Today's Law As Amended


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SB-368 Health care coverage: deductibles and out-of-pocket expenses.(2021-2022)



As Amends the Law Today


SECTION 1.

 Section 1367.0061 is added to the Health and Safety Code, immediately following Section 1367.006, to read:

1367.0061.
 (a) For a health care service plan contract issued, amended, or renewed on or after January 1, 2022, in the individual or group market, a health care service plan shall monitor an enrollee’s accrual toward their annual deductible, if any, for covered benefits.
(1) A health care service plan shall provide an enrollee with their accrual balance toward their annual deductible for every month in which benefits were used.
(2) An enrollee may request their most up-to-date accrual balance toward their annual deductible from their health care service plan at any time.
(b) For a health care service plan contract issued, amended, or renewed on or after January 1, 2022, in the individual or group market, a health care service plan shall monitor an enrollee’s accrual toward their annual out-of-pocket maximum, if any, for covered benefits.
(1) A health care service plan shall provide an enrollee with their accrual balance toward their annual out-of-pocket maximum for every month in which benefits were used.
(2) An enrollee may request their most up-to-date accrual balance toward their annual out-of-pocket maximum from their health care service plan at any time.
(c) Accrual updates shall be mailed to enrollees unless the enrollee has elected to opt out of mailed notice and elected to receive the accrual update electronically.
(1) Enrollees who have opted out of receiving mailed notice may opt back in at any time.
(2) Accrual updates may be included with evidence of benefit statements.

SEC. 2.

 Section 10112.281 is added to the Insurance Code, immediately following Section 10112.28, to read:

10112.281.
 (a) For a health insurance policy issued, amended, or renewed on or after January 1, 2022, in the individual or group market, a health insurer shall monitor an insured’s accrual toward their annual deductible, if any, for covered benefits.
(1) A health insurer shall provide an insured with their accrual balance toward their annual deductible for every month in which benefits were used.
(2) An insured may request their most up-to-date accrual balance toward their annual deductible from their health insurer at any time.
(b) For a health insurance policy issued, amended, or renewed on or after January 1, 2022, in the individual or group market, an insurer shall monitor an insured’s accrual balance toward their annual out-of-pocket maximum, if any, for covered benefits.
(1) A health insurance policy shall provide an insured with their accrual balance toward their annual out-of-pocket maximum for every month in which benefits were used.
(2) An insured may request their most up-to-date accrual balance toward their annual out-of-pocket maximum from their health insurer at any time.
(c) Accrual updates shall be mailed to an insured unless the insured has elected to opt out of mailed notice and elected to receive the accrual update electronically as allowed according to Section 38.6.
(1) Insureds who have opted out of receiving mailed notice may opt back in at any time.
(2) Accrual updates may be included with evidence of benefit statements.
SEC. 3.
 No reimbursement is required by this act pursuant to Section 6 of Article XIII B 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 XIII B of the California Constitution.