Rakestraw

I

Introduction

This appeal presents the issue whether a private health care service plan contract requiring a $1,000 copayment for inpatient hospital services in connection with pregnancy and child delivery violates the prohibition against the use of copayments “because of sex” in the Knox-Keene Health Care Service Plan Act of 1975 (the Knox-Keene Act). (Health & Saf. Code, § 1340 et seq.) 1 We find it does not. The Knox-Keene Act allows health care service plans to limit coverage for pregnancy-related services and also generally allows copayments, subject to some exceptions. Furthermore, since this health care service plan was not part of plaintiffs’ employment compensation and because the Knox-Keene Act specifically governs health care service plans, cases prohibiting employment discrimination because of pregnancy have no relevance to this appeal. We conclude that the trial court correctly sustained a demurrer to the third amended complaint, and that plaintiffs have not met their burden of showing they can amend to cure the defect in their complaint. We therefore affirm the judgment.

II

Standard of Review

A demurrer tests the legal sufficiency of factual…

I respectfully dissent.

I would reverse the judgment because there is a reasonable possibility the complaint can be amended to allege that the Blue Shield contract violated the Knox-Keene Health Care Service Plan Act of 1975 (Health & Saf. Code, § 1340 et seq.)

Section 1365.5 prohibits a health care service plan contract from altering the contract or limiting benefits or coverage because of a contracting party’s “sex,” among other categories. California law recognizes that “pregnancy discrimination is a form of sex discrimination under article I, section 8 of the California Constitution” (Badih v. Myers (1995) 36 Cal.App.4th 1289, 1296 [ 43 Cal.Rptr.2d 229 ]), first adopted in 1879. (Cal. Const., former art. XX, § 18; Matter of Maguire (1881) 57 Cal. 604, 605 ; Sail’er Inn, Inc. v. Kirby (1971) 5 Cal.3d 1, 8 [ 95 Cal.Rptr. 329 , 485 P.2d 529 , 46 A.L.R.3d 351 ].) The fact that Badih is an employment case in no way detracts from its conclusion that pregnancy discrimination amounts to sex discrimination within the meaning of the California Constitution. It therefore follows that differential treatment on the basis of pregnancy likewise amounts to discrimination on the basis of…

Certified for Partial Publication. [*]

This appeal presents the issue whether a private health care service plan contract requiring a $1,000 copayment for inpatient hospital services in connection with pregnancy and child delivery violates the prohibition against the use of copayments "because of sex" in the Knox-Keene Health Care Service Plan Act of 1975 (the Knox-Keene Act). (Health & Saf.Code, § 1340 et seq.) [1] We find it does not. The Knox-Keene Act allows health care service plans to limit coverage for pregnancy-related services and also generally allows copayments, subject to some exceptions. Furthermore, since this health care service plan was not part of plaintiffs' employment compensation and because the Knox-Keene Act specifically governs health care service plans, cases prohibiting employment discrimination because of pregnancy have no relevance to this appeal. We conclude that the trial court correctly sustained a demurrer to the third amended complaint, and that plaintiffs have not met their burden of showing they can amend to cure the defect in their complaint. We therefore affirm the judgment.

A demurrer tests the legal sufficiency of factual…