CA SB368

Health care service plans and health insurers must monitor and track enrollees' accrual balances toward annual deductibles and out-of-pocket maximums for contracts issued, amended, or renewed on or after July 1, 2022, in individual or group markets.

Plans and insurers must provide enrollees with monthly accrual balance statements for every month benefits were used until the full deductible or out-of-pocket maximum is reached, and must maintain systems allowing enrollees to request current balance information at any time.

Accrual updates must be mailed to enrollees by default, unless enrollees opt out of mailed notices and elect to receive updates electronically, or have previously opted out of mailed notices; updates may be included with evidence of benefit statements.

Health care service plans and insurers must notify enrollees of their rights under the law, including how to request information and opt out of mailed notices, as directed by the Department of Managed Health Care or Department of Insurance.

Delegated entities such as medical groups or independent practice associations must comply with these requirements, though the health care service plan or insurer remains ultimately responsible for compliance.