For purposes of this section, a portable HEPA purifier uses a mechanical air filter that can remove at least 99 percent of airborne particles that are 10 microns in size.

(c) This section is applicable to both of the following:

(1) A health care benefit plan or contract entered into with the Board of Administration of the Public Employees’ Retirement System pursuant to the Public Employees’ Medical and Hospital Care Act (Part 5 (commencing with Section 22750) of Division 5 of Title 2 of the Government Code).

(2) Members of the State Teachers’ Retirement System (CalSTRS).

(d) This section shall not apply to a Medicare supplement policy.

(e) The department may issue guidance to health insurers until the emergency is terminated. This guidance shall not be subject to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).

(f) This section shall not be construed to limit the Governor’s authority under the California Emergency Services Act (Chapter 7 (commencing with Section 8550) of Division 1 of Title 2 of the Government Code), or the commissioner’s authority under this chapter.

(g) For the purposes of this section, “local or state emergency” means an emergency declared pursuant to Article 14 (commencing with Section 8630) of Chapter 7 of Division 1 of Title 2 of the Government Code or a declaration by the Governor pursuant to Section 8625 of the Government Code.

SEC. 3.

No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.

SEC. 4.

This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:

Pregnant women who are exposed to particulate matter from wildfire smoke face a higher risk of preterm birth than women who were not exposed. Wildfire smoke can additionally trigger asthma attacks or chronic obstructive pulmonary disease (COPD). To mitigate these outcomes, it is necessary that this act take effect immediately.