AB 2533 Summary

• Health care service plans and insurers that contract with alternative payment rates must arrange for enrollees/insureds to receive medically necessary covered services from noncontracting providers if unable to obtain care from contracted providers in an accessible and timely manner.

• Health care plans and insurers cannot impose copayments, coinsurance, or deductibles on enrollees/insureds for noncontracting provider services that exceed what they would pay for contracting provider services.

• Noncontracting providers agreeing to provide services under these provisions cannot bill enrollees/insureds for amounts exceeding the in-network reimbursement rate, except for copayments and deductibles allowed under the plan or insurer.

• Health care plans and insurers must report annually to their respective departments on denials of care and complaints regarding accessible and timely access to care; departments must review complaints and post annual reports on their websites.

• Insurance Commissioner must promulgate regulations by January 1, 2016, review them every 3 years, and may investigate and assess administrative penalties against insurers for noncompliance with these provisions.