California SB1049: Health care claims reimbursement.

What the bill says

An act to add Section 1371.21 to the Health and Safety Code, and to add Section 10123.134 to the Insurance Code, relating to health care coverage. health care coverage Health care claims reimbursement. 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 a crime. Existing law provides for the regulation of health insurers by the Department of Insurance…

From the chaptered text, September 30, 2026:

An act to add Section 1371.21 to the Health and Safety Code, and to add Section 10123.134 to the Insurance Code, relating to health care coverage. health care coverage Health care claims reimbursement. 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 a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan or health insurer to reimburse a complete claim or a portion thereof within 30 calendar days after receipt of the claim, or, if a claim or portion thereof does not meet the criteria for completeness, to notify the claimant no later than 30 calendar days after receipt that the claim or portion thereof is contested or denied. This bill would grant a claimant no less than 90 calendar days to submit a corrected claim after a health care service plan or health insurer denies a claim or portion thereof or sends a notice of overpayment for a claim based on a defect that may be remedied by submitting a corrected claim. The bill would prohibit a plan or insurer from denying a corrected claim on the …

Read the full official text

Sponsors

• Akilah Weber Pierson (D, SD39) · primary sponsor
• (D, AD76)