CA SB1176

Health care service plans and insurers must monitor and track the accrual of out-of-pocket costs toward annual limits for enrollees and insureds, rather than requiring consumers to track these costs themselves.

Plans and insurers are solely responsible for monitoring cost sharing from in-network providers and contracted vendors that counts toward annual out-of-pocket limits.

Plans and insurers must accept claims from providers or information from consumers regarding cost sharing for out-of-network emergency services or other covered benefits arranged by the plan or insurer.

Plans and insurers must reimburse enrollees or insureds within five working days after receiving a claim for cost sharing that exceeds the maximum annual out-of-pocket limit, or notify the claimant that the claim is contested or denied.

Applies to nongrandfathered individual and group health care service plans and health insurers, as well as specialized plans and insurers that provide essential health benefits coverage, for plans issued, amended, or renewed on or after January 1, 2015.