CA Healthplan Legislation Update: In-Network Member Cost Sharing

October 29, 2016


California Legislations Passes to Protect Patients from “Surprise” Medical Bills
Under medical plan policies issued, amended, or renewed on or after July 1, 2017, patients who receive care in in-network facilities will have to pay only in-network cost sharing. Newly-signed A.B. 72 mandates that health plans pay non-contracting health care providers the plan's average contracted rate or 125% of the Medicare rate, whichever is greater. The new law also tightens requirements on health plans to offer adequate provider networks.

The new law applies to non-emergency care, since emergency physicians in California already are barred from balance billing patients. The bill's provisions do not apply to self-insured employer health plans, which are shielded from state regulations by the federal Employee Retirement Income Security Act.

The full text of the bill can be found here: AB 72 (PDF)

Please reload

Featured Posts

CA Law Alert: Minimum Salary Increase

December 16, 2016

Please reload

Recent Posts
Please reload