CA SB1156

Health care service plans and insurers must accept premium payments from Ryan White HIV/AIDS Programs, Indian tribes, local/state/federal government programs, and family members without restrictions.

Financially interested entities (other than those listed above) making third-party premium payments must provide assistance for the full plan/policy year, inform enrollees of all coverage options, and cannot steer patients to specific providers or condition assistance on use of particular facilities.

Financially interested entities must annually certify compliance with requirements and disclose enrollee names to plans/insurers before making initial premium payments.

Reimbursement to financially interested providers is capped at the lower of the plan/policy contract rate or Medicare reimbursement rate, and providers cannot bill enrollees except for required cost sharing.

Health plans and insurers must report annually to their respective departments on premium payments by financially interested entities and provider reimbursement practices under these requirements.