Bill Text: CA AB298 | 2025-2026 | Regular Session | Amended
Bill Title: Health care coverage cost sharing.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Failed) 2026-02-02 - From committee: Filed with the Chief Clerk pursuant to Joint Rule 56. [AB298 Detail]
Download: California-2025-AB298-Amended.html
|
Amended
IN
Assembly
January 05, 2026 |
|
Amended
IN
Assembly
March 04, 2025 |
CALIFORNIA LEGISLATURE—
2025–2026 REGULAR SESSION
Assembly Bill
No. 298
| Introduced by Assembly Member Bonta |
January 23, 2025 |
An act to add Section 1367.55 to the Health and Safety Code, and to add Section 10123.187 to the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 298, as amended, Bonta.
Health care coverage cost sharing.
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’s requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law limits the copayment, coinsurance, deductible, and other cost sharing that may be imposed for specified health care services.
This bill would prohibit a large group health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2026,
2027, from imposing a deductible, coinsurance, copayment, or other cost-sharing requirement for in-network health care services, as defined, provided to an enrollee or insured under 21 years of age, except as otherwise specified. The bill would prohibit an individual or entity from billing or seeking reimbursement reimbursement, as provided, for in-network health care services provided to an enrollee or insured under 21 years of age, except as otherwise specified. Because a willful violation of these provisions by a health care service plan would be a crime, the 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.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YESBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 1367.55 is added to the Health and Safety Code, to read:1367.55.
(a) A large group health care service plan contract issued, amended, or renewed on or after January 1,(b) An individual or entity shall not bill or seek reimbursement from an
enrollee or contractholder of a large group health care service plan contract for in-network health care services provided to an enrollee under 21 years of age, except as provided in subdivision (c).
(c) In the case of a large group health care service plan contract that is a high deductible health plan qualifying as eligible for use in combination with a health savings account under the definition set forth in Section 223(c)(2) of Title 26 of the United States Code, the health care service plan contract shall not impose either of the following:
(1) A deductible, coinsurance, copayment, or other
cost-sharing requirement for preventive care services, as defined for purposes of Section 223(c)(2) of Title 26 of the United States Code, provided to an enrollee under 21 years of age.
(2) Coinsurance, a copayment, or other cost-sharing requirement for in-network health care services provided to an enrollee under 21 years of age once a health care service plan contract’s deductible has been satisfied for the plan year.
(d) For purposes of this section, “in-network health care services” means all of the following:
(1) Covered services provided by a contracting provider.
(2) Covered services from a contracting health facility at which, or as a result of
which, the enrollee receives services provided by a noncontracting provider.
(3) Covered emergency services.
(4) Covered services provided to an enrollee by a noncontracting provider when a contracting provider is not available to provide the service in accordance with the timely access requirements described in Section 1367.03.
(e) This section does not expand or otherwise affect the scope of required coverage for out-of-network emergency services, except to the extent that cost-sharing requirements for covered out-of-network emergency services shall not be imposed on an enrollee under 21 years of age pursuant to subdivision (a).
SEC. 2.
Section 10123.187 is added to the Insurance Code, to read:10123.187.
(a) A large group health insurance policy issued, amended, or renewed on or after January 1,(b) An individual or entity shall not bill or seek reimbursement from an insured or
policyholder of a large group health insurance policy for in-network health care services provided to an insured under 21 years of age, except as provided in subdivision (c).
(c) In the case of a large group health insurance policy that is a high deductible health plan qualifying as eligible for use in combination with a health savings account under the definition set forth in Section 223(c)(2) of Title 26 of the United States Code, the health insurance policy shall not impose either of the following:
(1) A deductible, coinsurance, copayment, or other cost-sharing requirement for preventive
care services, as defined for purposes of Section 223(c)(2) of Title 26 of the United States Code, provided to an insured under 21 years of age.
(2) Coinsurance, a copayment, or other cost-sharing requirement for in-network health care services provided to an insured under 21 years of age once a health insurance policy’s deductible has been satisfied for the plan year.
(d) For purposes of this section, “in-network health care services” means all of the following:
(1) Covered services provided by a contracting provider.
(2) Covered services from a contracting health facility at which, or as a result of which, the insured receives services provided by a
noncontracting provider.
(3) Covered emergency services.
(4) Covered services provided to an insured by a noncontracting provider when a contracting provider is not available to provide the service in accordance with the timely access requirements described in Section 10133.54.
(e) This section does not expand or otherwise affect the scope of required coverage for out-of-network emergency services, except to the extent that cost-sharing requirements for covered out-of-network emergency services shall not be imposed on an insured under 21 years of age pursuant to subdivision (a).
