AB 1086

Bill Subjects

Abstract

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 that act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires, on and after January 1, 1994, every group health care service plan, that provides hospital, medical, or surgical expense benefits for plan members and their dependents to authorize and permit assignment of the enrollee's or subscriber's right to any reimbursement for health care services covered under the plan contract to the State Department of Health Care Services when health care services, excepting specified contracted services, are provided to a Medi-Cal beneficiary. This bill would require certain health care service plans, on and after January 1, 2016, to authorize and permit an enrollee or subscriber to assign the enrollee or subscriber's right to reimbursement for health care services covered under the plan contract by a noncontracting physician and surgeon who furnished the services, as specified. The bill would require certain disability insurers to pay group insurance benefits to a physician and surgeon rendering health care services to an insured upon obtaining written consent of the insured. The bill would require a noncontracting physician and surgeon who renders services to an enrollee or an insured to give the enrollee or the insured a written estimate of the cost of care and a notice regarding, among other things, the estimated cost of care and the enrollee's or subscriber's, and the plan's or the insurer's responsibility for payment of the cost of care, as specified. The bill would prohibit a noncontracting physician and surgeon who accepts an assignment of benefits from collecting more than the estimated cost of care from the enrollee or insured. The bill would prohibit a noncontracting physician and surgeon from accepting an assignment of benefits from a patient with whom the physician and surgeon or an employee of the physician and surgeon communicates in a language other than English or one of specified languages, unless the notice described above is given in that language. Because a willful violation of the bill's requirements relative to health care service plans 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.